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  Dr Lau Chee Chong
Senior consultant, Ear Nose Throat, Head & Neck Surgery
   

  Snoring
 

Snoring

Is snoring a serious medical problem? Depending on the severity, yes. Chronic snoring is the "first classification of a scale of sleep disordered breathing syndromes. These syndromes are classified in accordance with their severity:

Chronic snoring

Upper Airway Resistance Syndrome (UARS)

Obstructive Sleep Apnea (OSA)

 
 

OBSTRUCTIVE SLEEP APNEA

Obstructive Sleep Apnea (OSA) is a disorder characterised by repetitive episodes of upper airway obstruction that occur during sleep. These episodes of obstruction cause the sleeper to actually stop breathing for periods of time. "Apnea" is the term used for non-breathing periods that each last for more than 10 seconds.

  1. OSA is considered mild if a patient has between 5–20 episodes of apnea per hour of sleep. OSA is considered severe if a patient has more than 40 apnea episodes in an hour. 

  2. As a result of the non-breathing periods in OSA, the oxygen levels in the sleeper’s blood are often lowered. This has an adverse effect on the sleeper’s brain and heart:
  • To compensate for the lowered oxygen levels in the blood, the sleeper then makes an extra (unconscious and instinctive) effort to breathe, causing the chest to retract against a closed airway. Snoring follows as air is squeezed through the closed airway. The sleeper may toss and turn in his instinctive search for a position to maximise airflow. The sleeper may also sit up during sleep, and may experience excessive perspiration. 

  • The heart may also compensate for the lowered oxygen levels by increasing the heart rate or cardiac output. This may all result in blood pressure fluctuations. If the OSA is left uncorrected, it may eventually cause, over time, irreparable damage to the body and even serious cardiac problems. 

  • The reduction in oxygen supply to the brain may result in “suffocation” of the brain, difficulty in getting up from sleep, daytime sleepiness, inattentiveness, moodiness and poor performances at work and games.

Upper Airway Resistance Syndrome (UARS) was first described in 1976 by Professor Christian Guilleminault of Stanford University (often known in medical circles as the "Father of Sleep Apnea") to describe cases where there are no periods of apnea or lowering of oxygen levels, but there is laboured breathing and a similar effect on the heart.

Diagnosis : Diagnosis can be made using information from a number of sources:

The observations of patients, spouses and family members Physical examination of the nose, mouth, throat, palate and neck by the ENT specialist

An additional option is for a polysomnogram (a sleep study). The patient may be admitted overnight into a "sleep centre" (available at a number of hospitals) or special arrangements can be made for the study to be done at home by a technician.

Treatment : There are a range of treatments for the various causes of snoring and OSA. The treatment must be tailored to the cause of the problem and to the individual patient. The possible treatments include:

  1. Weight management and the control of any obesity problems.
  2. Medical treatment of nasal congestion from sisnusitis, polyps or allergic rhinitis (or possibly surgery if the patient does not respond to medical treatment) .
  3. Surgery to remove obstruction in the airway (such as enlarged tonsils or adenoids).
  4. Laser surgery to for removal of obstructions.
  5. Uvulopalatopharyngoplasty (UPPP) – a surgery to tighten the flabby tissues in the soft palate and throat, thereby creating enlarged airway.
  6. Radiofrequency of obstructive parts, such as the base of the tongue and the soft palate.
  7. Orthodontic treatment.
  8. In cases that for one reason or another cannot be successfully treated medically or surgically, CPAP (continuous positive air pressure) machine is a possible means to ensure that the sleeper gets adequate amounts of air. The CPAP machine has an air pump that pumps air directly to the child through a firmly-fitting facial mask that must be worn continuously through the night. The air provides a positive pressure that keeps the upper airway open during sleep.


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ENT Articles
 
 
   Snoring
   Obstructive Sleep Apnea
   Snoring & OSA in Children
   Cochlear Implants
   Navigational / Image-Guided
System for Sinus Surgery
   Nose Cancer
   Chronic Cough
   Laryngopharyngeal Reflux (LPR)
 

Contact Info
 
 
 

Ear Nose & Throat Centre CC Lau
3 Mount Elizabeth 
Suite 14-11 (14th Floor)
Mount Elizabeth Medical Centre Singapore 228510

Phone: (65) 6235 9535
Fax: (65) 6738 4377

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