Snoring & Sleep Apnoea
What is snoring?
Snoring is noisy breathing that occurs during sleep. It affects up to 48% of adults to some degree and over 20% of middle-aged Australian males snore for more than half the night.
What causes it?
Snoring arises from partial obstruction of the upper airway during sleep. The upper airway is composed of the nose, mouth (including the tongue and palate), throat (pharynx) and voicebox (larynx). Some parts of the upper airway are composed of bone and cartilage, which are firm tissues.
Abnormalities of these structures can cause a constantly narrowed upper airway, but some patients may not be aware of this narrowing during the day. During sleep, the soft parts of the airway, which are composed of muscle, connective tissue and mucosa (or skin), may become floppy and lead to further narrowing of the airway and partial obstruction.
How is it treated?
Treatment of snoring may involve lifestyle measures, weight loss, dental splints or surgery.
What is Obstructive Sleep Apnoea (OSA)?
Obstructive sleep apnoea (OSA) is characterized by upper airway obstruction with reduction in airflow and disruption of sleep quality. It affects up to 25% of middle-aged adults in Australia. While snoring and breathing difficulties may be apparent at night, patients may be affected during the day with fatigue, difficulty concentrating, alterations in mood and sleepiness.
Why does it happen?
In a similar way to snoring, the upper airway collapses during sleep. However in OSA, the collapse is complete and leads to additional problems, including a drop in blood oxygen levels, higher blood pressure and increased respiratory muscle effort to overcome the obstruction. Ultimately, the patient’s sleep is disturbed, they rouse to overcome the airway obstruction and commence breathing again. Sleep allows the body to recharge after the day’s activities, so disturbed sleep can affect a patient’s functioning during the day.
How is it treated?
Treatment is based on the patient’s history, examination and sleep study results. It may involve lifestyle measures, weight loss, a mask worn at night to deliver pressurized air to prevent airway collapse (CPAP), dental splints or surgery.
The role of surgery may be to assist other therapies (such as CPAP), to act as salvage treatment after other therapies fail or, less commonly, to cure OSA due to isolated pathologies, such as very large tonsils.
Which surgery do I need for my snoring or obstructive sleep apnoea?
Surgery for snoring or OSA aims to widen or stiffen the airway. It usually involves multiple sites. Surgery may be required more than once.
Nasal surgery may reduce CPAP pressure requirements and increase a patient’s ability to tolerate the CPAP, which can often be uncomfortable. In selected cases, it can reduce snoring.
While adenotonsillectomy is curative in the majority of children with snoring or sleep apnoea, its role is confined to a minority of adults. In properly selected adults, however, it can reduce snoring or the severity of OSA significantly.
Newer, reconstructive techniques of uvulopalatopharyngoplasty (UPPP) have been described for this operation, which, had fallen out of favour due to a lack of predictable results. The Friedman staging system, which takes into account tonsil size, palate position and obesity, allows stratification of patients. Friedman stage 1 patients have an 80% success rate with UPPP.
New techniques of tongue base reduction and lingual tonsillectomy using coblation technology, offer low morbidity alternatives to more traditional approaches. Quality of life and severity of OSA have shown improvements. Overall, multi-level upper airway surgery for OSA has similar quality of life outcomes to CPAP.
Ultimately, decisions about non-operative versus surgical treatments are based on individual factors, making choosing the right patient for the right treatment vital to successful outcomes.