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Snoring & Obstructive Sleep Apnoea ( OSA )

Snoring & Obstructive Sleep Apnoea ( OSA )

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 sleep 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 rattling or snorting noise made by a person during breathing while sleeping.

Why Bother About Snoring?

 

From a social perspective, a snorer may cause sleepless nights for their bed partner or roommates. This can lead to fatigue and frustration from the bed partner or roommates due to insufficient or disrupted sleep. A loud snorer may also be a subject of ridicule by his or her friends and family, resulting in psychological consequences.

 

Medically, snoring may be a sign of Obstructive Sleep Apnoea (OSA), a medical condition with potentially severe consequences if left untreated.

 

Obstructive Sleep Apnoea (OSA)

 

Obstructive sleep apnoea (OSA) is a common but potentially serious condition where breathing repeatedly stops and starts during sleep due to blocked airways. Characterised by snoring, OSA occurs when the throat’s muscles relax too much, narrowing the airway and reducing oxygen flow to vital organs

Illustration on the difference between ordinary sleep, snoring, and OSA.

 

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 clinic are recommended to help manage complications. Sleep apnoea can be categorised into three types:

 

1. Obstructive Sleep Apnoea (OSA): The most common type of sleep apnoea, in which the airway has become narrowed or blocked.

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)
Image of an enlarged tonsils.
Image of enlarged tonsils and uvula.

 

2. Excessive nose 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 from:

 

  • Enlarged inferior turbinates (Figure 2a & b)
  • Enlarged adenoids (Figure 3)
  • Deviated nasal septum (Figure 4)
  • Sinusitis with or without nasal polyps (Figure 5)
Illustration of normal inferior turbinates vs enlarged inferior turbinates.
Image of enlarged inferior turbinates.
Illustration of enlarged adenoids.
Illustration of normal nasal septum vs deviated nasal septum.
Illustration of sinusitis vs normal sinus.

 

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.

 

4. Small or receding jaw (micro- or retrognathia)
People with a small or receding jawbone are at a higher risk of snoring due to a smaller airway space behind their tongue.
It may occur in older people as well as those who are overweight. Making some lifestyle changes, such as weight management and sleeping positions, can mitigate OSA symptoms. However, understanding the specific causes is advisable for optimum treatment.

 

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 OSA. 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.

Image of flexible nasoendoscopy being performed on a patient in the clinic.
Image of the patient undergoing polysomnography (PSG).
Image of the patient using a WatchPAT for the sleep study.

 

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 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?

Treatment Options for Obstructive Sleep Apnoea (OSA)

 

Sleep apnoea treatment aims to ensure airflow is not obstructed during sleep. Some potential treatment methods include:

 

  • Weight management
  • Addressing sleeping positions
  • Continuous Positive Airway Pressure (CPAP) therapy* (Figure 1)
  • Nasal decongestants
  • Dental devices
  • Surgery
Image of a patient on Continuous Positive Airway Pressure (CPAP) therapy.

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:

 

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 to 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 & SinusSnoring & OSAChildren’s ENTEar & BalanceThroat & VoiceHead & Neck
AllergiesSnoringSymptoms in childrenHearing issuesTonsilsEar, nose and throat overlaps
Sinus issuesObstructive Sleep Apnea (OSA)Fever and irritabilityBalance problemsUpper oesophagusOral cavity to salivary glands
Nasal obstructionsLearning or speech delaysEar conditions affecting body balanceTrachea and larynx issuesThyroid, glands, muscles, nerves
Recurrent colds or fluConditions affecting food and air passageSkin and soft tissue conditions

When Should You See an ENT Snoring Specialist in Singapore?

  • Ear, Nose or Throat discomfort or concerns
  • Persistent blocked nose with mouth breathing or snoring
  • Frequent sore throats or a sensation of a lump in the throat that doesn’t go away
  • Recurring sinus infections or persistent sinus pressure
  • Difficulty swallowing or pain during swallowing
  • Unexplained hearing loss or persistent ear discomfort
  • Continuous nasal congestion, especially if it’s affecting your sleep quality
  • Witnessed pauses in breathing during sleep, followed by gasping or choking
  • Persistent fatigue or sleepiness during the day, even after a full night’s sleep
  • Chronic cough or throat clearing not attributed to other conditions
  • Voice changes or hoarseness lasting more than a few weeks
  • Unintended weight gain and difficulty in losing weight, potentially linked to sleep disorders

Dr Gan provides a comprehensive management in a broad array of Ear, Nose and Throat as well as Head & Neck conditions. He has a special interest in treating various nose and sinus conditions including snoring and Obstructive Sleep Apnoea (OSA)

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