ABSTRACT
Obstructive sleep apnea is a significant medical problem affecting up to 4 percent of middle-aged adults. The most common complaints are loud snoring, disrupted sleep and excessive daytime sleepiness. Patients with apnea suffer from fragmented sleep and may develop cardiovascular abnormalities because of the repetitive cycles of snoring, airway collapse and arousal. Although most patients are overweight and have a short, thick neck, some are of normal weight but have a small, receding jaw. Because many patients are not aware of their heavy snoring and nocturnal arousals, obstructive sleep apnea may remain undiagnosed; therefore, it is helpful to question the bedroom partner of a patient with chronic sleepiness and fatigue. Polysomnography in a sleep laboratory is the gold standard for confirming the diagnosis of obstructive sleep apnea; however, the test is expensive and not widely available. Home sleep studies are less costly but not as diagnostically accurate. Treatments include weight loss, nasal continuous positive airway pressure and dental devices that modify the position of the tongue or jaw. Upper airway and jaw surgical procedures may also be appropriate in selected patients, but invasiveness and expense restrict their use.
Subject(s)
Sleep Apnea, Obstructive , Adult , Humans , Sleep Apnea, Obstructive/diagnosis , Sleep Apnea, Obstructive/etiology , Sleep Apnea, Obstructive/physiopathology , Sleep Apnea, Obstructive/therapySubject(s)
Asbestosis/diagnosis , Asbestosis/etiology , Asbestosis/pathology , Environmental Exposure , Humans , Lung/diagnostic imaging , Lung/pathology , Lung Neoplasms/chemically induced , Lung Neoplasms/diagnosis , Lung Neoplasms/pathology , Mesothelioma/chemically induced , Mesothelioma/diagnosis , Mesothelioma/pathology , Pulmonary Fibrosis/chemically induced , Pulmonary Fibrosis/diagnosis , Pulmonary Fibrosis/pathology , RadiographySubject(s)
Exercise Test , Heart Diseases/diagnosis , Lung Diseases/diagnosis , Lung/physiopathology , Adenosine Triphosphate/metabolism , Adult , Coronary Disease/diagnosis , Glucose/metabolism , Heart Rate , Humans , Lactates/metabolism , Muscle Contraction , Oxygen Consumption , Physical Exertion , Physical Fitness , Respiratory Function TestsABSTRACT
Tracheostomy resulted in dramatic and sustained improvement in the symptoms of 11 patients with upper airway sleep apnea. However, seven of eight patients who had a standard tracheostomy experienced tracheal granuloma or stomal stenosis. Tracheostomy was revised in five of these eight patients using cervical skin flaps. Three of the 11 patients had a skin flap tracheostomy as the original procedure. Only two of eight patients had tracheal complications after a skin flap procedure. Postoperative problems unrelated to the procedure included recurrent purulent bronchitis in four and psychosocial difficulties in ten. Permanent tracheostomy should be limited to patients with serious cardiopulmonary complications of upper airway sleep apnea. The cervical skin flap is the preferred procedure for long-term tracheostomy in these patients.