Otolaryngologists Play a Critical Role in the Management of Sleep Disorders
With their extensive knowledge of the upper respiratory tract and its relation to sleep quality, otolaryngologists are uniquely qualified to manage sleep disorders related to the airway, especially obstructive sleep apnea (OSA) and snoring. Both conditions may be caused by physical obstructions and airway abnormalities.
“In patients with OSA, the upper airway collapses during sleep, resulting in cessation of breathing or shallow breathing and lack of sufficient oxygen,” says Xiaoyang Hua, MD, PhD, a physician researcher and associate professor in the Department of Otorhinolaryngology at McGovern Medical School at UTHealth Houston. “Some patients may also have elevated levels of carbon dioxide in the blood, called hypercapnia. People with OSA frequently wake up during sleep, a condition called respiratory effort-associated arousal. The combination of blood gas disturbance and sleep fragmentation results in poor sleep quality and daytime tiredness. Over time, this can significantly impair the function of critical organs, including the brain, heart, lungs, vascular system, and endocrine system. About 85% of people with OSA also snore, which often disrupts their bed partner’s sleep.”
OSA is diagnosed as mild, moderate, or severe with symptoms that range from snoring to gasping for air or cessation of breathing for several seconds. People with severe apnea may have 30 or more episodes per hour of not breathing for as long as 10 seconds, creating a systemic response linked to cardiovascular disease, hypertension, heart attack, and stroke, all of which dramatically affect quality of life and life expectancy. “When you consider health care costs, work and home safety issues, and traffic fatalities, the impact of OSA on our society is enormous,” Dr. Hua says.
The underlying causes of OSA vary and may include enlarged tonsils, nasal polyps, a deviated septum, excessive soft tissue in the throat, narrow jaw structures, or decreased muscle tone. “Because of this complexity, effective OSA management often requires a multidisciplinary approach, involving specialists in otolaryngology, sleep medicine, oral surgery, internal medicine, and weight management,” he says. “Individualized treatment plans are essential and should be tailored to each patient’s anatomy, medical history, and lifestyle.”
Continuous positive airway pressure (CPAP) and auto-adjusting PAP (APAP) remain the gold standard for OSA therapy. But 50% to 60% of people are unable to tolerate either. Both can worsen the quality of sleep, and some people feel claustrophobic wearing the mask. Other nonsurgical strategies include establishing consistent sleep schedules, avoiding alcohol and respiratory-suppressing medications such as opioids and benzodiazepines, weight reduction, positional therapy, and a dental device.
“As ENT specialists, we focus primarily on surgical treatment for patients who cannot tolerate CPAP and APAP,” Dr. Hua says. “Depending on the patient’s anatomy, the severity of their OSA, and any co-existing health issues, we may recommend nasal, throat, or neck procedures, including tonsillectomy, septoplasty, sinus surgery, tongue reduction, various forms of pharyngoplasty, neck surgeries, or implantation of the Inspire® device.”
Inspire is a small implantable device that stimulates the hypoglossal nerve in patients who are intolerant of PAP therapy and who do not have a circumferential collapse behind the soft palate. In general, patients need a recent sleep study and a drug-induced sleep endoscopy (DISE) to determine their eligibility. Dr. Hua implants the device, and the patient works with a sleep medicine specialist who programs it over about six weeks.
“Sleep medicine continues to evolve rapidly,” Dr. Hua says. “Hundreds of conditions are now known to impact sleep health. Many individuals with OSA may also suffer from other sleep disorders, such as insomnia, restless leg syndrome, circadian rhythm disturbances, or narcolepsy. At UTHealth Houston, we believe that quality sleep is a cornerstone of overall well-being. Our multidisciplinary team – including otolaryngology, sleep medicine, neurology, oral surgery, and internal medicine – works together to deliver personalized care and comprehensive sleep solutions.”