Snoring & OSA | Euan's ENT Surgery

OBSTRUCTIVE SLEEP APNOEA (OSA)

What is OSA?

Obstructive Sleep Apnea (OSA) is a condition where a person stops breathing (apnea) or performs shallow ineffective breathing (hypopnea) in repeated short periods during sleep.

What causes OSA?

When we fall asleep, the body's muscle tone relaxes, and the tongue and soft tissues tend to fall backwards, narrowing the upper airway space. When the airway narrows or closes as we breathe in, airflow to the lungs is obstructed, reducing the amount of oxygen absorbed.

Once your body senses that you’re not getting enough oxygen during sleep, your brain will suddenly wake you up to help you breathe. These awakenings can be so brief you don’t remember them. This can cause interruptions in your sleep patterns, which can affect your quality of life and health in the long run with consequent medical issues.

OSA is more common in:

Overweight or obese people
Menopausal women
Men rather than women
The middle-aged or elderly
People who smoke, or drink alcohol regularly
People who suffer from nasal congestion, structurally or due to allergies
People with congenitally narrow airways
People with enlarged tonsils or adenoids

OSA Symptoms & Effects

Snoring is the most characteristic symptom of OSA and is caused by air squeezing through the narrowed airway space forcefully, causing tissue vibration and creating the sound of snoring due to the Bernoulli Effect.

Waking up throughout the night because of sleep apnoea can also make you excessively tired during the day. Daytime fatigue from OSA can affect work performance, cause feelings of irritability, and can increase the risk of motor and work-related incidents.

Some other symptoms of OSA can include:

Restlessness due to sleep fragmentation
Waking up feeling tired or unrefreshed
Dry or sore throat upon waking up
Making periodic snorting, choking or gasping sounds while sleeping

In addition to interrupting sleep, OSA can cause decreased oxygen blood levels. In serious cases, lack of oxygen from OSA can aggravate or cause significant health issues to your heart or brain functions if left untreated.

Untreated OSA can lead to increased risk of:

Stroke
Hypertension
Diabetes
Heart attack or heart disease

OSA Assessment & Diagnosis

To assess for OSA, the doctor will check your BMI, and perform a nasoendoscopy to evaluate the upper airway tract. If OSA seems likely based on the results, the doctor may recommend arranging a Polysomnography (PSG), also known as a sleep study.

A PSG sleep study is done in one night while you sleep, usually carried out at home. Attendants will bring equipment to monitor your breathing and sleep patterns throughout the night. For an attended PSG, this is done in a hospital setting. Treatment for OSA has to be designed to the individual’s particular situation and needs. The results of the sleep study will allow the doctor to evaluate the severity of your OSA to plan the best course of treatment going forward.

OSA Treatment Options

OSA treatment is aimed at promoting airway patency and improving airflow to reduce interruptions during sleep.

Oral Appliances

Oral appliances or mouthpieces are an option for people with mild or moderate OSA.

These devices keep your airway open by pulling your lower jaw forward during sleep, which can sometimes relieve snoring and OSA. Some other devices hold your tongue in a different position. For this treatment, you should see a dentist experienced in dental sleep medicine appliances for the fitting and follow-up therapy.

Corrective Surgery

Surgery to remove airway blockages can treat OSA and is usually considered when other treatment methods are ineffective. Suitable correction can differ between individuals depending on where the obstruction is most prevalent.

Some surgical options include:

Uvulopalatopharyngoplasty (UPPP) – the surgical removal of tissue from the back of the mouth, and top of the throat. This is performed in the hospital under General Anaesthesia.

Nasal Surgery – to remove nasal obstructions or open up space in the nasal airways, usually to facilitate CPAP administration.

Jaw Surgery (Maxillomandibular Advancement) – the MMA procedure where the upper and lower parts of your jaw are moved forward from the rest of your facial bones. This enlarges the space behind the tongue and soft palate, making obstruction less likely. This is applicable for patients with retrognathia, or overbite. This surgery is invasive requiring the restructuring of the jaw and may cause other changes to your eating or breathing habits, as well as changing your facial appearance.

Continuous Positive Airway Pressure (CPAP) Therapy & Machines

The most widely accepted treatment for OSA is known as Continuous Positive Airway Pressure (CPAP) therapy. CPAP is considered the “gold standard”, and most effective nonsurgical treatment for OSA. It is continuous, sometimes lifelong and requires a CPAP machine.

CPAP applies gentle air pressure through the nasal passages to keep the airways open, allowing a person to breathe uninterruptedly during sleep. It is administered through a mask that seals the nose and the mouth through a CPAP machine.

CPAP masks are purchased, while CPAP machines can be purchased in full or rented. Both must be fitted and adjusted to the individual for comfortable breathing and can be customized for comfort or travel mobility.