Sleep Apnoea

About snoring

Snoring is a sound made by vibrations of the soft palate and other tissue in the mouth, nose and throat (upper airway). Snoring is caused by turbulence inside the airway during breathing. The turbulence is caused by a partial blockage that may be located anywhere from the tip of the nose to the vocal cords. The blockage may occur only during sleep, or it may persist even during waking hours. It is often the bed partner, family or friends who notice the symptoms first.

Snoring causes

Snoring can originate from the nose, oropharynx or the base of the tongue. In recent years it has been found that the tongue plays a far more important role in causing snoring. Reduced muscle tone during sleep leads to the throat and airway tissue vibrating which leads to snoring. During waking hours muscle tone usually keeps the airway open – so that’s why snoring usually isn’t a problem when awake.

Paediatric sleep apnoea

The surgical treatment of paediatric sleep disordered breathing is tonsillectomy and adenoidectomy in most children.
In the paediatric population, resolution of sleep apnoea occurs in 85-90% of children who are treated with tonsillectomy and adenoidectomy.

The following information relates to sleep apnoea in adults

What is sleep apnoea

Sleep apnoea is also called sleep apnea and obstructive sleep apnoea. Obstructive sleep apnoea – OSA – is the cessation of airflow during sleep preventing air from entering the lungs. Sleep apnoea is a common disorder involving collapse of the upper airway during sleep. Sleep apnoea is caused by an upper airway obstruction. Sleep apnoea occurs during sleep when the throat muscles relax causing the airway to collapse – during the day there is usually sufficient muscle tone to keep the airway open allowing for normal breathing.

Apnoea during sleep causes the brain to automatically wake you up, usually with a very loud snore or snort, in order to breathe again – this repetitive disturbance results in sleep fragmentation, hypoxemia, hypercapnea, increased sympathetic nervous system activity. People with sleep apnoea will experience these wakening episodes many times during the night and consequently feel very sleepy during the day – they have an airway that is more likely to collapse than normal.

The difference between snoring and sleep apnoea

Snoring is usually a symptom of sleep apnoea, however, people with sleep apnoea may complain of the consequences of airways obstruction and sleep disturbance including:

Excessive daytime sleepiness often with irritability or restlessness
Extremely loud heavy snoring, often interrupted by pauses and gasps
Excessive daytime sleepiness, e.g., falling asleep at work, whilst driving, during conversation or when watching TV (This should not be confused with excessive tiredness with which we all suffer from time to time)
Irritability, short temper
Morning headaches
Forgetfulness
Changes in mood or behaviour
Anxiety or depression
Decreased interest in sex

Not everyone who has these symptoms will necessarily have sleep apnoea

We all possibly suffer from these symptoms intermittently but people with sleep apnoea have these symptoms most of the time

Sleep apnoea diagnosis

Sleep apnoea can range from mild to severe. The severity is often measured using a sleep study or polysomnogram using the apnoea/hypopnoea index (AHI), which is the number of apnoeas plus the number of hypopnoeas per hour of sleep – (hypopnoea being reduction in airflow).

These periods of ‘stopping breathing’ only become clinically significant if the cessation lasts for more than 10 seconds each time and occur more than 10 times every hour – an AHI of less than 10 is not likely to be associated with clinical problems.

To determine whether you are suffering from sleep apnoea you must first undergo a specialist ‘sleep study’. This will usually involve a night in hospital where equipment will be used to monitor the quality of your sleep. The results will enable a specialist to decide on your best course of treatment.

Sleep apnoea treatment

As specialists in upper airway anatomy, physiology and surgery, ENT surgeons are uniquely qualified to treat patients with sleep apnoea
For adults with obstructive sleep apnoea it is recommended that evaluation for primary surgical treatment be considered in select patients who have severe obstructing anatomy that is surgically correctible (e.g., tonsil enlargement blocking the airway) and in patients in whom continuous positive airway pressure (CPAP) therapy is inadequate
Dietary modification and weight reduction will also help people with sleep apnoea; For obese people, a dramatic weight loss can be an effective way to improve moderate to severe sleep apnoea, scientists at Karolinska Institutet report – those with severe sleep apnoea when the study began benefited most from weight loss.
In most patients with moderate to severe OSA, continuous positive airway pressure (CPAP) is the first line treatment
Successful long term treatment of OSA with CPAP is difficult to achieve and fewer than 50% of patients on CPAP are adequately treated, as defined by 4 hours of use 70% of nights
Surgical procedures may be considered as a secondary treatment for OSA when the outcome of CPAP therapy is inadequate, such as when the patient is intolerant of CPAP, or CPAP therapy is unable to eliminate OSA
Surgery may also be considered as a secondary therapy when there is an inadequate treatment outcome with an oral appliance (OA), when the patient is intolerant of the OA, or the OA therapy provides unacceptable improvement of clinical outcomes of sleep apnoea

Surgery may also be considered as an adjunct therapy when obstructive anatomy or functional deficiencies compromise other therapies or to improve tolerance of other OSA treatments

Sleep apnoea summary

Surgery for sleep apnoea has been shown to improve important clinical outcomes including survival and quality of life
If you or your partner has snoring or obstructive sleep apnea contact your doctor who will arrange for you to see an ear nose throat specialist.