The UAB Department of Otolaryngology offers exceptional, comprehensive, and state-of-the-art treatment that is tailored to the individual needs of patients with sleep-disordered breathing.

Common Sleep Disorders

Snoring and obstructive sleep apnea (OSA) are the most common manifestations of sleep-disordered breathing. Individuals with disruptive snoring, witnessed episodes of cessation of breathing, excessive daytime sleepiness, or other signs and symptoms of sleep disordered breathing should undergo a formal sleep study to confirm the diagnosis. This evaluation with a sleep medicine physician is crucial to successful management of OSA.

While many potential negative consequences of OSA exist, they can largely be divided into two main categories: health effects and quality of life effects. While research into the untoward health impacts of OSA is providing us with new data almost daily, some negative effects have also been shown to exist. Untreated OSA is strongly associated with the risks of developing hypertension, stroke, heart attack and early death, and these risks are greatest in those with more severe disease. Despite this, the main reason most patients initially seek help with OSA is as a result of the negative quality-of-life impact. While snoring may go unnoticed by the snorer, it can certainly be the source of substantial problems with bed partners or even people sleeping in another room. Repeated arousals and disruptions of sleep lead to non-restorative sleep. Patients can suffer from excessive daytime sleepiness, diminished cognitive abilities such as memory, work problems, and even accidents (i.e., motor vehicle accidents).

Treatments

Non-surgical treatments for snoring and obstructive sleep apnea include weight loss, positional therapy to avoid sleeping on one's back, avoidance of alcohol or other sedating medications, and positive pressure therapy such as CPAP or BiPAP. The latter uses air pressure delivered via a tight-fitting mask to 'splint' the airway open, thereby eliminating the obstruction. This is currently the first-line treatment for obstructive sleep apnea because it is highly effective when patients can tolerate it and sleep comfortably through the night every night. 

Surgical treatment of patients with OSA can be thought of as either adjunctive therapy or salvage therapy. In the former, the goal is to improve some aspect of the airway in order to improve the tolerability of the CPAP or BiPAP. This approach most often involves surgery in the nose, as nasal obstruction is associated with decreased CPAP acceptance and increased CPAP pressures. Occasionally, tonsil and/or conservative palate surgery may have a role in this approach. With salvage therapy, the goal is to utilize surgical procedures as the primary treatment modality in hopes of not needing additional treatment for OSA. While it is generally believed that surgery cannot achieve the same improvement in severity of obstructive sleep apnea compared to positive pressure therapy, surgical therapy is not plagued with the same issues of non-compliance.

It is our belief that successful surgical treatment of obstructive sleep apnea starts with accurate identification of the pattern of airway obstruction followed by the development of an effective, comprehensive treatment plan. There are three major areas at which airway blockage can occur: the nose, the tonsils/palate, and the tongue regions. Each patient treated at UAB will undergo an individualized evaluation to determine which areas are involved. Commonly, patients will have more than one area of obstruction.

Procedures offered by UAB Department of Otolaryngology for the treatment of snoring and obstructive sleep apnea include, but are not limited to:

• Inspire implantation

• Nasal surgery

• Rhinoplasty (i.e., nasal valve repair)

• Septoplasty

• Turbinate reduction

• Sinus surgery

• Palate surgery

• Uvulopalatopharyngoplasty

• Lateral pharyngoplasty

• Pillar implants

• Radiofrequency palatoplasty

• Tongue base resection

• Hyoid suspension

• Genioglossus advancement

• Transoral robotic-assisted surgery (TORS)

• Lingual tonsillectomy

• Tongue base radiofrequency

• Epiglottic surgery (partial epiglottidectomy, epiglottopexy)

• Hypoglossal nerve stimulation