Sleep Apnea

Sleep apnea is a sleep disorder that is characterized by repetitive episodes of upper airway obstruction. While it can lead to daytime drowsiness and lethargy, it can be potentially life threatening if left untreated. Sleep apnea is a condition where the blockage of the airway prevents air from getting into the lungs. This leads to snoring at regular pace and short periods of time where the breathing ceases. Apnea is the lack of spontaneous breathing. The patient may become limp and lifeless, have a seizure or turn bluish.

This is followed by sudden attempts to breathe with a loud gasp and snort. Consequently this condition affects the sleep and the person is not well rested. Besides the oxygen levels remain low leading to drowsiness and tiredness. Severe sleep apnea is likely to cause pulmonary hypertension. A large neck or collar size can be one of the causes of obstructive sleep apnea. Sleep apnea can be potentially life threatening since it can cause heart attacks or strokes.

Prolonged apnea is called as respiratory arrest. In children, this can quickly lead to cardiac arrest in which the heart stops beating whereas in adults, cardiac arrest usually is the first to happen followed by respiratory arrest. In adults, common causes of apnea and respiratory arrest include choking, drug overdose, near-drowning, head injury and cardiac arrest. In children, the causes may be different - prematurity, swelling of the airways, choking on a foreign object, seizures, regurgitating food or near-drowning.

Obstructive sleep apnea: This is a condition where tissues of the body obstruct the airways during sleep. Obstructive Sleep apnea is common in obese men who sleep on their backs. Other factors include Smoking, heavy alcohol consumption, emphysema, and an inherited tendency toward a narrowed airway.

Diagnosis of sleep apnea

• ECG to show arrhythmia during sleep
  
  
• Echocardiogram to study the heart functioning
  
  
• Thyroid function tests
  
  
• Sleep studies
  
  

Sleep apnea treatment

Treatment for sleep apnea can range from lifestyle modification, medication to even surgery in some cases. Weight loss and avoiding smoking are some of the changes that may need to be introduced into the lifestyle to prevent episodes of sleep apnea.

The risk of obstructive sleep apnea choking can be reduced by avoiding alcohol, tobacco smoking, tranquilizers and sedatives before bed. There is a surgical procedure called as LAUP (Laser Assisted Uvula Palatoplasty) where removal of the offending tissue is done to allow for unobstructed airflow.

Sleep apnea is often treated with surgery that removes the cause of obstruction. Enlarged tonsils or adenoids are removed to cure sleep apnea. Another sleep apnea surgery is UPPP - Uvulopalatopharyngoplasty, which involves removal of excess tissue from the back of the throat. This is done to increase the size of the upper airway. Usually it involves removal of the soft palate that hangs down the back of the throat. Such sleep apnea surgery is performed under general anesthesia. These days it is done under local anesthesia with laser assistance. Nasal reconstruction surgery straightens the nasal septum and shrinks the nasal tissue, thereby improving nasal airway. Changing the bony structure in the upper airway allows air to move more freely, especially during sleep.

The CPAP (Continuous Positive Airway Pressure) mask uses air pressure to push the tongue forward. This opens the throat to air and reduces snoring and apnea. It does not cure sleep apnea but relieves the patient by preventing recurrent episodes. Personalized sleep apnea masks are created to fit exactly on your face, nose, cheeks, lips and forehead. The sleep apnea mask is secured well so that there are no leaks.

Otolaryngologist

Also known as otorhinolaryngolongists or ENT specialists, otolaryngolongists are doctors who specialize in diagnosing and treating disorders of the ear, nose and throat. After completing medical school, a one year residency in general surgery is compulsory further followed by four years of residency in otolaryngology. Being specialists in the ENT organs, otolaryngolongists perform the following functions:

• Primarily treat disorders related to ear, nose, and throat.
  
• Treat conditions like sinus and problems with nasal cavities by either prescribing medicines or performing surgery.
  
• They treat allergies and help improve the shape and look of the nose (rhinoplasty).
  
• They treat hearing problems, ear infections, balance disorders of the ears, tinnitus (ear noise), cranial nerve disorder etc.
  
• They treat conditions like sleep apnea.
  
• They cure tonsils either through medication or surgery, they treat throat disorders including voice and swallowing disorders.

Modern techniques used in the field of otolaryngology

ENT field has seen a lot of innovations in use of equipment and technology, modern methods have paved avenues for better treatment methods.

• Modern equipment have paved ways for these specialists to perform reconstructive surgeries for nose, jaw, ear and facial areas.
  
• RAST (radio-allergosorbent-test) is used for curing allergies.
  
• Technique called the skin endpoint titration is used to cure allergies.
  
• Endoscope technique is used to treat sinus and other blockages.
  
• Modern audio logic equipment is used to diagnose and treat hearing problems.

Guide to choose the right otolaryngologist

• Ask your family physician to refer to the right specialist.
  
• Check if the specialist you have chosen is certified by an authorized board.
  
• Check if the hospital where your specialist practices has the required infrastructure and modern equipment needed for your treatment.
  

Marfan's syndrome

Marfan's syndrome is a disorder that affects the connective tissue. The connective tissues hold the body together and provide a framework for growth and development. When a person suffers from this condition, the connective tissue fails to act as it should. Marfan syndrome affects the skeleton, nervous system, skin, lungs, eyes, heart and blood vessels. This syndrome is usually hereditary but spontaneous gene mutation in a person can also cause this condition. Marfan's syndrome can range from light to severe and can occur in many parts of the body. In severe cases this syndrome affects the cardiovascular system.

Marfan's syndrome is caused by a defect in the gene that is responsible to produce a protein that is an important component of the connective tissue. This defect leads to increase in another protein called TGFB (Transforming Growth Factor Beta) that leads to the condition.

Marfan's syndrome symptoms

Symptoms can vary from mild to moderate depending on the severity of the problem. Generally symptoms progress along with the age of the patient. Symptoms depend upon which part of the body is afflicted.

Skeleton

• People are tall, slim and have loose joints.
  
• People have long arms, fingers, legs and toes as this syndrome affects the long bones of the skeleton.
  
• Person has long and narrow face.
  
• Flat feet
  
• Crowded teeth as the mouth is arched.
  
• Curved backbone
  
• Breastbone either sticks out or caves in.
  

Lungs

• Lung collapse in a few cases
  
• Breathing difficulties
  
• Sleep apnea
  

Nervous system

• Swelling of the sac around the spinal column
  

Skin

• Stretch marks
  
• Hernia
  

Eyes (ocular system)

• Dislocation of eye lens
  
• Retinal detachment
  
• Glaucoma
  
• Cataract
  
• Near sightedness
  

Cardiovascular system

• Valve malformations
  
• Palpitations
  
• Heart murmur
  
• Aortic aneurysm
  
• Aortic dilatation
  
• Aortic dissection
  

Marfan's syndrome diagnosis

Diagnostic criteria for Marfan's syndrome are sometimes called Ghent Criteria, named after the city in Belgium where doctors decided which features to include on the list.

• Physical examination
  
• Echocardiogram
  
• MRI
  
• CT scan
  
• Slit-lamp exam for the eyes
  
• Eye pressure test
  
• Blood test for genetic testing
  

While there is no treatment for the condition as such, treatments are aimed at the associated symptoms.