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Obstructive Sleep Apnoea is the most common sleep-related breathing disorder. It has also serious consequences on our health and wellness. Here we will cover and help viewers learn more about how to recognise obstructive sleep apnoea and its treatments.
What is OSA?
There are several types of sleep apnoea but the most common is obstructive sleep apnoea or OSA for short. When you sleep, all the muscles in the body become more relaxed. This includes the muscles that help keep your throat open so air can flow into the lungs.
Normally, the throat remains open during sleep to let air pass by. Unfortunately, many people have throat that has narrowed due to various causes.
When the muscles in the upper throat relax during sleep, that narrowed throat closes in and block, partially or completely, the airway, leading to either a reduction or a full pause in breathing.
The brain will sense this impaired breathing and briefly rouse you from your sleep so that you can reopen your airway. This awakening is usually so brief that you don’t remember it.
This sleep and wake pattern can repeat itself 5 to 30 times per hour, all night long.
And this can seriously disrupt your ability to reach the deep restful phases of sleep and you’ll probably feel sleepy during your waking hours.
A noticeable sign of obstructive sleep apnoea is loud snoring.
Risk Factors of OSA
Fat deposits around the upper airway can narrow the airway and when the muscles are relaxed when you are sleeping, the extra weight can cause the airway to ollapse and be blocked.
We do know that the risk of OSA increases with age but plateaus off after your 60s.
Some patients may have narrowed airway. It could be due to enlarged adenoids or tonsils or they could have chronic nasal congestion of various causes like chronic allergic rhinitis.
These narrowed airways will increase your risk of developing obstructive sleep apnoea.
Men are 2-3 times more likely than pre-menopausal women to have obstructive sleep apnoea. However the frequency of OSA increases in women after menopause.
Having family members with OSA might increase your own risk.
Smoking is associated with an increase risk of OSA as well
Symptoms of OSA
- Excessive daytime sleepiness, which may cause you to fall asleep while working, watching television, having your meals or even driving.
- Difficulty concentrating during the day
- Mood changes such as irritability or even depression
- Morning headache
- Awakening with dry mouth or sore throat
- Decreased libido
Signs of OSA
Signs of obstructive sleep apnoea which is usually observed by your partner , not by yourself, are
- Loud snoring
- Observed episodes of stopped breathing during sleep
- Abrupt awakenings accompanied by gasping or choking
- even high blood pressure
Negative Effects of OSA
OSA is not just a sleep disorder, it can affect the patient’s health and mental well being.
Increases chances of cardiovascular disorders
OSA can be a cause of your hypertension. It can also increase your risk of getting coronary artery disease, heart attacks and even heart failure and strokes. There is even an association with irregular heart rhythm.
Because of the lack of restorative sleep, people with OSA suffer from severe daytime fatigue and irritability. They will have problems concentrating and find themselves falling sleep at work and that puts them at a high risk of work-related accidents.
Even worse, some patients may fall asleep even when driving and that can lead to road traffic accidents! For children and students, they may do poorly in school and commonly have attention or behaviour problems.
Detrimental to mental well being
People with OSA can suffer from morning headaches. They can be very irritable, they can have mood swings and some even develop depression.
Their memory may be affected and sometimes it may even affect their relationship with their partners because their partners may choose to sleep in another room to escape the loud snoring.
How can OSA be diagnosed?
There are sleep study tests that can be done both in the laboratory and even at home.
In a formal sleep study, you can be hooked up to equipment that monitors your brain activity, your vitals, breathing patterns, blood oxygen levels and even your limb movements while you sleep in the lab. The results of this test can formally diagnose you with OSA
Nowadays, there are simpler devices which you can wear while sleeping at home to make a diagnosis too, for example the watchpat.
Treatment for OSA
Now, after a diagnosis has been made, treatment should be started as soon as possible. Treatment for OSA is generally divided into surgical and non surgical.
Make lifestyle changes
- Lose weight if you are overweight, exercise regularly and reduce your overall calories intake.
- Quit smoking and drinking.
- Treat your chronic allergic rhinitis if you have with nasal decongestants and allergy medications.
- Avoid taking sedative medications.
Oral mouthpieces may also be prescribed by your doctor if you have mild to moderate apnoea. These devices are designed to keep your throat open and that sometimes can relieve snoring and OSA.
Positive Airway Pressure Device
The last non surgical treatment option would be that of a positive airway pressure device. These machines delivers air pressure through your nose or through your mouth while you sleep. By doing so, these positive pressured air can help open up your narrowed or close airway during sleep.
This treatment has been shown to reduce daytime sleepiness and improve quality of life.
In the event non surgical options are not effective, then surgery may be recommended. Some of the surgeries that are done includes
- Tissue removal, where organs or tissues found to be obstructing the airway are removed
- Jaw surgery, where the position of the jaw is a adjusted to enlarge the space behind your tongue and soft palate
- Upper airway stimulation, where a small devise is implanted into your chest. This small device can deliver an electrical impulse that triggers tongue movement when it senses an airway obstruction
By : Dr Chen Yiming
Family Physician, MBBS (Singapore), GDFM (NUS), GDFP Dermatology (NUS)