Many people think that snoring and apnea are pulmonary or bronchical problems and that the Continues Positive Airway Pressure (CPAP) affect the lungs.
Both snoring and apnea are due to collapse or obstruction of the upper airway at the level of the pharynx, specifically at the crossroads where the base of the tongue, the soft palate and pharyngeal walls contact each other. Additionally to this pharyngeal obstruction, the patient often has a chronic nasal obstruction due to a deviated nasal septum, turbinate hypertrophy, nasal polyps etc .
We talk about snoring when referring to the noise caused by the air passing through a narrow or collapsed area. We speak about apnea in severe cases of obstruction, in which the airflow stops and causes a respiratory arrest with a concomitant oxygenation decrease in important organs : heart, brain, kidney, endocrine glands etc. and the appearence of various symptoms: daytime sleepiness, daytime somnolence, headaches, hypertension, impotence etc etc.
So snoring and apnea are not due to any bronchopulmonary problem, as in 100% of the cases the airflow obstruction is situated in the pharynx and nostrils. This is proven by the fact that patients operated on for tracheostomy, never suffer from snoring and apnea.
The CPAP has no effect on bronchi and lungs. It just dilates the pharyngeal area which blocks up in horizontal position.
The CPAP is a device that emits compressed air. By placing a mask over the nostrils and the mouth during sleep, the device causes a dilation of the pharynx in the area of the upper airway obstruction or collapse.
The CPAP is very effective for obstructive sleep apnea (OSA), the symptoms caused by the lack of oxygen (hypoxia) will disappear since the first days of its use. The only problem is that patient has to use this device for life, and some persons don't tolerate it, especially those who have a nasal obstruction due to a deviated septum, nasal polyps, turbinates hypertrophy etc. These problems should be corrected by surgery so that the patient suffering from apnea, can tolerate the CPAP during sleep at conventional pressures.
A pure sleep apnea, confirmed by nocturnal polygraph doesn't reduce by surgery. On the other hand a patient suffering from apnea and nasal obstruction will not tolerate the CPAP, nasal obstruction if not previously operated .
The final conclusion is that in many cases of sleep apnea a combinated therapy is appropriated : Surgery and CPAP.
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