Surgical Management in Snoring and Sleep-disordered Breathing Rodolfo Lugo Saldaña
INDEX
×
Chapter Notes

Save Clear


1Surgical Management in Snoring and Sleep-disordered Breathing2
3Surgical Management in Snoring and Sleep-disordered Breathing
Rodolfo Lugo Saldaña MD Professor of Otolaryngology, Head and Neck Surgery Sleep Respiratory Disorders, Snoring and Rhinology Postgraduate Course Department of Otolaryngology, ISSSTE Hospital Constitution Benemeritan University Autonoma of Puebla (BUAP) Director, Ronquidomonterrey Clinic Monterrey, NL, Mexico Foreword David S Parsons
Jaypee Brothers Medical Publishers (P) Ltd4
Headquarters
Jaypee Brothers Medical Publishers (P) Ltd
4838/24, Ansari Road, Daryaganj
New Delhi 110 002, India
Phone: +91-11-43574357
Fax: +91-11-43574314
Overseas Offices
J.P. Medical Ltd
83 Victoria Street, London
SW1H 0HW (UK)
Phone: +44 20 3170 8910
Fax: +44 (0)20 3008 6180
Jaypee-Highlights Medical Publishers Inc
City of Knowledge, Bld. 237, Clayton
Panama City, Panama
Phone: +1 507-301-0496
Fax: +1 507-301-0499
Jaypee Medical Inc
The Bourse
111 South Independence Mall East
Suite 835, Philadelphia, PA 19106, USA
Phone: +1 267-519-9789
Jaypee Brothers Medical Publishers (P) Ltd
17/1-B Babar Road, Block-B, Shaymali
Mohammadpur, Dhaka-1207
Bangladesh
Mobile: +08801912003485
Jaypee Brothers Medical Publishers (P) Ltd
Bhotahity, Kathmandu, Nepal
Phone: +977-9741283608
© 2015, Jaypee Brothers Medical Publishers
The views and opinions expressed in this book are solely those of the original contributor(s)/author(s) and do not necessarily represent those of editor(s) of the book.
All rights reserved. No part of this publication may be reproduced, stored or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior permission in writing of the publishers.
All brand names and product names used in this book are trade names, service marks, trademarks or registered trademarks of their respective owners. The publisher is not associated with any product or vendor mentioned in this book.
Medical knowledge and practice change constantly. This book is designed to provide accurate, authoritative information about the subject matter in question. However, readers are advised to check the most current information available on procedures included and check information from the manufacturer of each product to be administered, to verify the recommended dose, formula, method and duration of administration, adverse effects and contraindications. It is the responsibility of the practitioner to take all appropriate safety precautions. Neither the publisher nor the author(s)/editor(s) assume any liability for any injury and/or damage to persons or property arising from or related to use of material in this book.
This book is sold on the understanding that the publisher is not engaged in providing professional medical services. If such advice or services are required, the services of a competent medical professional should be sought.
Every effort has been made where necessary to contact holders of copyright to obtain permission to reproduce copyright material. If any have been inadvertently overlooked, the publisher will be pleased to make the necessary arrangements at the first opportunity.
Inquiries for bulk sales may be solicited at: jaypee@jaypeebrothers.com
Surgical Management in Snoring and Sleep-disordered Breathing
First Edition: 2015
9789351528890
Printed at
5Dedicated to
My wife Leticia and my sons Rodolfo and Valeria.
My mom Alma Dora and my Father Rodolfo.
Without their love and support, it would have been
impossible to have done anything in my life.6
7Contributors 9Foreword
When reviewing professional, scientific books that I might want to read, I always look first at the authors. What are their credentials? Can I have confidence that they are authoritative? Are they mature enough to have a certifiable track record of experience?
I also want to know more personal information about them. Are their opinions, insights, and research held in high esteem by their colleagues? Do they make as much sense caring for their patients as they do in their book? Even more personally, if they are placed in a similar medical or surgical situation as I am facing (and that is why I am reading their book), how would they react to my specific unique problems? Do they have the “right stuff” to deal with my issues?
I have known Rodolfo Lugo Saldaña for a large number of years. I have seen him in action both with a fellowship in Carolina and in his own surgical theatres. I have heard his opinions voiced discussing problematic situations or teaching residents. I have found myself being lead by his thoughtfulness, sincerity, maturity and experience. I have seen his credentials. I know I can trust him.
The topic of management of obstructive sleep apnea is controversial. But the options for care are often viewed as somewhat limited by the surgeon in practice. The patient is often told that medical management is the only option, and surgery is of almost no benefit. Others speak just the opposite, and the patient has every right to be confused and eventually untrusting.
Surgical Management in Snoring and Sleep-disordered Breathing, hopefully for you, will discuss in depth the options and indications, which in turn, will direct you to the proper therapy. So you as a surgical manager will hopefully realize the broader selection of options for care with much more positive outcomes.
The target or the goal of this book is to provide a pathway to more “thinking” surgeons. The OSA patient is very complicated and very different in every aspect. Similarly, the treatment is also complicated and different as well. It must be tailored for each patient and that is the artistic point in surgically managing OSA.
This book is essential for surgical doctors wanting to know: “How do I do this?” You can trust Rodolfo to lead you through the challenging and often times overwhelming experiences of the sleep apnea patients.
David S Parsons MD, FAAP, FACS
Clinical Professor, Universities of North and South Carolina
Lake Wylie, SC, USA10
11Preface
The vast majority of the contributors of this book have been professors and guest speakers of the multiple obstructive sleep apnea (OSA) courses organized by ENT societies in many countries. The interest of the upper airway surgeons (otolaryngologists, maxillofacial surgeons) in this pathology is growing, and patients are seeking more accuracy and tailored treatment. The ideal outlook is to work in conjunction with other specialties in order to find the best option for patients suffering from this obstructive sleep breathing disease.
The reason for bringing out this book is to unite diagnostic and treatment criteria of the obstructive airway sleep disorders. The first option to these patients is the continuous or automatic positive air pressure therapy. Surgeons agree with this therapy and we have not only to do everything possible to optimize this treatment but also to give an option for those who cannot tolerate or have poor or no compliance to the continuous positive airway pressure (CPAP) therapy.
In this book, I had the honor to work together with a spectacular group, like the anesthesiologists from my private and public practice, maxillofacial surgeons focused in sleep apnea from my city, otolaryngologist from different countries with the same interest in this disease, sometimes with different points of views and sometimes with similarities in the diagnosis and therapeutic criteria.
I hope you will enjoy reading this book as much as I enjoyed editing and gathering that wonderful group of sleep-disordered breathing specialists.
Rodolfo Lugo Saldaña12
13Acknowledgments
There are many people who have been directly or indirectly related to this book. The first person I can mention is Dr Antonio Herrera, my otolaryngology, head and neck department chief, for her expert advice and encouragement throughout my early years of my profession; in addition, the many dear friends, professors and colleagues during my residency in Guadalajara Mexico in the “Valentin Gomez Farias” ISSSTE Hospital.
Many thanks to the all of coauthors and contributors, from Argentina, Brazil, Colombia, Spain, United States and Mexico, for all the time and attention given over to putting this book together.
I place on record my sincere gratitude to my hospital “Constitution” ISSSTE, medical board of directors and friends in Monterrey Mexico for this constant encouragement in all our projects.
And to all of speakers and professors in the meetings and classes that I attended in all these years and helped me develop a better understanding of the symptoms of the sleep-disordered breathing patients.14
15
16Introduction
Patients with a sleep-disordered breathing are often not well attended. It is very commonly seen that even after multiple surgical treatments, they do not show positive outcomes. This is due to the surgeons who do not have a previous sleep study, correct diagnosis, and have not selected the right surgical technique.
The first-line treatment in these patients is the positive air pressure respiratory therapy [continuous positive airway pressure (CPAP) or automatically adjusting positive airway pressure (APAP)]; there is no doubt about the effectiveness of this kind of therapy, and the surgeons would not be against that. Our interest as upper airway surgeons should always be focused on what is right for our patients.
The book will help the ENT surgeons to infer a proper diagnosis in such patients who go through some sorts of surgical procedures to the first-line treatment, the device of nocturnal positive pressure (CPAP or APAP). Ideally, our patients need more accurate diagnosis so as to get the most appropriate treatment depending on all anatomic variants that they present while sleeping.
The book includes a lot of information presented by otolaryngologists, anesthesiologists, and maxillofacial surgeons who are in contact with patients suffering from some type of sleep-disordered breathing that causes sleep fragmentation and therefore affects their quality of sleep and quality of life.
Arriving at a diagnosis of a syndrome of obstructive sleep apnea often is not complicated; what is complicated is to get the correct tailored treatment.
When the patient tolerates and adapts effortlessly to positive pressure ventilation therapy, it is an achievement and a goal is achieved. But our work does not end here, there is more contact with the patient; since the percentage of people who discontinue the use of positive pressure equipment is very high and often no longer have contact with the patient. We all know the great impact of the patients in our community who have sleep-disordered breathing, e.g. the taxi driver who is drowsy driving around town, or the person at work do not have good performance which can bring labor problems. Snoring as such is no longer considered a disease, but it remains the leading cause for consultation.
Physicians have a responsibility to know the background to this variant of the sleep disorders, which is the most common. And that is where multidisciplinary concept works, when the patient cannot tolerate CPAP or APAP. When after multiple attempts the patient keeps the mask aside and decides not to use it anymore, that is where we back and review the patient again depending on our diagnosis and anatomic and metabolic variables: if our case can be optimized, or if their lack of attachment and adhesion may be caused by some variable anatomical structure of the upper airway, and we as 17the physicians and surgeons can help improve and optimize the respiratory status of the patient.
This book focuses on the care of these patients, those who are intolerant and do not adapt to positive pressure breathing therapy (CPAP and APAP). Without forgetting that we can return to this option multiple times depending on the variants that each patient presents.
In this book, I have tried to explain all the steps necessary to make a correct and consistent medical approach, so that you can see all the details being given to each of my patients who come to my office asking for the solution of their problems.
How to perform a more accurate diagnosis of the upper airway narrowing areas with the aid of fiberoptic endoscopes in awake and drug-induced sleep patients for example?
Even the descriptions of the latest techniques for surgery of the upper airway that focus on improving the quality of sleep, reduce breathing resistance, and if possible a percentage decline of apnea–hypopnea index (AHI) and other equally important parameters like the rate of desaturation, arousals, RERA (respiratory arousals associated with respiratory effort) and sleep quality as well as increase the percentage of rapid eye movement (REM) sleep and stabilize and balance the large number of metabolic factors that are altered with sleep fragmentation.
That is why, it is important that all otolaryngologists and maxillofacial surgeons who are interested in this field, be as comprehensive as possible and not be “lone wolves”. We are specialists of treating patients who are different by one another with different diseases. Therefore, the treatments or procedures should not be a “cooking recipe” and must be individualized for each patient, not to be typecast with the same treatment. To achieve this goal, we must work in cooperation with other specialties like working together with anesthesiology, internal medicine and its subspecialties, such as neurology and psychiatry.
This field is very broad and is very interesting and should be known by all upper airway surgeons, because many times we are faced with patients with these types of entities without being diagnosed and often not suspected. Surgery is usually the best ally of positive pressure breathing therapy.
This book will give you the option, you have for your patients who are diagnosed with a sleep-disordered breathing disease with poor adherence or no tolerance for positive pressure devices (CPAP or APAP), which remains the treatment of choice. As I said, all these processes can help you to give a better quality of life for these patients.