Snoring & Obstructive Sleep Apnoea ( OSA )

Obstructive sleep apnoea

 

Obstructive sleep apnoea (OSA) is a potentially serious sleep disorder. Under normal circumstances, the air flows smoothly from the mouth and nose into the lungs at all times throughout sleep. However, people with OSA often stop breathing involuntarily for brief periods of time during sleep. The flow of air stops because the space in the throat is too narrow. Snoring ends up as a characteristic of sleep apnoea and is often caused by airflow squeezing through the narrowed space.

 

If left untreated, sleep apnoea can cause serious health problems such as:

 

• hypertension
• heart disease
• stroke
• diabetes

Thus, proper diagnosis and treatment at a sleep clinic are essential in preventing complications.

Sleep apnoea can be categorised into three types:

 

 

Causes

 

OSA is the most common type of sleep apnoea, and it tends to occur in older people as well as those who are overweight. Some lifestyle changes such as weight loss can significantly improve OSA symptoms. Besides weight management, patients suffering from sleep apnoea should try to not sleep on their back to prevent further aggravation.

 

Risk factors

 

Anyone can be at risk of developing OSA, however certain factors can increase your susceptibility to it: 

• Overweight: Fat deposits around the upper airway may play a role in obstructing breathing. Medical conditions associated with obesity such as hypothyroidism can also increase your risk for OSA
• Narrowed airway: Some people are born with narrow airways, or have enlarged tonsils and adenoids blocking the airway
• Chronic nasal congestion: OSA tends to occur more frequently in patients who have persistent nasal congestion at night

 

Symptoms

 

Since airflow is obstructed, OSA causes episodes of decreased oxygen supply to the brain and other parts of the body. As a result, OSA patients have poor sleep quality, leading to daytime drowsiness. Furthermore, patients with OSA may also experience the following:

 

• Headaches
• Temperamental 
• Poor memory
• Drowsiness

 

Daytime drowsiness puts people at risk for motor vehicle crashes as well as industrial accidents. Thus snoring and sleep apnoea treatments are good for helping them relieve OSA symptoms.

 

Complications

 

Patients who experience chronic or recurrent tonsillitis may also experience obstructive sleep apnoea (OSA). This is a result of swollen airways, preventing the patient from sleeping well and leading to other serious medical issues.

 

Diagnosis

 

It is best to consult your doctor on how you can be evaluated for the presence of OSA. Usually, it involves a consultation with your ENT specialist who will make a thorough check of your clinical history and conduct a physical examination. It is likely that a flexible nasoendoscopy (the passage of a small lighted tube with a camera into the nose and throat – Figure 1) will be performed in the clinic to evaluate the possible sites of narrowing in the upper airway.

 

An overnight sleep study (Figure 2), also known as polysomnography (PSG), is required to diagnose OSA. A sleep study is conducted in a sleep laboratory or at home. It records the body’s activity during sleep which may include brain waves, the oxygen level in the blood, heart rate and breathing as well as eyes and leg movements. A reliable and less complicated alternative to a full sleep study would be the use of a WatchPAT sleep study. It does not monitor as much information as a full sleep study but has been shown to be a reliable alternative for patients with symptoms suggestive of OSA and for patients who are not be able to sleep well with many wires and sensors attached to them. The advantage of a WatchPAT sleep study is its simplicity and patients can often sleep better with it (Figure 3).

 

The sleep study records the number of events known as apnoeas (when there is > 90% decrease in airflow to the lungs for >10 seconds) or hypopnoeas (when one has >30% decrease in airflow to the lungs for > 10 seconds and >3% drop in oxygen saturation or arousal) during sleep.

 

Treatment

 

The goal for sleep apnoea treatment is to ensure airflow is not obstructed during sleep. Some treatment methods include:

• Nasal decongestants: Nasal decongestants tend to be more effective in patients 
• Continuous Positive Airway Pressure: Often the first-line treatment option for OSA, CPAP is a facemask worn by patients at night. It delivers positive airflow to keep the airways open throughout the night. 
• Dental devices: Customised oral appliances can be used to reposition the lower jaw and tongue forward during sleep
• Surgical treatments

 

The type of surgery performed to treat OSA depends on the level of blockage or narrowing in the upper airway. These may include:

 

 In the nose: 

• Inferior turbinate reduction surgery (refer to section on “Inferior turbinate reduction hypertrophy”)
• Adenoidectomy (removal of adenoid)
• Sinus surgery

 In the mouth and throat:

• Uvulopalatalpharyngoplasty (UPPP) and tonsillectomy*: A surgical procedure to remove excessive or lax soft palate and tonsils to open the airway
• Stiffening procedures: Coblation or radiofrequency ablation to the soft palate and tongue can be used to induce scarring and stiffen the tissues in these regions to reduce snoring
• Tongue base reduction surgery: Tissue at the back of the tongue can be removed with a coblator or diathermy to reduce tongue bulkiness and open the airway
• Genioglossus advancement and hyoid suspension: A surgical procedure to pull the muscles of the neck and tongue (forward) to open the airway.

 

Know of anyone who snores and is looking to seek treatment for their sleep apnoea? Let us help you improve your health and quality of life, make an appointment at our specialist ENT and sleep clinic today.