Courtesy of THIS Quarterly magazine  
Obstructive Sleep Apnea  

SNORING IS THE NOISE MADE DURING SLEEP WHEN SOMETHING OBSTRUCTS airflow through the airways. The air squeezes past the obstruction, making a whistling or rattling sound.

The obstruction could be caused by rhinitis, sinusitis or some other infection. It could be due to an anatomical fault, like a crooked nasal septum, enlarged turbinates or tonsils or polyps. The obstruction could be due to floppy throat walls (these walls are stretched over time, with age) or excessive fat in the neck “strangulating” the airway.

Chronic snoring usually gets worse over time and may lead to a disorder called “obstructive sleep apnea” (OSA). In these cases, the obstruction is so severe that the air entering the lungs is greatly reduced. The heart and lung muscles must therefore work harder to get an adequate oxygen supply. The lungs become so tired that they “take a break.” The sleeper then stops breathing. A non-breathing period that lasts more than 10 seconds is called an “apnea”. A patient is diagnosed as having OSA if he has more than ten apnea episodes an hour. In severe OSA cases, the sleeper may have 50-60 (or even more) apnea episodes an hour, some lasting over a minute long.

OSA has many undesirable effects. When the blood oxygen levels drop, there is a drop in the oxygen supply to the brain and other organs, possibly leading to “brain suffocation” and adversely affecting the body’s performance and functions. Also, because of the lowered oxygen levels, the heart may increase its rate, cardiac output and blood pressure, which could increase the risk of heart attack or stroke.

Snoring treatment or management depends on the cause of the snoring or OSA. There is no single treatment. Instead, treatment must be tailored to the individual patient’s particular problems. Possible treatments and management solutions include:

  • Weight management to reduce the fat tissue around the neck which may be “strangulating” the airway.

  • Change in sleeping position. Avoid sleeping supine (on your back). In this position, the tongue and the soft palate may fall backwards, blocking the airway.

  • Avoiding of alcohol and sedatives (which cause airway muscles to relax and collapse further).

  • Stopping smoking, which damages the lungs and inhibits respiratory functions.

  • Medical treatment of nasal congestion or infection.
  • Using a Continuous Positive Air Pressure (CPAP) machine which pumps air through a tight-fitting mask throughout the night. The positive pressure from the pumped air prevents the airway from collapsing during sleep. This reduces the workload of the exhausted lung muscles. The latest CPAP machines are small, quiet and very effective. Unfortunately, many patients cannot tolerate wearing a mask throughout the night.

  • Surgical options to remove or correct specific physical obstructions or to widen the airway. Sometimes, up to six different types of surgeries are performed in one operation. It is almost impossible to identify and verify the exact “success” of each individual surgery; they must be taken as a whole. Also, even after surgery, patients can only maintain good results if they make the necessary lifestyle changes outlined earlier.

  • In certain, very specific cases where the problems are caused by abnormal cheekbones and very small jaws, surgical correction of the cheek and jawbone (to widen the airway) may be necessary.

  • Problems may be caused by habitual mouthbreathing. During mouth-breathing, the tongue does not stay trapped in the oral cavity but falls back, blocking the airway. This habit needs to be broken or, if due to nasal blockage, the blocked nose needs to be treated.

  • Dental appliances may also be useful to keep the mouth closed, the jaw forward and the tongue in its proper place.

Snoring and OSA may also occur in children. Lack of beneficial sleep may result in childhood learning and attention difficulties. Special growth hormones are released during deep sleep, so inadequate sleep may adversely affect the child’s growth. Snoring, OSA and mouth-breathing may also cause abnormal development of the child’s jaw and face, as approximately 60 percent of the child’s face is “built” by the time he is four. Left unchecked, such abnormal facial development may be irreversible and this will often lead to snoring and OSA in adulthood.

Most paediatric snoring and OSA problems can be readily treated either medically or surgically, with very good results. The most common surgeries for children are tonsillectomy and/or adenoidectomy.

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

Ear Nose & Throat Centre CC Lau
3 Mount Elizabeth
#14-11 Mount Elizabeth Medical Centre
Singapore 228510
Tel : (65) 6235 9535
Fax : (65) 6738 4377
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