Obstructive Sleep Apnoea & Snoring

Overview

Obstructive Sleep Apnoea (OSA) is a chronic and progressive condition where the upper airway has repetitive episodes of partial (airflow restrictions) or complete obstruction (airflow cessation or ‘apnoea’) during sleep. This can have a vast array of subsequent serious medical consequences when left untreated.

OSA affects up to 25% of men (1 in 4!) and 10% of women in Western Society. Recent data has suggested approximately 1 billion people world-wide are affected.

What happens if OSA is not treated?

Each episode of obstruction is associated with an arousal (partial waking-up) – which in the most severe forms of OSA can happen once or twice a minute; all night. These arousals lead to fragmentation of sleep, and are the cause of the excessive daytime tiredness and sleepiness that many OSA patients suffer from. OSA patients do not reach the levels of consistent quality sleep that allows us to rest and regenerate. Patients are tired, lethargic, irritable, and often have trouble concentrating. They often lack motivation, feel unhappy and have reduced libido. Untreated OSA can therefore have significant impacts on quality of life, ability to work and function normally. Untreated OSA can be very dangerous for the patient, and, where the patient is operating heavy machinery or driving a car/truck – the community also.

The episodes of breathing restriction/obstruction are often also associated with drops in blood oxygen levels. This places substantial stress on the major organs (heart, lungs, and brain) – as they are starved of oxygen and are required to work harder during sleep. Untreated moderate/severe OSA has been strongly associated with increased rates of mortality (death) compared to the normal population; as well as notable increased risk of stroke, heart attack/heart failure, high blood pressure, diabetes and other chronic conditions.

OSA is closely linked to loud, troublesome snoring. Snoring is normally generated by vibrations and collapse of soft tissue in the upper airway, at several levels. Whilst snoring alone is not directly dangerous to health; it can cause significant unrest within relationships and when traveling or sleeping near friends/family. This can therefore cause embarrassment and in the worst settings relationship breakdown.

Why do we treat OSA?

  • REDUCE RISK OF SERIOUS HEALTH COMPLICATIONS – as outlined above untreated moderate/severe OSA can lead to premature death, as well as a myriad of other serious medical conditions
  • FEEL BETTER – the tiredness/sleepiness associated with untreated OSA can severely impact quality of life and ability to function
  • SNORING – treating OSA often also treats snoring. Even if there is no dangerous OSA and no real “sleepiness/tiredness” symptoms – treatment of snoring alone is possible if this is the major concern

How is OSA diagnosed?

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.

To complete the OSA assessment a thorough physical examination is undertaken to identify levels of obstruction, and role for interventions

How is OSA 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 OSA 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
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 individualized 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