Sleep Disorders

Obstructive Sleep Apnoea


Article published in Business Times October 1st – “Tackling Sleep Apnoea”

OSA is a sleep disorder that involves cessation or significant decrease in airflow in the presence of breathing effort. It is the most common type of sleep-disordered breathing and is characterized by recurrent episodes of upper airway collapse during sleep. These episodes are associated with recurrent oxyhemoglobin desaturations and arousals from sleep.


1 in 3 Singaporeans are estimated to have moderate to severe OSA

Tends to affect male patients though females can suffer from the same condition

Associated with medical diseases:

  • Hypertension
  • Obesity
  • Congestive heart failure
  • Sudden Death
  • Type 2 Diabetes
  • Dementia
  • Stroke


Clinical Presentation

  • Snoring
  • Choking episodes
  • Excessive daytime somnolence
  • Mouth breathing at night 

OSA can occur in children as well. OSA in children has been recognised since the 1970s and since then the effects of paediatric OSA has been well-studied.

Consequences of untreated obstructive sleep apnoea include failure to thrive, enuresis (bed-wetting), attention-deficit disorder, behaviour problems, poor academic performance, and cardiopulmonary disease. The most common etiology of obstructive sleep apnoea in children is adenotonsillar hypertrophy.


Picture of Tonsillar hypertrophy and narrow oropharynx

Post-operative picture after tonsillectomy

Post-operative picture after tonsillectomy


Clinical diagnosis of obstructive sleep apnoea in the clinic is reliable and may not warrant a sleep study if the cause of OSA is obviously from the adenotonsillar hypertrophy. According to the American Academy of Otolaryngology 2011 Clinical Practice Guideline, a sleep study will be necessary in children who have comorbidities such as obesity, Down’s Syndrome, neuromuscular diseases, sickle cell disease or mucopolysaccharidoses. Overall, less than 10 per cent of children who suffer from OSA will need a sleep study before surgery.

Females may have atypical presentation of OSA. Snoring may not be a presenting symptom. 

  • Fatigue
  • Insomnia
  • Morning headache
  • Lack of energy
  • Depression
  • Incidence increases during menopause
  • Evaluation via a nasoendoscope to assess the narrowest point in the nasal or oral passages.
  • Sleep study to diagnose and assess severity of condition
  • Change in diet and lifestyle including exercise
  • Medications to treat conditions such as allergic rhinitis
  • Oral appliances
  • Use of Continuous Positive Airway Pressure (CPAP) machine
  • Surgery in selected cases where the nasal or oral passages are narrow


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