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Snoring & Obstructive Sleep Apnoea (OSA)

 Narrowed air passageway cause snoring

Narrowed air passageway

What is Snoring and OSA?
Snoring is a noise produced by vibration of tissues at the back of the throat and tongue during sleep. These tissues vibrate due to critical narrowing of the air passageway at the back of the throat. The narrowed air passageway, which is caused by sleep induced relaxation of the tissues at the back of the throat, can progress to complete airway closure in some patients, a condition called OSA. Not all patients who snore have OSA.

OSA is diagnosed when there are more than 5 episodes of complete air passageway closure lasting at least 10 seconds that occur during sleep. During these periods, the person is not breathing, leading to the body being starved of oxygen which eventually causes a partial arousal from sleep and with that a return to breathing. This cycle is repeated numerous times during sleep in OSA patients.

Is Snoring/ OSA serious?
Snoring alone is not life threatening. It is more a social problem with snorer possibly causing others sleepless nights. OSA on the other hand can be deadly. The frequent arousals in OSA causes sleep fragmentation leading to excessive daytime sleepiness, poor concentration and impaired memory. Sleepy patients have been found to be 6 times more prone to road traffic accidents. The OSA induced oxygen starvation during sleep can also cause a person to develop hypertension, hear problems and stroke.

Main Symptoms of OSA

  • Snoring
  • Gasping and choking for air during sleep
  • Excessive daytime sleepiness
  • Poor concentration and poor job or school performance

Who gets OSA?
Both adults and children can have OSA. The typical adult patient with OSA is a middle aged, obese male. Men are two times more likely to have OSA as compared to women. Other patients may not have this typical profile but the OSA is due to enlarged tonsils, enlarged and floppy soft palate and blocked noses. Children with OSA typically have enlarged tonsils and adenoids.

How is OSA diagnosed?
Diagnosis of OSA is made from history, clinical examination and a sleep study. The clinical examination includes a nasoendoscopic examination in the clinic. A flexible tube with a light source is passed through the nostrils to view the throat and tongue to pinpoint the degree and site of air passageway narrowing.

Sleep Study
All patients who snore or are suspected having OSA need to have a sleep study. During the study, which can be done at home, special sensors measure certain physical parameters of the body during sleep to assess for OSA. The data will then be analyzed and a report generated.

Treatment of Snoring/ OSA
Treatment is individualized and will depend on whether a patient has snoring alone or associated with OSA. The severity of OSA also dictates the treatment.
In general the treatment for snoring and OSA includes:

  • Lifestyle changes: weight loss, reducing alcohol intake and improving sleep hygiene
  • Continuous positive airway pressure devices (CPAP): A highly effective treatment for OSA where air pressure is used to keep the air passage way open during sleep.
  • Surgery: Surgical procedures on the upper airway range from the simpler clinic procedures for snoring alone/ mild OSA to the more complex throat, palate, and tongue surgery done under general anesthetic for those with severe OSA.

Clinic procedures for snoring performed under local anaesthesia:
Bipolar Radiofrequency Tissue Volume Reduction (RaVoR) for snoring and mild OSA.

RaVoR Surgery of the Soft Palate
This procedure causes reduction and stiffening of the soft palate to treat snoring/mild OSA due to soft palate floppiness.

RaVoR Surgery of the Nasal Inferior Turbinates
Enlarged inferior turbinates causing blocked nose can result in snoring and mild OSA. This procedure causes shrinkage of the turbinates thus enhancing nasal airflow.