All you need to know about sleep apnoea.
Obstructive Sleep Apnoea (OSA) is a serious, potentially life-threatening condition that is far more common than realised by people. Apnoea is a condition where breathing stops for 10 seconds or more. Prevalence studies done in Singapore have estimated OSA to affect 15 per cent of the local population. Being a common disease, OSA poses a major public health problem. Men are 2.0 to 3.7 times as likely as women to suffer from OSA.
Is Snoring a Symptom?
Snoring, which may cause both psychological and social strain to one’s other family members, is one of the symptoms of OSA. Snoring is the harsh sound produced when the soft palate, uvula, throat tissues or even the tongue vibrates during inhalation at sleep. As we fall asleep, the soft tissues at the back of the throat and the tongue muscle relax, causing the airway to narrow.
When air passes through a narrower airway, it moves faster and causes the muscles to vibrate against each other. This creates a rattling or snoring sound. Snoring becomes louder if the airway passage continues to narrow and pressure increases. Snoring is estimated to affect 40.3 per cent of the local population regularly, with more men (47.7 per cent) affected than women (33.6 per cent). The prevalence of snoring increases with age up to 55 years old.
How can it Affect Me?
Apart from being a major health hazard, OSA also affects the performance and concentration of people suffering from the condition while at work. This can in turn result in tremendous economical losses and social impacts on our society. OSA leads to severe sleep disruption and fragmentation, with development of excessive sleepiness during the day, poor concentration, memory loss, and even marital problems.
In fact, patients with OSA have a seven-fold greater rate of automobile accidents than do people without OSA, and 24 per cent of patients with OSA reported falling asleep at least once per week while driving. Studies have also shown that patients with OSA were 2 to 3 times more likely to have had an occupational injury in the past 10 years than control subjects. In addition, OSA has been associated with many medical problems with much increased risk, like strokes and cerebrovascular accidents, hypertension, and cardiovascular diseases such as heart attacks.
Some factors that cause people to have a higher likelihood to suffer from OSA include obesity, increasing age, male gender, facial skeletal problems, as well as anatomic abnormalities of the upper airway such as deviated nasal septum, enlarged turbinate, nasal polyps, large tonsils and adenoids, large and retro-placed tongue, and floppy redundant soft palate and uvula.
Am I Suffering from OSA?
The diagnosis of OSA is made from the patient’s history, and clinical examination that includes a detailed upper airway evaluation and sleep study. A sleep study helps doctors to diagnose the severity of OSA but it is not able to pinpoint the level and degree of obstruction. To do so, Changi General Hospital (CGH) has developed an international award-winning computer-assisted endoscopic upper airway measurement. This can be done in CGH’s Sleep Laboratory and will enable the doctor to identify and measure the site of obstruction accurately, which is important if the patient needs surgery to correct any anatomical problems.
There are various treatment options for OSA and a combination of such treatments may sometimes be necessary:
- Life-Style Changes
- Losing weight, reducing the intake of alcohol, avoiding smoking, and observing hygiene of sleeping area.
- Air Pressure Device
- Using a Continuous Positive Airway Pressure (CPAP) device to open up the airway during sleep.
- Dental Devices
- Using dental devices to advance the tongue or jaw forward during sleep.
- Upper airway surgery will depend on the level, site and degree of obstruction. These include day surgery procedures like temperature-controlled radio frequency under local anaesthesia, as well as other nasal, palatal, tongue and throat procedures.
Regardless of which option or combination of options chosen by patients, they will need to be followed up well to ensure that their sleep disorders are treated and they are in good health.
Madam Chua (full name withheld) was one of Dr Hsu’s patients who was successfully treated of OSA. The 41-year-old working mother had been plagued by snoring since giving birth to her second child in 2000. She finally sought treatment at CGH in June 2007 when her snoring got unbearable, and was subsequently diagnosed with OSA.
As Madam Chua had requested for a long-term solution, Dr Hsu performed a surgical procedure to open up her airways. The day surgery took less than an hour and effectively treated her of OSA. “The surgery is simple and done very well. Before, I could not sleep well and would wake up about four to five times a night. My snoring also disrupted my husband’s sleep. Now, I can sleep soundly throughout the night and wake up the next morning feeling fresh,” said Madam Chua.
CGH Sleep Laboratories
The Otolaryngology (Ear Nose Throat) Department at CGH started the sleep laboratories service in 2003, with just two beds. The service has since expanded to cater to a rapidly growing demand. The department now has two sleep laboratories with five beds equipped with wireless transmission capability, conducting over 700 sleep studies a year. In addition to diagnostic sleep tests, the laboratories also conduct other tests such as the Continuous Positive Airway Pressure (CPAP) Titration sleep study, Multiple Sleep Latency Test (MSLT) and Multiple Wakefulness Test (MWT) using state-of-the-art sleep test machines.
The sleep laboratories are designed to simulate the home environment so that patients can relax and sleep in peace. The rooms are sound-proof and come with light-blocking curtains, attached toilets, television sets, and magazines for entertainment. Infrared synchronised cameras that work in darkness are also installed in the rooms to capture sleep positions without disturbing the patients.