COVER STORY

Dealing with obstructive sleep apnoea

Dr Prashant Saxena Dr Prashant Saxena

Obstructive sleep apnoea (OSA), which causes breathing to stop and start while sleeping owing to partial or complete obstruction in the upper airway, is becoming common among Indians. Some 3.5 crore patients are diagnosed with the disorder. Poor management of metabolic issues like diabetes as well as unhealthy practices—lack of exercise, unmanaged weight gain owing to poor eating habits—have an impact on the increasing incidence of sleep apnoea.

Sleep apnoea, in turn, has been found to have a direct correlation with cardiovascular diseases, and is most likely to develop into a congestive heart failure, if not treated in time. According to a study released by The Indian Council of Medical Research in 2017, it has been estimated that people with diabetes in India are likely to more than double in the next decade from the current seven crore. And, 40 to 48 per cent of these patients are likely to suffer from sleep apnoea. In such a bleak scenario, it becomes extremely critical to ensure that there is effective treatment and management of sleep apnoea. A healthy lifestyle and low-carbohydrate diet, combined with increased physical activity and treatment of OSA and obesity, are successful in maintaining weight loss and reducing OSA severity.

Over the years, the diagnostic tools and therapeutic approaches for OSA have evolved—from usage of different oral appliances to surgical interventions. Some of these are:

Positive airway pressure therapy is the most common form of treatment for moderate and severe OSA. It delivers pressurised air to the upper airway, preventing the airway from collapsing during sleep.

Hypoglossal nerve stimulation involves implanting a small device in the chest, which can be turned on and off by the patient. The device stimulates a nerve and ensures that the upper airway is open while you are asleep. Initial research indicates fewer side effects and good compliance.

Pillar procedure is a minimally invasive palatal stiffening technique, usually performed using local anaesthesia. A permanent suture is inserted into the soft palate, inducing scar formation. This stiffens and stabilises the palate, reducing airway vibration and collapse.

Somnoplasty is a minimally invasive surgery that uses a radiofrequency current to reduce tissue volume in a precise, targeted manner.

Transoral robotic surgery is used to cut all or part of the lingual tonsils or cut out a portion of the base of the tongue.

Maxillary mandibular advancement is a procedure in which the upper and lower jaws are surgically moved to the front to enlarge the airway.

In adult patients with OSA, who are intolerant to continuous positive airway pressure (CPAP) therapy or prefer an alternative therapy, oral appliances are recommended.

Combination therapy, which involves using an oral appliance along with CPAP, can improve treatment adherence by lowering the air pressure setting required to normalise breathing.

At the same time, a close correlation between metabolic disorders and sleep apnoea means that procedures that help combat obesity and reduce weight are quite effective as part of the comprehensive treatment methodology. Hence, gastric banding, sleeve gastrectomy and gastric bypass surgery, which lead to significant weight loss, including lessening the buildup of fat tissue in the upper thorax and neck, help in addressing OSA.

Dr Prashant Saxena, head, pulmonology and sleep medicine, and principal consultant, critical care medicine, Max Smart Super Speciality Hospital, Saket.

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