Treatment of Sleep Apnea and Sleep Disorders in All Age Groups
W. McDowell Anderson, MD
University of South Florida
Tampa, FL, USA
Management of patients with allergic diseases of the nose, sinuses and lungs, has a great impact on their sleep quality and daytime functioning. This further complicates the treatment of obstructive sleep apnea (OSA). Avoidance of irritants, oral and nasal antihistamines as well as steroids are the mainstay of therapy. Bronchodilators are coupled with the steroids in the patient with asthma. These techniques may work well until the patient is found to have significant OSA and must begin therapy with a nasal interface for continuous positive airway pressure (CPAP). We find that these patients are often lifelong mouth breathers and often present with no prior evaluation or treatment for nose or sinus disease. Careful attention to the various mask interfaces for CPAP may improve their adherence to CPAP therapy. Furthermore, studies have shown that maximizing heat and humidity to the nose and pharynx may enhance therapy for allergic disorders as well as prove imperative to successful CPAP therapy of even the most severe cases of OSA. In children, we find that
these same interventions are also necessary, however, obstruction by enlarged tonsils and adenoids may be the predominate cause of airway obstruction.
This may require surgical resection in addition to the drug therapy described above. Careful follow-up of the child with OSA is needed however, as surgery may not be curative.