Obstructive Sleep Apnoea (OSA) affects up to 25% of men (1 in 4) and 10% of women in Western Society – there is some thought this number could be significantly underestimating the true incidence.
Recent data has suggested approximately 1 billion people world-wide are affected.
Signs you or your partner could be suffering from OSA:
- Loud snoring, every night – even when well
It is normal to occasionally snore lightly (particularly if there have been a few beers or glasses of wine involved). However, when snoring becomes an issue every-night, in all positions (on back or side) and is causing issues with partner/friends sleeping – this can be a sign of something more sinister at play. Snoring itself is not dangerous, except its presence can affect relationships (and in turn quality of life) significantly and be embarrassing with friends or family.
- Pauses in breathing/gasping/choking while asleep
When snoring/breathing is coupled with episodes of gasping, choking and periods of no breathing (apnoea) it is likely OSA is present. Often partners give a history of pushing or prodding the patient at night to get them to start breathing again.
- Waking up tired and unrefreshed
If despite a good amount of time asleep (for adults 6-8 hours) you are waking tired, unrefreshed and struggling to start your day – something is not right.
OSA patients often report a “cloudiness” in the mornings, inability to concentrate and poor short-term memory. Patients often supplement themselves with caffeine and/or high energy foods in the morning to gain energy.
Commonly OSA patients complain of a “tight” forehead morning headache that causes significant discomfort.
OSA patients often report low/reduced mood and poor libido levels.
There are some medical conditions other than OSA that cause sleepiness (narcolepsy etc.) and some medications can also contribute. However, OSA patients often report an overwhelming sleepiness – particularly once they stop and rest from work or activity. If you fall asleep as soon as you open a book, or sit down in the evening to watch TV, or more concerningly when you are stopped at traffic lights – something abnormal is going on.
- Poor Concentration/Memory
Untreated OSA is associated with poor neurocognitive function, and poor memory. This can affect performance at work, and in day-to-day life.
- Early onset of medical problems
In combination with the sleep breathing features outlined, if you or your partner has early age onset of high blood pressure, stroke, heart failure or other medical condition – OSA should be considered as a possible comorbidity
How is OSA diagnosed in Adults?
A lot of information can be derived from the patient history (symptoms of tiredness/sleepiness, and co-existing medical conditions) and most importantly the history from the sleep partner outlining snoring, laboured breathing patterns/working hard to breath, gasping/choking/stopping breathing.
** We strongly request you bring your sleep partner to your appointment
The “GOLD-STANDARD” or best test to diagnose and measure severity of OSA is a formal “Sleep Study” (polysomnogram [PSG]).
If you have not had one of these prior to your consultation, we can arrange this if needed. This study ideally involves an overnight stay in a sleep laboratory where all parameters are measured. Some “at home” sleep study options are also available in some places – and suitability can be discussed.
The sleep study measures a lot of different parameters, and in turn provides us with the information needed to make a sound management decision – including the severity of OSA and therefore risk.
To complete the OSA assessment a thorough physical examination is undertaken to identify levels of obstruction, and role for interventions
How is Obstructive Sleep Apnoea treated?
No two cases of OSA are the same.
EVERYONE IS DIFFERENT.
Each patient needs individual assessment, and discussion regarding their goals of treatment.
In general Obstructive Sleep Apnoea can be treated in the following ways:
Non Surgical / Conservative
- Lifestyle: weight loss (diet, exercise, weight loss surgery)
- Avoid alcohol, other sedating medications
- Treat nose and sinuses: if allergies and/or inflammation – optimise nose with steroid sprays/rinses. May involve surgery to nose/sinuses
- Stay off your back while asleep: some OSA/snoring is only present with the patient sleeping on their back. The simplest way to treat this form of OSA is to stay on your side – options include positioning in bed, and devices to aid lateral sleep
- Mandibular advancement splints (MAS): upper & lower teeth fitted, sequentially advanced by a qualified dentist – aid to hold lower jaw forward and stop slipping backward
- CPAP (Continuous Positive Airway Pressure) – mask device (full face, nasal prongs, nasal pillows) delivering constant column of air pressure to airway, keeping it open and preventing collapse.
When used consistently and correctly, will successfully overcome OSA.
However, unfortunately a large proportion of patients do not tolerate the device, and do not wear it enough to gain benefits. Some patients outright refuse, as the idea of the mask and machine in bed is not suitable for them.
Surgical treatment for OSA/snoring is a complex undertaking, and often requires attention to multiple levels of the airway.
Our aims of surgical treatment are to:
Facilitate the use of CPAP or MAS (Mandibular Advancement Splint) where these treatments remain the best option for the patient.
To significantly reduce the severity of OSA/snoring and associated symptoms
We are dedicated to providing comprehensive, and individualised surgical plans for all of our OSA patients wishing to consider surgery.
Surgical management of OSA may involve one, or a combination of:
- Nasal/sinus surgery: to facilitate nasal breathing/use of medications in nose
- Palate surgery: repositioning surgery to the soft, and occasionally hard palate to improve airway and reduce snoring
- Tongue and tongue base: reduction in bulk of tongue, and lingual tonsil with multiple variations/options
- Skeletal surgery: bringing the upper and lower jaws forward, usually performed with Oral & Maxilofacial Surgeon
- Hypoglossal Nerve Stimulation: exciting new technology where the tongue is stimulated forward by an implanted device while asleep
- Drug Induced Sleep Endoscopy (DISE): when there is a question regarding the levels of airway collapse in OSA, a diagnostic procedure termed DISE can be performed to identify surgically correctable levels of collapse
For more more detail see:
Snoring and OSA Surgery