Obesity It is well known that children, adolescents or adults with<unk>  are often obese. Obese people show an increase in neck fat tissue which potentiate respiratory obstruction during<unk> . However, people of all ages and sex with normal body mass indices (BMIs) can also demonstrate<unk>  – and these people do not have significant measures of subdermal or intra neck fat as shown on DEXA scans. It is speculated that they may have increased muscle mass, or alternatively have a tendency to decreased muscle tone potentiating airway collapse during<unk> . However loss of muscle tone is a key feature of deep<unk>  anyway, and whilst obesity seems a common association, it is not an invariable state of<unk> .<unk> ing supine (on one's back) is also represented as a risk factor for<unk> . Clearly, gravity and loss of tongue and throat tone as a person enters deep<unk>  are clear and obvious factors contributing to<unk>  developing. But this explanation is also confounded by the presence of neck obesity. Use of CPAP definitively primarily expands a collapsed upper airway, allowing for nasal breathing – and positive use of CPAP would prove that airway collapse is the cause of<unk> . Throat lesions, particularly enlarged tonsils, are well recognised as aggravators of<unk> , and removal may provide full or partial or semi-permanent relief from<unk> , which also indicates that enlarged tonsils may play a role in the pathogenesis of<unk> . Age Old age is often accompanied by muscular and neurological loss of muscle tone of the upper airway. Decreased muscle tone is also temporarily caused by chemical depressants; alcoholic drinks and sedative medications being the most common. Permanent premature muscular tonal loss in the upper airway may be precipitated by traumatic brain injury, neuromuscular disorders, or poor adherence to chemical and or speech therapy treatments. Muscle tone Individuals with decreased muscle tone and increased soft tissue around the airway, and structural features that give rise to a narrowed airway are at high risk for<unk> . Men, in which the anatomy is typified by increased mass in the torso and neck, are at increased risk of developing<unk><unk> , especially through middle age and later. Women suffer typically less frequently and to a lesser degree than do men, owing partially to physiology, but possibly also to differential levels of progesterone. Prevalence in post-menopausal women approaches that of men in the same age range. Women are at greater risk for developing<unk>  during pregnancy. Medication and lifestyle Lifestyle factors such as smoking may also increase the chances of developing<unk>  as the chemical irritants in smoke tend to inflame the soft tissue of the upper airway and promote fluid retention, both of which can result in narrowing of the upper airway. Cigarettes may also have an impact due to a decline of blood nicotine levels, which alters<unk>  stability. Smokers thus show a higher risk to develop<unk> , but the effect of cigarettes on increased<unk>  is reversible with the cessation of smoking. Children exposed to cigarette smoke may also develop<unk>  as the lymphadenoid tissue will proliferate excessively in contact with the irritants. An individual may also experience or exacerbate<unk>  with the consumption of alcohol, sedatives, or any other medication that increases<unk> iness as most of these drugs are also muscle relaxants. Allergic rhinitis and asthma have also been shown to be implicated in the increased prevalence of adenotonsillar hypertrophy and<unk> . Genetic<unk>  also<unk> rs to have a genetic component; those with a family history of it are more likely to develop it themselves. Craniofacial syndromes Of substantial recent interest is the idea that there is a general human tendency towards developing short lower jaws (neoteny) is a major cause of<unk>  through a combined condition called glossoptosis. The posterior “normal” tongue is displaced backwards by a smaller “abnormal” anterior tongue and lower jaw. In much the same way, a narrow upper jaw will also contribute to<unk>  due to its relation to airway volume. A more narrow upper jaw results in more narrow nasal passages and a more narrow throat, this also<unk> rs to be why so many<unk>  patients experience nasal congestion especially while lying down. Maxillofacial surgeons see many effects of small lower jaws, including crowded teeth, malocclusions, as well as<unk>  – all of which are treatable by surgical operations that increase and normalise jaw size. Operations such as custom BIMAX, GenioPaully, and IMDO (in adolescence) offer a valid medical option that replaces all traditional forms of<unk>  treatment – including CPAP, Mandibular Advancement Splints, tonsillectomy and UPPP. There are patterns of unusual facial features that occur in recognizable syndromes. Some of these craniofacial syndromes are genetic, others are from unknown causes. In many craniofacial syndromes, the features that are unusual involve the nose, mouth, and jaw, or resting muscle tone, and put the individual at risk for<unk>  syndrome. Down syndrome is one such syndrome. In this chromosomal abnormality, several features combine to make the presence of<unk>  more likely. The specific features of Down syndrome that predispose to<unk>  include relatively low muscle tone, narrow nasopharynx, and large tongue. Obesity and enlarged tonsils and adenoids, conditions that occur commonly in the western population, are much more likely to be<unk>  in a person with these features than without them.<unk>  does occur even more frequently in people with Down syndrome than in the general population. A little over 50% of all people with Down syndrome suffer from<unk> , and some physicians advocate routine testing of this group. In other craniofacial syndromes, the abnormal feature may actually improve the airway, but its correction may put the person at risk for<unk>  after surgery when it is modified. Cleft palate syndromes are such an example. During the newborn period, all humans are obligate nasal breathers. The palate is both the roof of the mouth and the floor of the nose. Having an open palate may make feeding difficult, but generally, does not interfere with breathing, in fact, if the nose is very obstructed, then an open palate may relieve breathing. There are a number of clefting syndromes in which the open palate is not the only abnormal feature; additionally, there is a narrow nasal passage – which may not be obvious. In such individuals, closure of the cleft palate – whether by surgery or by a temporary oral appliance – can cause the onset of obstruction. Skeletal advancement in an effort to physically increase the pharyngeal airspace is often an option for craniofacial patients with upper airway obstruction and small lower jaws (mandibles). These syndromes include Treacher Collins syndrome and Pierre Robin sequence. Mandibular advancement surgery is one of the modifications needed to improve the airway, others may include reduction of the tongue, tonsillectomy or modified uvulopalatoplasty. Post-operative complication<unk>  can also occur as a serious post-operative complication that seems to be most frequently associated with pharyngeal flap surgery as compared to other procedures for the treatment of velopharyngeal inadequacy (VPI). In<unk> , recurrent interruptions of respiration during<unk>  are associated with temporary airway obstruction. Following pharyngeal flap surgery, depending on size and position, the flap itself may have an "obturator" or<unk>  effect within the pharynx during<unk> , blocking ports of airflow and hindering effective respiration. There have been documented instances of severe airway obstruction, and reports of post-operative<unk>  continues to increase as healthcare professionals (i.e. physicians, speech language pathologists) become more educated about this possible dangerous condition. Subsequently, in clinical practice, concerns of<unk>  have matched or exceeded interest in speech outcomes following pharyngeal flap surgery. The surgical treatment for velopalatal insufficiency may cause<unk>  syndrome. When velopalatal insufficiency is present, air leaks into the nasopharynx even when the soft palate should close off the nose. A simple test for this condition can be made by placing a tiny mirror on the nose, and asking the subject to say "P". This p sound, a plosive, is normally produced with the nasal airway closes off – all air comes out of the pursed lips, none from the nose. If it is impossible to say the sound without fogging a nasal mirror, there is an air leak – reasonable evidence of poor palatal closure. Speech is often unclear due to inability to pronounce certain sounds. One of the surgical treatments for velopalatal insufficiency involves tailoring the tissue from the back of the throat and using it to purposefully cause partial obstruction of the opening of the nasopharynx. This may actually cause<unk>  syndrome in susceptible individuals, particularly in the days following surgery, when swelling occurs (see below: Special Situation: Anesthesia and Surgery). Finally, patients with<unk>  are at an increased risk of many perioperative complications when they are present for surgery, even if the planned procedure is not on the head and neck. Guidelines intended to reduce the risk of perioperative complications have been published.
Obstructive sleep apnea
Sleep apnea
Central sleep apnea
Obesity hypoventilation syndrome
Hyperventilation syndrome
Sleep-related breathing disorder
Central hypoventilation syndrome
Reactive airway disease