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Sleep Apnoea Treatment in Singapore
Whether it is a loud rattling or mild snorting sound, snoring can be irritating for both snorers and bed partners. According to international studies, up to 40% of adults snore, and this is a common experience for many in Singapore. Many may brush it off as nothing more than just a nuisance or inconvenience. However, snoring may be the tip of the iceberg of more severe health concerns such as sleep apnoea.
If you suspect that you or your partner is suffering from sleep apnoea, it is advisable to consult a snoring specialist in Singapore. They may recommend a visit to the clinic for further examination to provide you with optimal treatment options, which may help relieve symptoms such as snoring.
What is Snoring?
Snoring is the grumbling, rattling, or snorting noise made by a person during breathing while sleeping. It occurs when the air we breathe causes the relaxed tissues in the throat to vibrate.
Although light, occasional snoring isn’t typically a concern for most, chronic or excessively loud snoring can be a critical indicator of an underlying medical issue, most notably obstructive sleep apnea (OSA). That’s when it may be necessary to consult a snoring specialist for a proper diagnosis and management plan.
Obstructive Sleep Apnoea (OSA)
Obstructive sleep apnoea (OSA) is a potentially serious condition where breathing repeatedly stops and starts during sleep due to blocked or narrow airways. Characterised by snoring, OSA occurs when the throat’s muscles relax too much, narrowing the airway and reducing oxygen flow to vital organs.
A person with OSA wakes up just enough to breathe again, but this constant disruption leads to excessive daytime fatigue and potentially dangerous or life-threatening long-term complications.
If left untreated, sleep apnoea can cause serious health problems such as:
- Hypertension
- Heart disease
- Stroke
- Diabetes
Thus, proper diagnosis and treatment at a sleep and snoring clinic are recommended to help manage complications. Sleep apnoea can be categorised into three types:
2. Central Sleep Apnoea: There is no blockage in the airway; instead, the brain does not signal the respiratory muscles to breathe.
3. Mixed Sleep Apnoea: A combination of OSA and central sleep apnoea.
Causes
OSA is the most common type of sleep apnoea, and it can stem from various factors, including:
1. Excessive throat tissues
The throat can be congested and narrow if one has:
- Enlarged tonsils (Figure 1)
- Long uvula or soft palate (Figure 2)
- Bulky tongue at the back of the throat
- Obesity (with increased soft tissues in the throat)
2. Excessive nasal tissues
A blocked nose may result in mouth breathing, leading to excessive breathing effort. This creates a vacuum that causes soft tissues in the throat to collapse, causing one to snore. The nose can be obstructed by:
- Enlarged inferior turbinates (Figure 2a & b)
- Enlarged adenoids (Figure 3)
- Deviated nasal septum (Figure 4)
- Sinusitis with or without nasal polyps (Figure 5)
3. Floppy soft tissues in the throat and poor muscle tone in the tongue
In people with these conditions, their tongue may fall backwards into the airway, and their throat tissues at the side may be drawn in during sleep. These may result in a partially obstructed airway, vibration of the tissues and snoring.
Risk factors
Anyone can be at risk of developing OSA, however certain factors can increase your susceptibility:
- Overweight: Fat deposits around the upper airway may play a role in obstructing breathing. Medical conditions associated with obesity, such as hypothyroidism, can also increase the risk of OSA.
- Narrow airways: Some people are born with narrow airways or have enlarged tonsils and adenoids blocking the airway.
- Chronic nasal congestion: OSA tends to occur more frequently in patients who have persistent nasal congestion at night.
Symptoms
When the airflow is blocked, OSA may cause episodes of decreased oxygen supply to the brain and other parts of the body. As a result, OSA patients may experience:
- Poor sleep quality
- Daytime drowsiness
- Morning headaches
- Mood changes
Other associated symptoms may include frequent urination at night, depression, and decreased sex drive. These symptoms may necessitate a consultation with a snoring specialist for proper diagnosis and treatment.
Complications
Patients who experience chronic or recurrent tonsillitis may also experience obstructive sleep apnoea (OSA). This may be a result of swollen airways, potentially preventing the patient from sleeping well and leading to other serious medical issues.
Diagnosis of Obstructive Sleep Apnoea (OSA)
It is advisable to consult a doctor to help diagnose the presence of obstructive sleep apnoea. Usually, it involves a consultation with the ENT specialist, who will review your clinical history and conduct a physical examination. The test may include nasoendoscopy (inserting a small lighted tube with a camera into the nose and throat – Figure 1), which will be performed in the clinic to evaluate the possible sites of narrowing in the upper airway.
An overnight sleep study (Figure 2), known as polysomnography (PSG), may be recommended to help diagnose OSA. Typically conducted in a sleep laboratory or at home, it involves recording the body’s activity during sleep, which may include brain waves, the oxygen level in the blood, heart rate, and breathing as well as eyes and leg movements.
Alternatively, the specialist may recommend a sleep study using a WatchPAT sleep study. While it may not offer as much information as a full sleep study, it has been shown to be a reliable option for patients with symptoms suggestive of OSA and for patients who are not able to sleep well with many wires and sensors attached to them. The advantage of a WatchPAT sleep study is its simplicity, and patients may sleep better with it (Figure 3).
The sleep study records the number of events known as apnoeas (when there is > 90% decrease in airflow to the lungs for >10 seconds) or hypopnoeas (when one has >30% decrease in airflow to the lungs for >10 seconds and >3% drop in oxygen saturation or arousal) during sleep.
In adults, the diagnosis of OSA is made when one has an AHI (Apnoea-Hypopnoea Index – the average number of apnoeas and hypopnoeas in an hour) of more than five in an hour. The severity of OSA in adults is based on the AHI as follows:
- Normal < 5 (diagnosed as a primary snorer in the absence of daytime sleepiness)
- Mild – 5-15
- Moderate – 16-30
- Severe – >30
The scoring of AHI is different in children. The ENT specialist will discuss these differences with you.
How Severe is OSA?
- High blood pressure
- Irregular heartbeats
- Heart attacks
- Stroke
- Diabetes
- Poor concentration during the day
- Road traffic accidents
- Behavioural disturbances in children
Treatment Options for Obstructive Sleep Apnoea (OSA)
Sleep apnoea treatment aims to ensure airflow is not obstructed during sleep. Some potential treatment methods used in snoring clinics include:
- Weight management
- Addressing sleeping positions
- Continuous Positive Airway Pressure (CPAP) therapy* (Figure 1)
- Nasal decongestants
- Dental devices
- Surgery
The type of surgery performed to help address OSA depends on the level of blockage or narrowing in the upper airway. These may include:
In the nose:
- Inferior Turbinate Hypertrophy
- Adenoidectomy (removal of adenoid)
- Sinus surgery
In the mouth and throat:
- Uvulopalatalpharyngoplasty (UPPP) and tonsillectomy*: This procedure involves removing excessive or lax soft palate and tonsils to help open the airway.
- Stiffening procedures: Coblation or radiofrequency ablation of the soft palate and tongue may help induce scarring and stiffen the tissues in these regions to reduce snoring.
- Tongue base reduction surgery: Tissue at the back of the tongue can be removed with a coblator or diathermy to reduce tongue bulkiness and open the airway.
- Genioglossus advancement and hyoid suspension: A surgical procedure to pull the neck and tongue muscles (forward) to open the airway.
*In children, OSA may stem from enlarged tonsils and adenoids as well as obesity. If enlarged tonsils and adenoids are the potential reasons for OSA in your child, surgery may be recommended to help remove the tonsils and adenoids.
Meet Our ENT Sleep Apnoea Doctor
Dr Gan is an Ear, Nose, and Throat (ENT) specialist. He is renowned for his expertise and approach to addressing various ear, nose, and throat conditions, including snoring and obstructive sleep apnea (OSA). With a particular interest in treating nose and sinus conditions, Dr Gan employs suitable diagnostic approaches and strategies to help manage these issues. His approach to patient care is evident in the treatment methods aimed at improving the sleep quality of many in Singapore.
Common Ear, Nose & Throat Conditions
| Allergy, Nose & Sinus | Snoring & OSA | Children’s ENT | Ear & Balance | Throat & Voice | Head & Neck |
|---|---|---|---|---|---|
| Allergies | Snoring | Symptoms in children | Hearing issues | Tonsils | Ear, nose and throat overlaps |
| Sinus issues | Obstructive Sleep Apnea (OSA) | Fever and irritability | Balance problems | Upper oesophagus | Oral cavity to salivary glands |
| Nasal obstructions | Learning or speech delays | Ear conditions affecting body balance | Trachea and larynx issues | Thyroid, glands, muscles, nerves | |
| Recurrent colds or flu | Conditions affecting food and air passage | Skin and soft tissue conditions |
Dr Gan Eng Cern
Ear, Nose & Throat Specialist · Rhinology & Endoscopic Skull Base Surgery
Dr Gan is a fellowship-trained ENT specialist with deep expertise in rhinology and endoscopic skull base surgery. He completed subspecialty training at St Paul's Sinus Centre, University of British Columbia, Vancouver — a globally recognised centre for nose and sinus care. He has served as Senior Clinical Lecturer at NUS Yong Loo Lin School of Medicine and has published research in international peer-reviewed ENT journals.
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