Snoring is a common symptom found in the general population. In cases where there is only snoring (without sleep apnea), it causes annoyance to close ones and people around, leading to embarrassment and teasing. However, if snoring is accompanied by sleep apnea, in addition to the problems mentioned above, it also negatively affects the person’s physical health. During episodes of sleep apnea, blood oxygen levels drop, a condition called Hypoxia which causes cells throughout the body to receive insufficient oxygen. Upon waking, the person feels unrefreshed despite having slept enough, experiences irritability, and has poor concentration.
During periods of low blood oxygen, significant problems arise in the body because it generates a large amount of free radicals in the body’s cells. These excessive free radicals cause the body to experience Oxidative stress. This Oxidative stress leads to inflammation of the walls of small blood vessels throughout the body, resulting in poor blood circulation in various organs, causing degeneration, premature aging, and over time, leading to degenerative diseases that occur earlier than in the general population, such as diabetes, hypertension, cardiovascular diseases, memory loss or Alzheimer’s, osteoarthritis, glaucoma, and cataracts. Therefore, if there is snoring with sleep apnea, treatment should be sought promptly and not neglected any longer.
There are two main methods to treat snoring and sleep apnea as follows:
- Non-surgical methods include weight loss and exercise, avoiding medications or drinks that depress the central nervous system, adjusting sleeping positions, or ultimately using a breathing aid device that pressurizes air through the narrow throat to increase airflow through the narrow airway during sleep (Continuous Positive Airway Pressure: CPAP). This method works for some patients but can cause discomfort and lead to refusal of use in others.
- Surgical methods vary depending on the identified cause of the problem, such as:
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- If caused by swollen nasal mucosa, it can be treated by radiofrequency ablation (RFVTR) to reduce its size.
- If there is a deviated nasal septum, surgery called Septoplasty can correct it.
- If there is airway obstruction in the throat, such as enlarged tonsils, tonsillectomy (removal of tonsils) may be performed, which is a traditional method. Nowadays, a better and more modern method is laser surgery to reduce the size of the tonsil tissue combined with suturing to repair the tonsils to maintain their normal shape and function. This method is collectively called LASER Tonsilloplasty.
- If the cause is a lax soft palate and elongated uvula, the traditional method uses a scalpel and suturing to reshape the soft palate, called UPPP (Uvulopalatopharyngoplasty). The disadvantages include a long surgery time, significant blood loss of 50-100 cc, severe postoperative pain, a hospital stay of 2-3 nights, a long recovery period, and an unattractive surgical wound in the throat.
Surgery has since evolved with laser-assisted surgery (LASER-assisted Uvulopalatoplasty: LAUP), but the surgical outcomes were still not optimal. Currently, a new, highly effective, and globally accepted technique called the Modified CAPSO technique (Modified cautery assisted palatal stiffening operation technique) combined with suturing to reshape the soft palate and uvula, known as Modified CAPSO and Uvulopalatoplasty, has been developed. The advantages of this new technique are shorter surgery time and minimal blood loss, not exceeding 10 cc. Patients experience less postoperative pain, only require a 1-night hospital stay, recover quickly, and have aesthetically pleasing surgical wounds in the throat.
This surgery is suitable for treating patients with mild sleep apnea (Mild OSA). However, when combined with other treatments such as radiofrequency ablation of the nasal mucosa (RFVTR) and laser surgery to reduce tonsil tissue size combined with suturing to repair the tonsils (LASER Tonsilloplasty), it can also treat patients with moderate to severe sleep apnea (Moderate to Severe OSA).
Dr. Soranchai Kiatsurayanon
ENT Specialist
and Facial Plastic and Reconstructive Surgery
Ear, Nose, and Throat Center Phyathai 3 Hospital
