Sleep apnea syndrome is a constellation of symptoms resulting from recurrent episodes of
apnea during sleep. Often the upper airway becomes obstructed during slumber in this disorder. Symptoms relate to
sleep deprivation and include morning
headaches,
daytime somnolence, personality changes with deteriorating intellectual capacity,
nocturnal enuresis, and sexual dysfunction. Diagnosis is assisted by polysomnographic recordings.
Therapy is directed at the cause of obstruction when one can be found,
weight loss in massively obese patients,
tracheostomy in the symptomatic patient. Four patients with documented
sleep apnea syndrome are discussed. One patient, a thin adolescent female underwent
adenoidectomy without improvement. Two massively obese adult males required
tracheostomy with marked amelioration of symptoms. One additional adult male was found to have
sleep apnea due to severe, acquired
micrognathia; he was significantly improved by
tracheostomy. All three adult patients were found by endoscopic visualization to have marked pharyngeal soft tissue collapse with inspiration during apneic episodes. Possible causes of pharyngeal collapse are discussed.