Surgical remedies for snoring and sleep disorders

Like thousands of Americans, snoring keeps Dr. Kenny Pang awake at night.

It’s not his own nocturnal nasal sounds, or those of his wife, that trouble Dr. Pang -- it’s the why behind the sounds.

As the first Sleep Surgery Fellow at the Medical College of Georgia, Dr. Pang is spending the next year studying surgical remedies for snoring and sleep disorders. He’s receiving hands-on experience and mentoring in a unique program that combines knowledge from oral and maxillofacial surgeons, otolaryngologists and pulmonary specialists. The fellowship is one of two sleep surgery fellowships in the nation, said Dr. David Terris, the program’s director and chair of the MCG Department of Otolaryngology-Head and Neck Surgery. Dr. Terris developed the nation’s first program at Stanford University and began a similar fellowship when he joined the MCG faculty in 2002.

“Sleep medicine is a relatively young field and we continue to expand our ability to recognize and treat very serious sleep disorders,” said Dr. Terris. “Sleep-disordered breathing and sleep apnea are similar to hypertension and diabetes in that they are chronic diseases that exact their toll over many years. At MCG, we not only provide the very latest cutting-edge surgical treatments of these diseases, but we are training the next generation of clinician-scientists who will continue to advance our understanding of the disorders.”

As many as 30 percent of adults -- or 60 percent of men over age 40 -- disturb another person’s sleep with snoring.

“Snoring is produced by a vibration of the soft palate, uvula, base of the tongue and other soft tissues in the throat when one inhales,” said Dr. Pang, who has 7 years of experience in the field otolaryngology. “Sleep apnea is when the person stops breathing due to an obstruction from this vibration. Because oxygen levels drop with the obstruction, this can be a dangerous condition.”

Through the Sleep Disorders Center at MCG, Dr. Pang is studying the sleep patterns of people with snoring and obstructive sleep apnea to determine if surgery is the best method of treatment.

“Not all snorers obstruct at night,” he said. “During an overnight stay in our sleep lab, the patient is connected to a machine to monitor brain waves, respiratory airflow, the level of breathing effort, oxygenation and snoring volume level. A polysomnogram determines the number of times they obstruct, or stop breathing, per night. We can also measure the sleep quality by monitoring brain waves.”

Surgical techniques, such as jaw advancement, tongue reduction or other soft-tissue removal, can reduce or eliminate the nocturnal problems by enlarging space in mouth, said Dr. Pang. More space means better airflow and fewer vibrations, and thus, a more peaceful night for bunkmates.

Due to the confined anatomy of the upper airway, extremely obese patients don’t respond well to surgery, he said. “With obese patients, surgery is very difficult because too much fatty tissue is involved.”

A consultant otolaryngologist, Dr. Pang plans to return to his home country of Singapore after completing his fellowship next June. Recruiting is underway for the 2005 sleep surgery fellow, who will begin July 1, said Dr. Terris.

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