When it Comes to Sleep-Disordered Breathing, Be Sure to Evaluate the Whole Patient

Dr. Walker: In looking at her sleep study, I would probably diagnose her as a symptomatic, very mild apneic. I would guess that the menopause is probably what set it off. I really believe in looking very closely at their metabolic system; she could be tired for a whole lot of reasons. You need to talk to patient to get a really good idea of the whole picture. If she never snored before, she definitely didn’t grow a new uvula-she lost her muscle tone.

Dr. Friedman: I treat the snoring patient in the same way, as far as evaluation, as I would treat any other patient with upper airway problems. I look at the entire airway and I think of it as having multiple areas of potential obstruction. I do endoscopy on every patient; any patient with an airway issue, snoring or otherwise, deserves full endoscopy. If it’s just snoring, I might go back and do more tongue-based radiofrequency; it’s not going to work all the time, but very often it will solve the problem. And it might only work for six months or a year, but then I will just do it again.

Dr. Woodson: I find that, both with apnea and with snoring, it is really quite beneficial to go in there and really see what’s going on. Many times I will do a sedated endoscopy, and if it corroborates what I see in the office, then go on and do Pillar implants, injection snoreplasty, radiofrequency, or whatever. Injection snoreplasty, I think has a pretty good track record.

Dr. Senior: Snoring is really a grab bag, but I would definitely work up the nose, making sure it is as open as possible. I would just want to see, on a very objective level, if the snoring improves with management of nasal obstruction. I also find that endoscopy is very, very helpful. I basically look for the final common pathway for the snoring; I want to see if it’s palatal obstruction.

Dr. Walker: And there are times where you fix the deep vibratory sound; then the patient comes back and now they are wheezing or making some other sound, which might be worse than the snoring. You can sometimes unmask different sounds as you treat others. I simply won’t operate on the unrealistic patient who is looking for complete silence. I think that’s a huge problem.

Dr. Woodson: Another huge problem, and we see this all the time, people get diagnosed with apnea-even by board-certified sleep doctors-who have symptoms but don’t actually have the disorder.