What is Obstructive sleep apnoea?

Obstructive sleep apnoea(OSA) is a common lifestyle disorder in which patients either temporarily stop or decrease their breathing rate during sleep. This sleep disorder affects people of all ages, most commonly seen in middle-aged male (40-60 years). The estimated prevalence of OSA is 2-14%. Sleep apnoea should be differentiated from merely snoring, where the latter is a social issue rather than a medical disease. Snoring is one of the many symptoms of obstructive sleep apnoea.

In OSA, there will be intermittent relaxation of the muscles of throat and palate, which collapses the airway when the patient is asleep. The complete cessation of breathing for a minimum duration of 10 seconds is called apnoea. There will be increased breathing effort and it also affects the amount of oxygenation to the vital structures of the body. This forces the person to awaken from sleep and the breathing resumes.

The risk factors for development of OSA includes obesity, enlarged adenoids and tonsils, large tongue, hypertrophied palate, large uvula, retrognathia (lower jaw is set back compared to upper jaw level), collar size (neck circumference) more than 17 inches and smoking.

The symptoms and signs of sleep apnoea include loud snoring, chronic fatigue, excessive daytime sleepiness, morning headache, lack of concentration, mood swings, depression, memory loss and sexual dysfunction. Sleep apnoea can lead to development of other diseases such as Type II Diabetes Mellitus, systemic hypertension, heart disease, stroke, weight gain, acid reflux, high cholesterol levels and poor liver function.

The gold standard test to diagnose obstructive sleep apnoea is polysomnography or overnight sleep study. An awake flexible nasal endoscopy can detect the structural defects like site of obstruction/collapse from the level of nose up to laryngeal inlet that can lead to OSA and helps in planning the treatment.

The treatment of OSA can be either medical or surgical. Medical management includes lifestyle changes such as weight loss and cessation of smoking. CPAP(Continuous Positive Airway Pressure) device helps in relieving symptoms of obstructive sleep apnea. It consists of a mask covering nose and mouth of the patient and pumps air into the patient’s airway at a constant pressure which will prevent negative pressure and airway collapse during sleep. The main disadvantage of CPAP is that it causes social discomfort.

The surgical treatment aims at correcting the structural defects that inturn causes OSA and the type of surgery depends on the site of obstruction. The surgical options include correction of nasal septum (septoplasty), correction of soft palate, uvula, anterior and posterior tonsillar pillars (uvulopalatopharyngoplasty), and mandibular/maxillary advancement surgery, hyoid suspension surgery, tongue base reduction, etc.

We at SVASTII offer investigations to find structural abnormalities (fiber-optic laryngoscopy) and provide minimally invasive daycare surgeries in the management of sleep apnoea and snoring. Book your appointment today.

OSA is a lifestyle disease that can lead to various morbidities. Proper lifestyle changes like a healthy diet, physical exercises, and avoiding smoking and drinking can help to overcome this condition.