Current medical and surgical management of sleep related breathing disorders:
Gespeichert in:
| Format: | Buch |
|---|---|
| Sprache: | English |
| Veröffentlicht: |
Philadelphia [u.a.]
Saunders
2002
|
| Schriftenreihe: | Oral and maxillofacial surgery clinics of North America
14,3 |
| Schlagworte: | |
| Online-Zugang: | Inhaltsverzeichnis |
| Beschreibung: | VIII, 409 S. Ill. graph. Darst. |
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| 245 | 1 | 0 | |a Current medical and surgical management of sleep related breathing disorders |c N. Ray Lee, guest ed. |
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Datensatz im Suchindex
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| adam_text | CONTENTS
Preface xi
N. Ray Lee
History and Epidemiology of Sleep Related Breathing Disorders 273
Robert D. Vorona and J. Catesby Ware
Obstructive sleep apnea syndrome is a common problem that was not well recognized
until the 1980 s. It is a problem that the oral surgeon may see in nil age groups, both gen¬
ders and all races. Although OSAS is most classically noted in the middle aged ind
elderly, it can have potentially devastating effects on the young. Both pre and post
menopausal females are afflicted by OSAS but the astute oral surgeon will recognize that
most premenopausal women with OSAS will be obese or have skeletal deformities.
Different races look to have different skeletal and soft tissue structural factors that put
them at risk and that may play a role in determining optimal therapy. Finally, the data
linking OSAS and cardiovascular and cerebrovascular disease, while not utterly conclu¬
sive appears increasingly strong.
Pathophysiology of Obstructive Sleep Apnea 285
M. Safwan Badr
Obstructive sleep apnea is a fairly common disorder with significant adverse health
consequences; however, the pathogenetic mechanisms remain incompletely under¬
stood. Upper airway (UA) patency is determined by several neuromuscular and non
neuromuscular factors including (1) UA dilating muscle activity, (2) the collapsing
transmural pressure generated during inspiration, (3) changes in caudal traction, (4)
vasomotor tone, and (5) mucosal adhesive forces. This article addresses the effect of
sleep on UA function and how these factors conspire to cause UA obstruction.
Evaluation and Diagnosis of Sleep Disordered Breathing 293
Tom Bond
Central, obstructive and mixed sleep apnea are evaluated by the same methods. The
focus in this chapter is on obstructive sleep apnea syndrome. Obstructive sleep apnea
is best evaluated by a sleep consultation, full polysomnography, and follow up. The
consultation should include a history and physical exam by a board certified sleep
specialist. Using American Academy of Sleep Medicine guidelines, apnea is defined as
VOLUME 14 • NUMBER 3 • AUGUST 2002 v
a cessation of breath for at least ten seconds. Hypopnea is defined as an abnormal res¬
piratory event lasting at least ten seconds with at least a 30% reduction in airflow or tho
racoabdominal movement with at least a 4% oxygen desaturation.
Current Medical Management of Sleep Related Breathing Disorders 297
Kent E. Moore and Mary Susan Esther
Sleep disordered breathing, a disorder characterized by repeated apnea (cessation of
breathing) and hypopnea (partial cessation of breathing) during sleep, has been shown
to be prevalent in the general population. Obstructive sleep apnea hypopnea syndrome
(OSAHS) is a common disorder that can adversely impact longevity and quality of life,
and one in which the oral and maxillofacial surgeon possesses a unique ability to assist
in managing.
Principles of Oral Appliance Therapy for the Management of Sleep
Disordered Breathing 305
Alan A. Lowe
Oral appliances are effective in varying degrees and appear to work due to an increase
in airway space, the provision of a stable anterior position of the mandible, advancement
of the tongue and/or soft palate and possibly by a change in genioglossus muscle activ¬
ity. This review provides an overview of the seven most frequently used oral appliances
and provides guidelines for their use. A detailed titration sequence for one specific
adjustable oral appliance is outlined since this clinical procedure is often not well under¬
stood by practitioners new to the field.
Lasers in the Management of Snoring and Mild Sleep Apnea 319
Robert A. Strauss
The use of lasers in the management of snoring is now a well documented technique.
The LAUP and LA UPPP are effective surgeries that emphasize the advantages of laser
surgery. Their use for sleep apnea patients has generated more controversy, however.
This article discusses the indications, techniques, and complications of these procedures
and examines the literature for comparative efficacy with other procedures.
Surgical Treatment of Snoring and Mild Obstructive Sleep Apnea 333
Mansoor Madani
Snoring has plagued individuals and societies for centuries. It is just within the past few
decades that it was recognized as a sign of a more serious illness of sleep disordered
breathing known as sleep apnea. Recent understanding of the pathophysiology of snor¬
ing, daytime sleepiness, restless sleep, and obstructive sleep apnea has allowed for suc¬
cessful treatment involving both nonsurgical and surgical intervention. The nonsurgical
management of snoring includes exercise, weight loss, decreased alcohol consumption,
smoking cessation, altered sleeping position, and dental or nasal appliances. Patient
compliance has persistently been the drawback in these types of management. Major
studies shows that over half the patients will not follow the conservative treatment for
an extended period or patients do not obtain sufficient relief from their snoring with con¬
servative methods and look for surgical modalities to correct their problem. In this arti¬
cle, we look at several surgical modalities to treat snoring and mild obstructive sleep
apnea. The surgical goal should be to find a simple, safe, effective, and economical sur¬
gical procedure, which benefits the patient and allows a speedy recovery and return to
normal daily activities.
vi CONTENTS
Surgical Evaluation for Reconstruction of the Upper Airway 351
N. Ray Lee
Surgical reconstruction of the upper airway is designed to reduce collapsibility and opti¬
mize stability of the airway. A universally accepted protocol for reconstruction of the
upper airway does not exist. The philosophy of identifying the anatomic site of airway
compromise and surgically correcting it, however, is generally accepted. A successful
surgical outcome should be equivalent to successful continuous positive airway pressure
(CPAP) treatment. Contributing factors for airway collapse can be complex and involve
physiologic, neurogenic, and anatomic findings that demand a comprehensive evalua¬
tion before embarking on the reconstructive process. This article discusses evaluation
considerations and surgical staging protocols that may be beneficial in achieving a suc¬
cessful surgical outcome.
Radiofrequency Thermal Ablation Therapy for Obstructive Sleep Apnea 359
Kasey K. Li, Nelson Powell, and Robert Riley
Radiofrequency thermal ablation is a minimally invasive technique that is being used for
the treatment of sleep disordered breathing. Based on a series of clinical trials, we have
demonstrated that RF can be safely and effectively applied to the delicate upper airway
tissue (soft palate and tongue) to improve obstructive sleep apnea. This article outlines
the results of the clinical trials as well as our current technique of RF thermal ablation.
Nasal and Palatal Surgery for Obstructive Sleep Apnea Syndrome 365
B. Tucker Woodson
The nose and palate are significant contributors to airway obstruction in OSAS.
Pharyngeal obstruction rarely does not involves the upper pharynx. Nasal surgery is an
import adjunct to assist in both medical and surgical treatment. Palate surgery, alone or
in combination with other airway reconstructive techniques, is used for both snoring and
OSAS. Various approaches to treat the palate have been developed. Procedures include
traditional Uvulopalatopharyngoplasty (UPPP), Laser Assisted Uvuloplasty (LAUP),
radiofrequency techniques, and modifications to advance the palate. Success is variable
and depends on both the techniques used and patients selected.
Soft Tissue Hypopharyngeal Surgery for Obstructive Sleep Apnea Syndrome 371
B.Tucker Woodson
Pharyngeal obstruction commonly involves the entire pharyngeal airway. Various
approaches to treat multilevel airway obstruction exist. To treat lower pharyngeal and
hypopharyngeal obstruction in obstructive sleep apnea various procedures have been
described. This chapter focuses on primarily soft tissue techniques to increase airway
size and decrease collapsibility. Procedures may include midline glossectomy, lin
gualplasty, hyoepiglottoplasty, tongue suspension suture, and hyoid suspension.
Genioglossus Muscle Advancement Techniques for Obstructive Sleep Apnea 377
N. Ray Lee
Genioglossus muscle advancement is a viable adjunctive procedure in the reconstruction
of the upper airway. The author has not experienced the complications of osseous segment
necrosis, and with appropriate drain placement with the anterior mandibular osteotomy
and trephine osteotomy techniques, the risk of infection is low. Neurosensory changes and
dental pulp necrosis may occur, however, and patients must be informed accordingly.
CONTENTS vii
Surgical Changes of Posterior Airway Space in Obstructive Sleep Apnea 385
Peter D. Waite and Georgios A. Vilos
There are numerous medical and surgical treatment modalities for the management of the
sleep apnea patient. Among the medical treatments, weight loss and positive pressure ther¬
apy are considered to be the most important. Surgical treatment is directed at increasing the
posterior airway space. Among the surgical procedures, tracheostomy, uvulopalatopharyn
goplasty (UPPP), and maxillofacial skeletal procedures are the most common.
Postoperative Management of the Obstructive Sleep Apnea Patient 401
Kasey K. Li, Nelson Powell, and Robert Riley
The postoperative management of the OSA patient presents a formidable challenge to the
sleep surgeon due to the presence of edema in an already compromised airway, the seda¬
tive effect of the analgesic as well as the comorbid factors. A risk management protocol
will be presented.
Index 405
viii CONTENTS
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| spelling | Current medical and surgical management of sleep related breathing disorders N. Ray Lee, guest ed. Philadelphia [u.a.] Saunders 2002 VIII, 409 S. Ill. graph. Darst. txt rdacontent n rdamedia nc rdacarrier Oral and maxillofacial surgery clinics of North America 14,3 Ademhalingsstoornissen gtt Chirurgie (geneeskunde) gtt Slaap gtt Sleep Apnea, Obstructive Atemstörung (DE-588)4124577-5 gnd rswk-swf Schlaf (DE-588)4052580-6 gnd rswk-swf (DE-588)4143413-4 Aufsatzsammlung gnd-content Atemstörung (DE-588)4124577-5 s Schlaf (DE-588)4052580-6 s DE-604 Lee, N. Ray Sonstige oth Oral and maxillofacial surgery clinics of North America 14,3 (DE-604)BV002758944 14,3 HBZ Datenaustausch application/pdf http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=010023657&sequence=000002&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA Inhaltsverzeichnis |
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| title_exact_search | Current medical and surgical management of sleep related breathing disorders |
| title_full | Current medical and surgical management of sleep related breathing disorders N. Ray Lee, guest ed. |
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| title_full_unstemmed | Current medical and surgical management of sleep related breathing disorders N. Ray Lee, guest ed. |
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