الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Obstructive sleep apnea (OSA) is a disease of uppe aIrway, therefore its diagnosis and treatmeant has been trust into the legitimate province of the otorhinolaryngologist.
Obstructive sleep-disordered breathing IS common In children.
from 3 percent to 12 percent of children snore, while obstructive sleep apnea syndrome affects 1 percent to 10 percent of children. The majority of these children have mild symptoms such as failure to thrive, enuresis, attention-deficit disorder, behavior problems, poor academic performance, and cardiopulmonary disease. The most common etiology of obstructive sleep apnea is adenotonsillar hypertrophy.
The diagnosis of OSA may arise because of patient daytime dysfunction, partner prompting, and other complications. The history focuses on the frequency and intensity of breathing disturbances during sleep, unsatisfact0IJ: sleep quality, daytime dysfunction, and OSA risk factors, including obesity, male gender, age, race, family history, craniofacial abnormalities, and the use of alcohol or other pharmacologic agents.
The physical examination concentrates on head and neck conditions that compromise upper airway patency. Typical but nonspecific findings are a low-draping soft palate, elongated uvula, prominent tongue base, redundant neck tissue, and excess body weight.
Methods have been used to identify sites of obstruction in OSA patients (eg, endoscopy , catheters ,fluoroscopy and CT scanning). The precise localization of the sites of obstruction in patients with OSA may not be possible using current techniques. The majority of studies,
irrespective of technique, indicate that the primary site of obstruction is at the level of the oropharynx, although extensions to the laryngopharynx are frequently observed.
The initial step in the management of sleep apnea is deciding which patients need treatment. The severity of the condition is measured by the number of apneas that cause sleep arousal.
Conservative treatment may involve weight loss, exerCIse, and behavioral therapy. CP AP is the most widely used in primary treatment for sleep apnea. Oral devices that facilitate mandibular and tongue advancement can b~ considered for patients with mild sleep apnea for whom CP AP treatment is not effective.
Untreated obstructive sleep apnea (OSA) introduces risks to anesthesia and surgery. For patients who prefer to avoid using a device each night or for those who are unable to tolerate it, there are many surgical options. Modem surgical management of OSA is designed to create site-specific alterations of the upper airway to eliminate airway obstruction.
The first operation performed was tracheotomy to bypass upper airway obstruction in 1969. Because of its high associated morbidity, this procedure is now seldom used.
Uvulopalatopharyngoplasty (UPPP) involves the removal of part of the soft palate, uvula and redundant peripharyngeal tissues, sometimes including the tonsils. This procedure is often effective in eliminating snoring; however, it is not necessarily curative for obstructive sleep apnea, because areas of the airway other than the soft palate also collapse in most patients with this sleep disorder.