Upper Airway Disorders: Snoring & Obstructive Sleep Apnoea (OSA)
Snoring and Obstructive sleep apnoea (OSA) are part of a spectrum of Sleep Disordered Breathing. Snoring is very common especially as one gets older and has been shown to affect about 40% of general population. Obstructive sleep apnoea affects about 10% of general population. With up to 93% moderate to severe cases going undiagnosed (that translates to about 250000 Kiwis), it is a huge problem requiring attention.
Why it is a problem:
OSA has been shown to increase risks of high blood pressure, heart disease, stroke, diabetes and cognitive problems. Untreated OSA is three to six times more likely to cause deaths than after treatment. It affects workplace productivity. Studies in the US have found approximately 50% of children being treated for ADHD to have undiagnosed OSA. That is a huge number of sleepy people who are struggling to cope with daily activities and who are vulnerable to chronic illnesses!
Simple' snoring and mild OSA do not have as high health risks associated with them. However, the strain on relationships cannot be underestimated, not to mention studies that have shown nerve deafness in long-term bed-partners of loud snorers! There is also some new evidence emerging on the risk of cardiovascular problems even with simple snoring without OSA.
How to recognise it:
OSA can manifest in several different ways, making it difficult to recognize. Daytime sleepiness, snoring and choking episodes at night are more obvious symptoms. But someone with difficult-to-control high blood pressure, heart disease, type 2 diabetes or vague headaches, facial pain and 'sinusitis'-like symptoms could actually have OSA. Several screening questionnaires are available and someone who scores high on these is at clear risk of OSA and should be referred for further assessment.
What to do about it:
Traditional gold standard treatment of OSA is CPAP or positive pressure mask therapy. Successful elimination of daytime sleepiness is the best motivation for patients to comply with CPAP. There is also an increasing recognition of role of additional modalities such as surgery, positional therapy and jaw splints to treat OSA, either by themselves or in combination with CPAP, in order to achieve high overall effectiveness.
Suspected OSA should ideally be assessed by a team specialising in Sleep Disordered Breathing. Sleep study and endoscopic upper airway examination by an ENT specialist are two important components. Patients with obvious airway obstruction in the nose or from large tonsils often proceed directly to surgery. This is on the basis of anticipated success rates of 80% or higher in patients with obstruction at the level of nose, palate and tonsils. Nevertheless, it is important to perform a thorough endoscopic examination for two reasons. One, palatal and throat surgery is proven to be more successful than simple tonsillectomy in these cases and two, the overwhelming cause of surgical failure is associated lower throat obstruction.
- OSA is a complex disorder with multi-system involvement.
- It often presents insidiously and can easily go undetected.
- Patients at risk are:
- difficult-to-control high blood pressure, type 2 diabetes or heart problems
- excessive daytime sleepiness or tiredness
- high BMI
- morning headaches, facial pain or 'sinusitis'-like symptoms
- 'brain fog', irritability or behavioural issues or bed-wetting in older children
- With prompt diagnosis and timely, effective treatment, we can significantly reduce risk of chronic debilitating illnesses and serious consequences.
- Epworth Sleepiness Score and STOP BANG questionnaire are easy-to-use screening tools to recognise patients at significant risk of OSA.
- Sleep study and specialist ENT assessment of upper airway are vital for diagnosis and treatment.