Sleep Apnea and Other Sleep Disorders

Obstructive sleep apnea (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 low oxygen levels and micro-arousals from sleep.This means the patient can be oxygen deprived during sleep and this has significant impact on the body’s various organs including the heart and the brain. There are several micro-arousals (micro-awakenings) where patient are woken up from deeper sleep to lighter stages of sleep without being aware. The lack of “deep sleep” or REM (Dream phase of sleep) sleep can have serious consequences on the body.

Epidemiology

1 in 3 Singaporeans are estimated to have moderate to severe OSA based on a local study. This condition tends to affect male patients though females can suffer from the same condition OSA is 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
• Mood changes
• Memory impairment or decreased concentration

In Singapore where many patients suffer from allergic rhinitis or chronic sinus disease, they can have concomitant obstructive sleep apnoea.

Sleep Apnea in Children

Dr Dennis Chua is a knowledgeable ENT doctor who also manages paediatric ENT conditions like Obstructive Sleep Apnoea. 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.

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. Sleep apnoea in children if left untreated can result in significant learning impairment and poorer academic performance. Many children with sleep apnoea may be “mouth-breathers” where they have to use their mouth to breathe at night. This is unnatural and over a long period of time can result in changes to facial skeleton, bite (occlusion) deformities.

Sleep Apnea in Women

Women may have atypical signs and symptoms of sleep apnoea. Snoring or noisy breathing may not be a prominent feature of sleep apnoea in women. They could have non-specific symptoms such as:

• Fatigue
• Insomnia
• Morning headache
• Lack of energy
• Depression
• Incidence increases during menopause

What you can do

• Evaluation via a nasoendoscope to assess the narrowest point in the nasal or oral passages.If there is significant obstruction, then a sleep study may be needed to confirm the diagnosis. A nasoendoscopy is a quick and relatively painless procedure that takes a few minutes to perform in the clinic. Dr Dennis Chua is a skilful ENT specialist who uses a paediatric sized nasoendoscope to assess the air passages in a relatively painless manner.
• Sleep study to diagnose and assess severity of condition. With advancing technology, a sleep study can now be performed in the comfort of your own home. Parameters such as number of episodes of obstruction per hour, oxygen level, stages of sleep and number of awakenings per night are monitored. This helps overcomes “first-night-effect” that can occur when a sleep study is performed in the hospital whereby a patient is unable to fall asleep in a foreign environment (hospital setting). Obstructive sleep apnoea only occurs during sleep and if you are unable to sleep well during the sleep study test, the accuracy is lower and you may need to repeat the test.

Treatment

Sleep apnea treatment options are recommended based on each patient’s unique condition. To receive the most suitable treatment plan, it is highly advisable to consult your ENT specialist.

• 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