Sleep disordered breathing: Our roles and responsibilities.

Sleep disordered breathing (SDB) is a significant medical problem. By some estimates, it affects upwards of 20 to 30% of adult Americans. Otolaryngologists have a special interest and expertise in selected conditions associated with this condition, particularly snoring and obstructive sleep apnea. As otolaryngologists increasingly serve as the entry point for patients with SDB, we need to be aware of this condition when taking a history and conducting a physical examination. We need to study and be informed about the full spectrum of SDB. We should be prepared to recommend and dispense medical and surgical treatments for this large group of patients.

Consider obstructive sleep apnea (OSA). This is a common, morbid condition that can be mild, moderate, or severe. Its manifestations include snoring, daytime somnolence, poor health, poor performance, and an increased risk of accident and injury. The otolaryngologist is increasingly called on to participate in the evaluation and management of these conditions. The otolaryngologist is king of the upper respiratory tract. This is the home of otolaryngology and the site of obstructive SDB. No one knows and examines this anatomy as well as we do, and no one else can operate there as well as we can.

There is an important group of individuals who have extensive training in sleep medicine. Many of them are pulmonologists. Others are psychiatrists or neurologists. Their time and training in sleep medicine is extensive. They have an interest and expertise in all forms of SDB. This area of interest includes OSA, for which their primary treatment modality is nasal continuous positive airway pressure. Their strongest interests are in patients who have moderate to severe OSA. This leaves a huge cohort of patients who have snoring and mild OSA. These patients are frequently young. They work and they have families. But their work is hampered by their daytime sleepiness. And their family lives are impaired by the resultant personality changes. Their snoring disturbs their households, traveling companions, and fellow campers.

The otolaryngologist has a great deal to offer patients with snoring and mild OSA. We can evaluate them and treat them both medically and surgically. We also have a responsibility to conduct clinical investigation sand demonstrate that proper treatment of these patients can prevent them from progressing to moderate or severe OSA. Not only will successful treatment alleviate their immediate symptoms, it will also minimize or prevent the long-term consequences of OSA, primarily hypertensive, cardiac, and neurologic diseases. We also have a responsibility to help educate the general public about SDB. And we have a responsibility to evaluate and dispense SDB treatments in a fiscally and medically sound fashion.

This and the next two issues of EAR, NOSE & THROAT JOURNAL will focus on SDB. The reviews and scientific studies we are publishing span the sleep field, from curriculum development to evaluation to treatment. You will find these articles to be comprehensive and instructive.

Dr. Davidson is a professor of surgery in the Division of Otolaryngology-Head and Neck Surgery and associate dean for continuing medical education at the University of California, San Diego, School of Medicine, and section chief at the VA San Diego Healthcare System.