Snoring and sleep apnea is a disease that affects at least 20% of our society, including children. Sleep endoscopy is a method used to evaluate the dynamic airway in patients with snoring or sleep apnea. ENT physicians who specialize in sleep surgery often resort to sleep endoscopy in complicated patients.
Snoring and sleep apnea are not diseases due to a single cause. There are many factors that trigger the formation of these diseases (multifactorial); the patient's anatomical structure (nose, soft palate, tongue base, jaw structure and neck), age, weight, other diseases (diabetes, hypertension, anemia, thyroid diseases, etc.) and the patient's family history.
Snoring is the sound produced due to the vibration of the soft palate while sleeping. Sleep apnea is the cessation of breathing during sleep for at least 10 seconds. Sleep apnea causes a decrease in the oxygen level in the blood in the short term, an increase in the heart rate, which causes us to wake up at night in a panic with a feeling of suffocation, headaches in the morning, muscle and joint pain, dryness in the throat, a feeling of obsession and tickling, feeling like we are not getting enough sleep and feeling like we are not getting enough sleep during the day. It causes us to fall asleep and lose concentration.
In the long run, it can cause sleep apnea, hypertension, heart enlargement, heart failure and even sudden death during sleep. In short, it is not a disease that should be ignored.
Nose-related diseases can be a cause of snoring; Deviation, narrow nasal angle, which we call nasal valve, large nasal concha, which we call concha, presence of polyps in the nasal cavity, and allergic rhinitis, which is a common disease today, are also among the reasons for nasal snoring.
Apart from this, diseases of the soft palate and the tonsil area called oropharynx may be the cause of snoring (drooping soft palate, large tonsils, etc.). The enlargement of the tongue root and blocking the airway during sleep is among the reasons that may occur behind the jaw structure, especially in patients with sleep apnea.
In order to diagnose snoring and sleep apnea, it is necessary to perform a polysomnography (PSG), also called a sleep test. This test determines whether the patient has snoring or sleep apnea, the patient's heart rhythm and pulse during sleep. It provides information about how oxygenation is and the severity of sleep apnea.
Unfortunately, it is not possible to fit every patient into a certain clinical mold as I explained above. Sometimes there are inconsistencies between the patient's sleep test result and the patient's clinic. Most of the time, the patient's obstruction is not only in a specific anatomical region. There are examination findings in both the soft palate and the base of the tongue that may cause congestion during sleep.
It may be necessary to perform additional tests to find out which blockages in the anatomical areas cause the patient to snore more. Computed tomography and magnetic resonance imaging (MRI) are some of these examinations. But examinations also have a disadvantage; It evaluates the patient while he/she is awake and the soft palate and base of the tongue are taken while they are motionless.
In short, we need such a test that this test evaluates the patient while he/she is asleep and also evaluates the soft palate and the root of the tongue when they are mobile, just like during sleep. This is where the test we call "sleep endoscopy" comes into play.
Sleep endoscopy is a test performed under operating room conditions. The patient is given a very small amount of anesthetic medication and is allowed to sleep in the operating room. After the patient sleeps, an endoscope is inserted through his nose to evaluate which area causes the patient to snore most during sleep.
Although this procedure is performed in the operating room, it is not a surgery. The patient does not undergo any procedures such as making any incisions or stitching. The patient is only put to sleep with a low dose of anesthetic medication in a safe environment.
Some sleep apnea patients use a nasal mask called CPAP. Some of the patients who use this nasal mask report some discomfort related to the use of the mask. Sleep endoscopy is also used to evaluate disorders related to CPAP use. CPAP is inserted after the patient sleeps, and the endoscopic examination is performed after the CPAP is inserted. An attempt is made to find the source of the patient's discomfort.
Rarely, surgery may be performed on the patient following sleep endoscopy. The patient is informed before sleep endoscopy. There is congestion in both the soft palate and the base of the tongue, After determining which one causes sleep apnea more by sleep endoscopy, the patient is discussed with the patient about performing surgery on the area with the most obstruction. The patient is first performed a sleep endoscopy in the operating room, and surgery is performed on the most suspicious area without waking the patient.
In summary;
Sleep endoscopy is a method used to clearly determine the location of the obstruction in patients with snoring and sleep apnea.
Sleep endoscopy is the preferred method if there is incompatibility between the sleep test (polysomnography) and the patient's findings.
Sleep endoscopy is a method used to detect patient problems related to nasal mask (CPAP). is the method.
Sleep endoscopy is a test performed under operating room conditions using mild anesthetic drugs. It is not surgery.
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