HEALTH: SNORING & SLEEP APNOEA | Dr. Merin Mathew, India

 

Do you snore? Is snoring a health concern as it is very common these days? Yes, Snoring is an important cause of Sleep Disturbance which is mostly associated with Sleep Apnoea/Obstructive Sleep Apnoea (OSA) and is now considered to be a major public health concern with significant morbidity & mortality in all age groups. OSA is a condition characterized by repetitive upper airway obstruction leading to sleep fragmentation, cardiac stimulation, and oxygen desaturation (reduction in blood’s oxygen level) during sleep; Together these lead to symptoms such as snoring, unrefreshing sleep, excessive daytime sleepiness, loss of memory, mood changes, fatigue, and the increased risk of cardiac disease (myocardial infarction, congestive heart failure), hypertension, insulin resistance (diabetes mellitus), cerebrovascular disease (stroke), and road traffic accidents due to sleeplessness.

OSA causes loud persistent snoring interrupted by gasping or choking episodes and silent periods which are apnoeas or cessation of breathing. However, simple snoring without apnoea is a more common and normal phenomenon. In certain habitual snorers, increased upper airway resistance during sleep may lead to sleep fragmentation and hypersomnolence even in the absence of frank apnoea.

In children, it causes significant sleep disruption which leads to daytime neurobehavioral problems such as an increase in total sleep time, hyperactivity, irritability, learning disabilities, bed-wetting, and morning headaches.

It is estimated that 25% of adult males and 15% of adult females snore and its prevalence increases with age. OSA has a prevalence of approximately 2% in the pediatric population. Sleep-disordered breathing can affect children of all ages, but its peak incidence is between the ages of 3 and 7 when the adenoid and tonsillar lymphoid tissue is disproportionately large relative to the pharyngeal airway.

Factors that increase the risk of OSA include abnormalities in both upper airway size and muscle activity; Obesity is a major risk factor, and upper body obesity results in fat deposition around the airway and in the related soft tissues. Gender is an important risk factor with higher predominance seen in male as men tend to gain weight more centrally & this pattern results in men having more fat stored in upper airway structures and abdomen than women; Sex hormones influence upper body obesity and mostly seen in postmenopausal women and are mostly associated with libido in men. Finally, individual variations in mandibular, tongue, and soft palate size and position contribute to upper airway size. Adenotonsillar hypertrophy during childhood causes abnormal craniofacial development which results in a narrow adult upper airway. Use of alcohol, sedatives, and hypnotics aggravates snoring.

The best test for OSA is overnight Polysomnography which involves monitoring of both sleep & respiration. However home multichannel testing is also available, advantages over in-hospital studies include better patient comfort, cost savings, prevention of hospital admission, and speed of analysis data. Overall, home evaluation is useful when the results are clearly positive. However, negative results do not rule out the presence of a sleep disorder.

The choice of treatment modality is guided by the nature, level of obstruction, and symptoms of the patient. Lifestyle changes such as Weight loss (particularly if the BMI is greater than 25g/m2) and dietary changes are recommended; it is advised to sleep on the side as supine position may cause obstructive apnoea; use of Nocturnal application of CPAP (Continuous Positive Airway Pressure) which acts as a pneumatic splint, whereby blowing air via a tube and mask through nasal and/or oral passageway, will support the pharyngeal and palatal walls, preventing collapse of the airway; Intraoral appliances such as Mandibular Advancement Device (MAD) which hold the mandible in protrusion during sleep are non-surgical treatment options.

Surgical Procedures have been developed to alter the offending anatomic abnormalities responsible for OSA. Identification of this offending anatomic site with application of most appropriate surgical procedure is essential for effective surgical treatment of OSA.

Obstructive Sleep Apnea is increasing in its prevalence and more patients are presenting to us with snoring and Sleep Apnoea. Obtaining information, in particular symptoms associated with OSA and other comorbidities is important in overcoming this health concern. The treatment of Sleep apnoea has evolved from only treating snoring and breath-holding to treating the symptoms and modifying cardiac risks. The role of OSA in road traffic accidents continues to provoke emotions among the public. CPAP remains the mainstay of medical treatment but emphasis must also be placed on lifestyle changes such as weight loss strategies.

Sleep is not a luxury, it’s an essential. To live well, you must sleep well and so take the questionnaire given below and visit your doctor at the earliest.

If you snore excessively and have any of the additional problems listed below, you may have sleep apnea. Please consider discussing a sleep evaluation with your doctor.

1. Do you snore loudly? Yes _ No ___
2. Does your bedroom partner complain about your snoring? Yes _ No ___
3. Does your snoring wake you up at night? Yes _ No ___
4. Do you or your bedroom partner notice that you make gasping and choking noises during sleep? Yes _ No ___
5. Do you have a dry mouth, sore throat or headache in the morning? Yes _ No ___
6. Do you often fall asleep during the daytime when you want to stay awake? Yes _ No ___
7. Are you often tired during the day? Yes _ No ___
8. Do you have high blood pressure? Yes _ No ___

(Reference and Sources: ​Scott-Brown’s Otorhinolaryngology)