Sleep Endoscopy

by Dr. Christopher Chang, last modified on 4/14/21.

If you have obstructive sleep apnea (OSA) and surgical options are being considered, the key to having the best possible outcome from surgery is to address all levels of obstruction whether at the nose, mouth, and tongue levels. The same is true for patients with severe snoring desiring surgical options. The proper surgery required depends on where the snoring is coming from... The nose? Uvula? Tongue???

Unfortunately, in some patients, it is hard to determine the anatomic area responsible for obstruction (or snoring) while awake. Clearly while awake, there are no symptoms and an examination in this awake state will often be unrevealing.

This is where a procedure called sedated (or sleep) endoscopy can be quite helpful.

Airway Level	Surgery to Correct
Nasal Level	Adenoidectomy for adenoid hypertrophy Septoplasty for deviated septum Turbinate Reduction for turbinate hypertrophy
Oral Cavity Level	Tonsillectomy for tonsillar hypertrophy Uvulopalatopharygnoplasty (UPPP) for uvulo-palatal hypertrophy and retro-lingual collapse Mandibular-maxillary advancement
Tongue Level	Base of tongue reduction Lingual Tonsillectomy Thyro-Hyoid Advancement (THA) Repose Procedure (Genio-glossal advancement) (GA) Genio-hyoid advancement (GHA) Mandibular-maxillary advancement (MMA)

There are non-surgical methods to treat each of these levels as well which can be reviewed here.

Watch Video on Sleep Endoscopy

Sleep endoscopy is a special procedure to determine exactly where an upper airway obstruction is localized causing obstructive sleep apnea or snoring WHILE A PERSON IS SLEEPING.

There are two distinct components to this procedure.

1) Endoscopy is when a thin flexible camera is inserted through the nose in order to examine the entire upper airway from the tip of the nose to the voicebox.

2) Sleep (or sedated) endoscopy is when the endoscopy is performed while a patient is sleeping instead of wide awake as traditionally performed.

Given most patients will immediately wake up if a doctor is inserting something into the nose (as well as most doctors will not wait for a patient to fall asleep at night in order to perform this procedure), the patient is sedated by an anesthesiologist using IV medications.

What are some of these areas of obstruction?

Areas that will be specifically examined during sleep endoscopy include:

Behind the palate
Uvula
Back of Tongue
Walls of the Throat
Epiglottis
Voicebox

Each of these areas may experience collapse causing obstructive or snoring symptoms.

Why is this information helpful? Well... once it is apparent where and what is the culprit causing a given patient's problems, surgical treatment can be geared more specifically and directly to the area of concern seen during sedated endoscopy.

Great! I want it... So what next?

You first need to be evaluated in our office for a basic evaluation as well as a baseline awake endoscopic evaluation of the airway. Not all patients require sedated endoscopy. Furthermore, depending on how obese you are, the procedure may need to occur in the operating room. Otherwise it is performed in an endoscopy suite. Once it is determined sedated endsoscopy is necessary and what hospital room it is best to be performed, the procedure will be scheduled on a different day and time. You will be instructed to eat nothing and drink nothing after midnight the day of the procedure. This restriction is to minimize the risk of vomiting during the procedure.

At the time of the procedure, an IV will be placed and you will drift off to sleep as an anesthesiologist injects medication that induces general anesthesia.

Once you fall asleep, endoscopy will be performed. Watch a video of this procedure.

The procedure itself lasts about 15 minutes long after which you will be woken up and observed for 30 minutes before being discharged home. Results will be discussed with you immediately after the procedure.

If snoring or sleep apnea is affecting your life, please call our office for an appointment.

Costs

This procedure is covered by insurance. It is performed at Fauquier Hospital as an outpatient procedure. As such, a patient who undergoes this procedure will receive THREE billing statements... one from our office for the surgeon's fee, another from Fauquier Hospital for hospital charges, and a third from anesthesiology for providing sedation.

Please note that our office has NO control over what charges the hospital and anesthesia bills for as well as how much they charge. Any complaints with hospital charges should be directed to their billing department. Again, we have no say, influence, or authority over charges beyond our own. You can reach Fauquier Hospital's finance department at 540-316-2970.

Only for those patients who do NOT have insurance, a discounted price from ONLY our office will be provided.

We should also add that our office receives absolutely NO payments, fees, or kickbacks whether financial or not from the hospital. It would be considered illegal as well (Stark Laws).

On a related note, media has written stories about this situation, especially given how surprisingly high hospital charges can be. Read a story about this issue here as well as here. Read blog article.

Links

Sleep Endoscopy

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