Snoring & Obstructive Sleep Apnea

What Is Snoring & Obstructive Sleep Apnea?

Obstructive sleep apnea (OSA) is a sleep disorder characterised by repeated episodes of partial or complete obstruction of the upper airway during sleep. These interruptions in breathing typically last for 10 seconds or longer and can occur multiple times per hour. OSA often leads to reduced oxygen levels in the blood and frequent awakenings throughout the night.

On the other hand, snoring is a common condition caused by partially obstructed airflow through the mouth and nose during sleep. This results in the tissues at the back of the throat vibrating, producing a sound ranging from a soft hum to a loud, disruptive noise. Age, weight, nasal congestion, and sleeping position can influence snoring.

While snoring may be a relatively common night-time nuisance, it can sometimes be a sign of obstructive sleep apnoea (OSA), which can significantly affect one’s health and quality of life if left untreated.

Different Types of Sleep Apnea

Sleep apnea is a sleep disorder characterised by repeated breathing interruptions during sleep. There are three main types of sleep apnea:

Obstructive Sleep Apnea (OSA)

This is the most common form of sleep apnea and occurs when the muscles in the back of the throat relax excessively, causing airway obstruction. Symptoms include loud snoring, gasping for air during sleep, and daytime fatigue.

Central Sleep Apnea

Unlike OSA, this type involves the brain failing to send proper signals to the muscles that control breathing. This is more common in individuals with certain medical conditions such as heart failure or stroke, and results in periodic lapses in breathing effort.

Complex Sleep Apnea

Also known as treatment-emergent central sleep apnea, this type of sleep apnea manifests when someone being treated for OSA starts to develop symptoms of central sleep apnea. It typically requires adjustments in treatment to address both obstructive and central components of the disease.

Barrie Tan ENT Head & Neck Surgery is able to provide comprehensive and effective care for snoring and all types of sleep apneas.

For a detailed evaluation of your symptoms, please reach out to us today.

What Are Common Symptoms of OSA?

Here are some of the most common symptoms associated with OSA:

Gasping or Choking During Sleep

Instances where one suddenly wakes up gasping for air due to blocked airflow.

Restless Sleep

Frequent tossing and turning, leading to a perception of non-restorative sleep

Sudden Awakenings

Frequent interruptions in sleep caused by breathing difficulties

Morning Headaches

Experiencing headaches upon waking due to low oxygen levels during sleep

Excessive Daytime Sleepiness

Persistent fatigue and drowsiness throughout the day

Difficulty Concentrating

Problems with focus, memory, and cognitive function due to poor sleep quality

Irritability and Mood Changes

Increased irritability, mood swings, and even symptoms of depression or anxiety

Loud Snoring

One of the most classic and noticeable symptoms

Decreased Libido

Reduced interest in sexual activities due to fatigue and hormonal imbalances

Dry Mouth or Sore Throat Upon Waking

Resulting from mouth-breathing during sleep

Potential Risks & Complications of OSA

Obstructive sleep apnea (OSA) is more than just disrupted sleep and loud snoring. If left untreated, it can lead to serious health complications, including:

Coronary Artery Disease

Increased risk of developing heart disease due to prolonged periods of low oxygen levels during sleep

Complications with Surgery

Increased risk of complications during and after surgery due to anaesthesia-related breathing issues

Type 2 Diabetes

Higher likelihood of developing insulin resistance and type 2 diabetes

High Blood Pressure

Frequent episodes of reduced blood oxygen can lead to hypertension

Heart Attacks

Increased risk of myocardial infarction as a result of chronic stress on the cardiovascular system

Depression

Mood disturbances and depressive symptoms arising from poor sleep quality and chronic fatigue

Daytime Fatigue

Persistent tiredness and lack of energy due to disrupted sleep, impacting one’s health, daily functioning, and quality of life

Stroke

Increased risk of stroke due to fluctuations in blood pressure and oxygen levels

Heart Failure

OSA can exacerbate existing heart conditions and contribute to heart failure

Liver Problems

Potential for liver dysfunction and fatty liver disease

What Are the Possible Causes of OSA?

Understanding the possible causes of OSA can help one identify risk factors and implement preventive measures where possible. Common causes include:

Weight and
Obesity

Excess weight, especially around the neck, can add pressure on the airway, making it more likely to collapse during sleep.

Obstructed
Airway Passages

Structural abnormalities or blockages in the nasal passages or throat can impede airflow.

Swollen
Tonsils

Enlarged tonsils can obstruct the airway, particularly in children.

Swollen
Adenoids

Similar to swollen tonsils, enlarged adenoids can also block airflow and contribute to OSA.

Nasal
Obstruction

Chronic congestion or a deviated septum can restrict nasal airflow.

Weak Airway
Muscle Tone

Reduced muscle tone in the airway muscles can lead to collapses during sleep.

Receding
Jaw

A smaller or receding jaw can narrow the airway, increasing the risk of obstruction.

Alcohol Use
& Smoking

Alcohol relaxes the muscles in the throat, while smoking can cause inflammation and fluid retention in the upper airway.

Sedatives
Use

Medications that relax muscles, such as sedatives or tranquillisers, can exacerbate airway collapse.

Genetics

A family history of OSA can increase the likelihood of developing the condition.

Dr Barrie Tan was formerly the Head of the Department of Otolaryngology (ENT) at Singapore General Hospital; and has devoted his career to the improvement of his patients’ ENT health and quality of life.

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How Is OSA Diagnosed?

Diagnosing OSA accurately relies on a comprehensive assessment of symptoms, medical history, and physical findings. These may include:

Medical History Review

A detailed review of the patient’s medical history, including sleep habits, daytime symptoms, and lifestyle factors, can provide essential context for diagnosis.

Physical Examination

The doctor may perform a physical examination on the throat, neck, and mouth, to identify any anatomical abnormalities or enlarged tissues that might contribute to airway obstruction.

Home Sleep Study (HST)

This involves using portable monitoring devices at home to track breathing patterns, oxygen levels, and heart rate during sleep. HST is convenient and can provide initial data for diagnosing OSA.

Polysomnography (PSG)

Considered the gold standard for diagnosing sleep apnea, this comprehensive overnight sleep study is conducted in a sleep lab. It monitors physiological parameters, including brain activity, eye movements, heart rate, blood pressure, and respiratory effort.

Oximetry

Overnight oximetry measures blood oxygen levels continuously during sleep to detect drops that suggest apnea episodes.

Treatment Options for OSA

There are various treatment options available to manage and alleviate the symptoms of OSA. These range from lifestyle changes and medical devices to surgical interventions, such as:

Weight Management

Losing weight among obese or overweight individuals can help decrease pressure on the airway.

Addressing Sleeping Positions

Sleeping on the back can worsen OSA symptoms. Training to sleep on the side may help keep the airway open.

Customised Oral Devices and Appliances

These devices reposition the lower jaw and tongue to keep the airway open during sleep, which is beneficial for mild to moderate OSA.

Nasal Decongestants

Medications or nasal sprays can help alleviate nasal congestion, improving airflow through the nasal passages.

Continuous Positive Airway Pressure (CPAP) Therapy

A machine pumps air through a mask worn during sleep to maintain open airways. This is often considered the most effective treatment for moderate to severe OSA.

Surgery

If non-surgical treatment options prove insufficient in alleviating symptoms, doctors may then recommend surgery. There are various surgical options available to remove or reduce tissues blocking the airway, such as uvulopalatopharyngoplasty (UPPP), removal of tonsils or adenoids, or more complex procedures like maxillomandibular advancement (MMA).