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