Snoring & Sleep Apnea Treatment 

In Singapore, the prevalence of those with moderate to severe OSA is estimated to be around 30.5%. Furthermore, this condition can affect people of all ages, especially those over the age of 50 and those who are overweight. Therefore, it is essential to understand the common signs and symptoms of OSA so that those with the condition can seek appropriate treatment.

The common signs and symptoms of Obstructive Sleep Apnea include:

• Awakening from sleep with a dry mouth
• Difficulty paying attention while awake
• Difficulty staying asleep (Insomnia)
• Excessive daytime sleepiness (Hypersomia)
• Gasping for air during sleep
• Intervals where breathing stops during sleep (usually noticed by another person)
• Irritability
• Loud snoring
• Morning headache

What Causes Obstructive Sleep Apnea

OSA can have various underlying causes. Some patients may even have more than one condition that causes OSA.

The causes of Obstructive Sleep Apnea can include, but are not limited to:

• Anatomical variation of facial bones
• Dental conditions such as large overbite
• Enlarged adenoids and tonsils
• Enlarged septal bone deviation and turbinates
• Heavy tobacco and alcohol consumption
• Nasal congestion
• Obesity

Complications Arising From Obstructive Sleep Apnea

OSA can have negative consequences on the human body. Those with the condition may experience repeated episodes of oxygen lowering, changes in carbon dioxide levels, direct effects on the heart caused by pressure changes within the chest, and high levels of inflammatory markers.

If left untreated, these changes can lead to health problems such as cardiomyopathy, diabetes, heart attacks, heart failure, high blood pressure, and stroke. Untreated OSA can also affect a patient’s day-to-day functions, such as work or school performance. Therefore, it is essential to seek appropriate sleep apnea treatment early before the condition deteriorates.

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 in Singapore 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.

Adenotonsillar Hypertrophy for Sleep Apnea

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 percent 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.

Snoring (Sleep Apnea) Treatment

Recommend diet and lifestyle modifications. Patients who are overweight or obese are recommended to undergo a weight loss programme to help relieve constriction of their airways. Losing weight can also help improve health and quality of life, thus reducing daytime sleepiness. Patients with OSA are also encouraged to sleep on their side or stomach rather than the back to prevent the tongue and soft palate from resting against the back of the throat, thus blocking the airway.

Medications may be prescribed to treat conditions such as allergic rhinitis or help manage the patient’s breathing. If the patient experiences congestion, they can consider using a saline nasal spray to help keep their nasal passages open.

Oral appliances are designed to keep the patient’s throat open by bringing the jaw forward. This can help relieve snoring and mild OSA.

A Continuous Positive Airway Pressure (CPAP) machine is more effective than oral appliances. As such, this form of sleep apnea treatment is often recommended for those with moderate to severe OSA. The device delivers air pressure through a mask while the patient sleeps, causing the upper airway passages to remain open, preventing apnea and snoring.

Surgery may be recommended for those with sleep apnea, but usually only after other treatments have failed or in select cases where the nasal or oral passages are narrow. Surgical options may include tissue removal, tissue shrinkage, jaw repositioning, implants, nerve stimulation, or tracheostomy.