The most common sign of obstructive sleep apnea is snoring. But not everyone who snores has obstructive sleep apnea. So, how can you tell the difference? The Central Surgery gives us an insight into this common and serious sleep disorder.
Many snorers come to our specialists in Otorhinolaryngology mainly due to annoying their other halves in the night. Most of these patients explained that they typically enjoyed a good nights’ sleep without daytime sleepiness, and therefore, strongly believed that they had no sleep apnea issue. Because of this, there often seemed to be no need to investigate further. While snoring does not always indicate obstructive sleep apnea (OSA), it may be the only symptom of OSA in the first few years. Interrupted sleep together with daytime tiredness may occur much later when the disease is more severe.
What is Obstructive Sleep Apnea?
According to Mayo Clinic, “obstructive sleep apnea (OSA) is a potentially serious sleep disorder which causes breathing to repeatedly stop and start during sleep. There are several types of sleep apnea, but the most common is obstructive sleep apnea. This occurs when your throat muscles intermittently relax and block your airway during sleep. A noticeable sign of obstructive sleep apnea is snoring.”
What is the concern of having OSA?
OSA is a disease of concern due to its serious medical complications including:
- Fatigue
- Daytime sleepiness
- Eye complications
- Hypertension
- Acute heart attack
- Heart failure
- Stroke
It is characterised by complete cessation or occurrence of shallow breathing during sleep for seconds to minutes.
People with OSA may also have memory problems, headaches, mood swings or feelings of depression.
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What is the prevalence of OSA?
According to The Lancet study to estimate and report the global prevalence of OSA, with almost 1 billion people affected, the prevalence exceeds 50% in some countries. The number of affected individuals was highest in China, followed by the USA, Brazil, and India.
In terms of risk factors, OSA becomes more prevalent with advancing age, being male, and having a higher body-mass index (over weight), among other reasons.
Most patients have multi-level obstructions located at:
- The nose
- The soft palate/tonsil
- The base of the tongue base
Patients tend to suffer more from these collapses when they are lying on their back, so it is true that OSA symptoms may become milder if you sleep on your side. Allergic rhinitis and sinus diseases may make OSA worse by adding nose blockage.
How is OSA diagnosed?
It is always important to assess each patient by endoscopy to determine the level(s) of obstruction. A proper ENT endoscopic examination can be carried out in the clinic and usually takes less than a minute. The results help determine the options of treatment after the diagnoses of OSA.
The gold standard diagnostic test for OSA is polysomnography (PSG) – also known as a Sleep Study. It monitors the sleeping state, respiration, electrocardiogram, movements of legs, oxygen level and snoring. It normally only requires one overnight monitoring to get an index number which indicates the severity of OSA.
People can now choose to do it at home on their own beds. Some companies can arrange agents to set up the system with you at your home. They will leave when you go to sleep and come back to pick up the equipment the next day.
A sleep watch is also available in the market for those who fear getting strangulated by all the wires of a traditional sleep study.
How is OSA treated?
Regarding the treatment of OSA, we always emphasise the importance of behavioural modifications on the part of patients, including:
- The adoption of a regular sleep schedule
- Ensuring a good sleeping environment
- The avoidance of alcohol consumption
Alcohol consumption is associated with exacerbation of the number and duration of apnea, desaturation and sleep fragmentation. Weight reduction is helpful for obese OSA patients.
We recommend the use of a continuous positive airway pressure (CPAP) machine for most OSA patients. They need to wear a mask every night and allow pressured air to lift up the soft palate and tongue. This immediately solves the snoring problem and relieves desaturation. For those who suffer from structural obstructions including turbinate hypertrophy (nose level), redundant soft palate with enlarged tonsils (soft palate level) and receding chin (tongue level), some patients may choose to have an operation. Endoscopic reduction of the turbinates, tonsillectomy +/- uvula and pharyngeal reduction, and chin advancement surgery are all available to relieve obstruction at different levels.
OSA can be successfully treated in most cases. If you snore most nights for more than a year, we suggest you to seek medical advice as you may have obstructive sleep apnea.
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