SNORING

& OBSTRUCTIVE SLEEP APNOEA

Snoring is an extremely common problem affecting up to 40% of the population. It can disrupt the quality of sleep of both the patient and the partner. About 10% of these patients can have a condition known as obstructive sleep apnoea whereby they have breath holding episodes in their sleep which can cause oxygen deprivation. This can result in poor sleep, morning headaches and daytime sleepiness. If sleep apnoea is left untreated then the chances of developing other disorders such as ischaemic heart disease, diabetes, memory problems and stroke can increase.

Snoring occurs as a result of a turbulent airflow and can affect both children and adults. The commonest cause in children is due to enlarged tonsils and adenoids and there is plethora of evidence in the medical literature to demonstrate that removal of tonsils and adenoids in these children dramatically improves their quality of sleep as well as their cognitive function. In adults the problem could be due to an obstruction in the nose as a result of a deviated nasal septum or nasal polyps but more commonly it is the redundant, floppy soft palate in the throat that may be the culprit. Certain life style factors such as increased alcohol intake or obesity could aggravate the symptoms.

Evaluation of these patients would include:

  • A full upper airway examination using fibre-optic flexible endoscopy to try and identify the obstructive segment.
  • In addition some patients may require a sleep study to ascertain whether they are “simple snorers” or have obstructive sleep apnoea.
  • Some patients require drug induced sedation endoscopy to examine the dynamics of the upper airway obstruction

Treatment and Management

Patients with moderate or severe obstructive sleep apnoea would benefit from CPAP (continuous positive airway pressure) therapy. This device is very effective but some find it to be cumbersome and many patients would seek an alternative.
Another non-surgical solution to this problem would be to use an appliance called a mandibular advancement device.
Compliance and adherence to these appliances are not universally good; in particular having to use these devices every night could turn out to be tedious and many patients would want a one stop fix if possible. Surgery in carefully selected patients could offer a good alternative.

Surgery

Surgery in adults could deal with the problems arising from the nose, soft palate or indeed the back of the tongue. There have been recent developments in the surgical field to help these patients and they include the use of laser, radiofrequency equipment and transoral robotic surgery for the more complex cases. Nasal surgery in the form of septoplasty, nasal polypectomy or endoscopic sinus surgery may not only help patients with “simple snoring” but may also help facilitate the use of CPAP in the sleep apnoea patients if they are finding difficulty in tolerating this form of therapy. The surgery on the soft palate is usually performed to shorten and stiffen it so that it vibrates less. This can be undertaken using the laser or radiofrequency treatment.
Patient selection for different treatment modality is of utmost importance and therefore careful evaluation of the upper airway in these patients is crucial especially if any form of surgery is being considered.