When To See A Doctor
If youre experiencing any of the following signs or symptoms, you should talk to your doctor about the possibility of sleep apnea.
- Daytime sleepiness
- Never feeling rested, even after a full night of sleep
- Difficulty falling or staying asleep
- Waking throughout the night, especially with a choking sensation
- Difficulty concentrating
- Falling asleep while driving, watching TV, or reading
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Here is what the editors at Physician’s Briefing chose as the most important COVID-19 developments for you and your practice for the week of March 7 to 11, 2022. This roundup includes the latest research news from journal studies and other trusted sources that is most likely to affect clinical practice.
Excess Mortality Adds to the Toll of the COVID-19 Pandemic
FRIDAY, March 11, 2022 — The full impact of the COVID-19 pandemic in terms of excess mortality has been much greater than indicated by reported deaths due to COVID-19, according to a study published online March 10 in The Lancet.
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FRIDAY, March 11, 2022 — There is a small increased risk for intracranial venous thrombosis, thrombocytopenia, and cerebral venous sinus thrombosis after the ChAdOx1-S COVID-19 vaccination, but not after the BNT162b2 vaccination, according to two studies published online Feb. 22 in PLOS Medicine.
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THURSDAY, March 10, 2022 — Masks are important for preventing COVID-19 incidence in kindergarten through grade 12 school settings, according to research published in the March 11 issue of the U.S. Centers for Disease Control and Prevention Morbidity and Mortality Weekly Report.
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Tonsillectomy Surgery For Sleep Apnea
HOW CAN ENLARGED TONSILS CAUSE SLEEP APNEA IN MY CHILD? When a child has an infection, it causes tonsils to enlarge, subsequently blocking nasal passages and making breathing through the nose difficult or even impossible. When enlarged tonsils become a chronic issue, a tonsillectomy is necessary to prevent the serious symptoms and side effects of obstructive sleep apnea , including:
- Loud snoring or noisy breathing during sleep
- Periods of no breathing at all. Although the chest wall may be moving, no oxygen is moving through your childs nose and mouth into the lungs. The duration of these events is variable and measured in seconds.
- Mouth breathing. The passage to the nose may be completely blocked by the enlarged tonsils, causing mouth breathing and even speaking with a nasal voice.
- Restlessness during sleep. This can occur with or without periods of being awake.
- Excessive daytime sleepiness or irritability. Because his or her quality of sleep is poor, your child may be sleepy, hard to wake from a nap, or irritable during the day.
- Hyperactivity during the day. Behavioral, learning and social problems can also be common for children with sleep apnea. In fact, sleep apnea is commonly misdiagnosed as ADHD.
Although not as common as with children, adults may also be candidates for a tonsillectomy if enlarged tonsils are contributing to sleep apnea or other health conditions.
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How To Pick The Right Sleep Apnea Treatment For You
Usually, a persons sleep specialist determines which sleep apnea treatment is best for them based on their unique symptoms and health situation. Along with treatment of any underlying health conditions, a CPAP machine is usually the first treatment prescribed for sleep apnea. CPAP therapy is considered most efficacious and reliable in those who are able to demonstrate compliance and tolerate it. If a sleeper has trouble tolerating CPAP therapy, their sleep specialist may next prescribe a BiPAP, ASV, EPAP, or oral device as an alternative treatment. Surgery is often only considered after non-invasive treatments have been tried.
Many treatments for sleep apnea require ongoing use of the device. If you have sleep apnea, you may try making lifestyle changes, like losing weight or quitting smoking, alongside any therapy your doctor prescribes. However, you should also continue to use treatments prescribed by your doctor or sleep specialist until directed otherwise.
Tonsillectomy As A Sleep Apnea Treatment
Swollen tonsils are more likely to cause sleep apnea in kids than adults. 79% of children with sleep apnea have their symptoms resolved through a tonsillectomy. For adults, a tonsillectomy can be effective, as long as the tonsils were swollen and causing the apnea episodes. Adults who get a tonsillectomy may not experience a complete resolution of their sleep apnea symptoms, but their symptoms may improve.
Get a personalized treatment plan for sleep apnea with the help of the sleep medicine specialists at Sleep Dynamics. We diagnose and treat a number of sleep disorders in New Jersey, from sleep apnea to narcolepsy. Find out more or schedule a consultation by calling 732-455-3030.
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Will A Tonsillectomy Work
If the cause of the sleep apnea is an obstructed airway, a tonsillectomy should clear up the apnea. If the sleep apnea continues post-surgery, further testing may be needed. The cause could be a result of a deviated septum, narrowed airway, age, weight, neurological status, or genetics. Lifestyle changes and sleeping with the head elevated on a pillow can improve symptoms.
Advice For Parents: Tonsillectomy Reasonable Option For Some
The finding reported by the Swedish team that the adding the suturing to the removal of tonsils and adenoids does not give added benefit is not surprising,1 says Nino Shapiro, MD, professor of head and neck surgery at the UCLA David Geffen School of Medicine. “The majority of the obstruction is due to the massive tonsils and adenoids blocking the airway,” she says, ”and not from lax tissue.”
Concern about soft tissue is often a more relevant consideration in adults, says Dr. Shapiro, who is a co-author of Hype: A Doctor’s Guide to Medical Myths, Exaggerated Claims and Bad Advice .
When suturing is done, she says, the sutures often come out accidentally after the surgery and while others think suturing the pillars might reduce bleeding that has not been proven.
As for the long-term risk study? Dr. Shapiro tells EndocrineWeb that parents should not be overly concerned. It is hard to truly evaluate the risks of these procedures.
“A lot of these kids will have the propensity to other sorts of health issues anyway,” she says. While the surgery does generally help with the sleep apnea, which was the point of recommending the procedure in the first place, other more solutions with fewer long-term risks ought to be considered.
Experts suggest the use of a CPAP machine, for continuous positive airway pressure therapy, which delivers air directly through a facemask during sleep to lessen episodes of apnea,5 particularly in children with obesity.
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Automatic Positive Airway Pressure
Automatic positive airway pressure machines, often called APAP or Auto-CPAP machines, also work similarly to CPAP machines in that they connect to a sleepers face using a tube and mask, then push out air to keep the airway open. APAP machines differ from CPAP machines with their ability to automatically adjust the pressure of air they release. This ability can make the machine more comfortable than a CPAP, since sleepers need different levels of pressure at different times of night, depending on their sleeping position, sleep stage, or amount of congestion.
APAP machines use pressure sensors and a computer algorithm to auto-titrate, or calculate exactly what pressure of air a sleeper needs at any given moment. As a result, an APAP machine might work better for someone who feels uncomfortable with the consistent pressure of air released from a CPAP. Sleep specialists can program APAP machines to only release air at pressures that fall within a preset minimum and maximum, to help ensure its effectiveness.
Two Studies Shed Light On The Benefits And Risks Of Tonsillectomy Adenoidectomy A Modified Tonsillectomy And Combined Surgeries In Children Diagnosed With Sleep Apnea
With Danielle Friberg, MD, PhD, and Nina Shapiro, MD
The usual surgical procedures aimed at opening the airway to improve sleep in children diagnosed with sleep apnea are typically effective, but refinements to these procedures do not always add benefit, and long-term risks can occur.
To add support to this understanding, a modified surgery to remove the tonsils and adenoids offers no additional benefit over the standard surgical procedures in children with the sleep disorder known as obstructive sleep apnea ,1 according to a study published in JAMA Otolaryngology.
Researchers compared adenotonsillectomy with a procedure called the adenopharyngoplasty, which also surgically pulls back added tissue behind the tonsils , during removal of the tonsils and adenoids.1
“The suturing of the palatal pillars during tonsillectomy is not better than a tonsillectomy alone in treating pediatric OSA,” says study leader Danielle Friberg, MD, PhD, associate professor at Karolinska Institute, Stockholm, and a lecturer at Uppsala University in Sweden. The idea was to open up the small airway even more by pulling back these pillars, but it did not make a difference in improving the apnea.
Children with sleep apnea are often referred for tonsillectomy, so what do parents need to know?
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When Is It Recommended
Some people are born with enlarged tonsils, which can present a whole host of problems for a person, but most commonly, sleep apnea. The airway will easily get blocked by the oversized tonsils, which can cause the breathing to repeatedly stop.
Often times, enlarged tonsils are noticed in children early on, which is one of the most common reasons that children have their tonsils removed at an early age. However, sometimes sleep apnea may not develop until a person becomes older. If a person has oversized tonsils and they experience sleep apnea, then tonsil removal can be performed to help treat the disruptive sleep patterns.
Thoughts On Tonsillectomy For Sleep Apnea As First
Hi Mark I would love to know how it is going also. Im scheduled to have surgery in early June. Was told I have severe apnea so Im hoping this helps. I heard it is painful the first few days, but well worth it. Would love to hear your story.
If you are not doing well with CPAP, you should at least consider surgery. The next step would be an evaluation to determine whether surgery and what kind of surgery might be best for you. Please feel free to contact me directly to discuss the specifics of your situation.
Im very interested in surgery for Sleep Apnea. I cannot sleep with the machine.
Kathleen, If you would like to schedule an appointment with me, you can contact our Patient Access Center at 323-442-5790. Please feel free to e-mail me directly with any questions or concerns. Eric
It wont cure your sleep apnea. Got a tonsilectomy, turbinectomy and septomplasty. Still have it and my levels are actually higher now. Was a llevel 8 before surgery, went up to a 11 after the healing process for surgery
Hi! I had a tonsillectomy in 1988 when younger had lot of different infections in the military!! I was always with infections and bleeding . Since then I have mild obstructed Sleep apnea. In the present use cpap machine. Why dose this happen . I didnt know that I could develop this condition. Also have chronic sinus, allergys ext. Thank You for your advice.
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So Why Isnt Tonsillectomy For Sleep Apnea A First
There are likely many reasons. First, not all patients have tonsils that are markedly enlarged. I would estimate that this about 5-10% of all adults with sleep apnea would be ideal candidates for tonsillectomy as a first-line treatment. This figure seems relatively small, but it still is quite a few patients who could have their tonsils removed because sleep apnea is so common. Second, most of these studies are relatively small. It would be important to repeat the studies in larger groups, just to confirm the findings. Third, the studies are not what are called randomized trials. Randomized trials could include patients with sleep apnea and markedly enlarged tonsils, either performing tonsillectomy or observing them without treatment for a period of time . Unfortunately, it turns out that making people wait for surgery just to be part of a research study is incredibly difficult. Patients will prefer not to be involved in these studies if they are interested in having surgery . Finally, there are perceptions about surgery for sleep apnea that we have to overcome. I have written before that most surgeons, other physicians, and the public think that there is only one surgery for sleep apnea. That is just not the case.
Is Surgery Right For You
When you have obstructive sleep apnea, it means that something is blocking your airway while you sleep. This prevents you from breathing and causes you to wake up over and over again throughout the night. In many cases, pressure on the airway causes sleep apnea, but swollen tonsils could be another factor. Many people wonder if a tonsillectomy could cure their sleep apnea without the need for CPAP treatment or other therapies. Is a tonsillectomy the cure for your sleep apnea?
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A Second Look At Surgery For Sleep Apnea In Children
In a second, related study,4 Australian researchers followed nearly 1.2 million children from a national registry in Denmark, born from 1979 through 1999, to evaluate the long-term effectiveness of tonsillectomy, adenoidectomy or both compared to none of these surgeries.
Among these children, more than 60,000 had had one of the three types of surgery during the first nine years of their lives.4 The researchers then calculated the long-term risks for 28 different diseases experienced by the participants for up age 40 years.
They found that children who had had either a tonsillectomy, an adenoidectomy, or both surgeries, were two to three times more likely to have upper respiratory tract diseases in later years.4 The children experienced a two to three-fold increase in upper respiratory tract infections but fewer infections, in general, and a reduction in allergic diseases.
However, the frequency of upper respiratory infectious disease was put in perspective when compared to the general population, dropping it to just a slight 2% increase, suggesting less of a concern,4 according to the authors.
In contrast, the surgeries that were intended to treat conditions in young children had very mixed outcomes later in life, with surgery reducing the long-term risk for seven of 21 conditions, but not changing the risk for nine others and actually increasing the risk for five measured health concerns.4
Why Choose Nyc Sleepwell For A Tonsillectomy
Led by Dr. Ruben Cohen, a Board Certified Oral and Maxillofacial Surgeon, our skilled team of sleep specialists, general and pediatric dentists, orthodontists, ENT surgeons, and anaesthesiologists have extensive experience in tonsillectomies in addition to other surgical treatments for a wide array of conditions related to sleep apnea. For your added peace-of-mind, our facility is accredited by the American Association for Accreditation of Ambulatory Surgery Facilities , the Gold Standard in Accreditation. Our goal at NYC SleepWell, plain and simple, is to help you sleep well and be healthy!
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Removing The Tonsils To Treat Sleep Apnea
Has your healthcare provider recommended a tonsillectomy or are you considering whether or not this would help stop your child’s snoring? Approximately 79% of children who have a tonsillectomy surgery for OSA experienced a resolution of their symptoms. Whereas if you wait, symptoms of sleep apnea will resolve on their own only about half the time. Having a discussion with your healthcare provider will help you know if waiting would be the better option for you since there are some risks with having a tonsillectomy.
If you are an adult with sleep apnea, your healthcare provider may elect to perform a tonsillectomy to improve symptoms. In those adults who have enlarged tonsils, this may be successful. However, adults usually require CPAP.
Pediatric Vs Adult Tonsillectomies
Tonsillectomies are more common in children than in adults. Children usually receive the surgery as a treatment for infected tonsils. Adults typically undergo tonsillectomies as a treatment for sleep apnea. Removal of the tonsils increases space in the airway, thereby improving overall breathing and sleep. Adenoids and palatine tonsils are generally removed at the same time.
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Pros And Cons Of Sleep Apnea Operation
Medical invasion is relatively safe when you have enlarged tonsils or adenoids. However, other types of sleep apnea surgeries can be riskier and less efficient. Researching about sleep apnea operation pros and cons will enable you to find a lot of useful information.
First of all, surgery requires additional pre-examination . Secondly, its been observed that patients after a sleep apnea operation deal with some side effects like problem swallowing, local pain, dryness, changed voice, etc. Thirdly, some patients have reported the return of the snore after a while.
So, obstructive sleep apnea operation should be a well-balanced decision made after detailed monitoring of body reactions, thorough examination, and consultation with a physician.
Is Having Sleep Apnea A Disability
The Social Security Administration no longer has a disability listing for sleep apnea, but it does have listings for breathing disorders, heart problems, and mental deficits. If you meet the criteria of one of the listings due to your sleep apnea, you would automatically qualify for disability benefits.
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Are There Other Studies Of Tonsillectomy For Sleep Apnea
This study followed previous smaller studies showing substantial improvement or resolution in sleep apnea after tonsillectomy alone and that tonsil size and body mass index were associated with outcomes after tonsillectomy alone and that tonsillectomy could reduce the required CPAP pressure in those who did not have resolution of their sleep apnea. This was supported by a larger study of 202 adults published in 2015. This study showed a 95% chance of surgical success after tonsillectomy for sleep apnea, with a decrease in the average apnea-hypopnea index from 18 to 3 events per hour.