Obstructive sleep apnoea is a potentially serious disorder where breathing typically stops for at least 10 seconds, more than 5 times per hour during the night. These pauses in breathing are called apnoeas. It is also the most common form of apnoea, although many adults may not even know they have the condition.
Apnoea cuts off the oxygen supply to the body and the rise in carbon dioxide eventually awakens the patient who gasps for air, making a snorting sound.
Obstructive hypopnoea, is another less severe form caused by incomplete airway obstruction. Breathing is continuous but shallow and is accompanied by snoring and decrease in blood oxygen.
It occurs when the tissues at the back of
the upper throat collapse during sleep,
blocking the air passage even though
the action of breathing continues.
If you think you may have sleep apnoea, see a sleep specialist who can take a detailed history and perform a head and neck examination. If the doctor suspects a sleep disorder, then you will be referred for an overnight sleep study (polysomnography).
The sleep study is the gold standard for diagnosing snoring and sleep apnoea. It tracks your brain, heart and eye activity as well as the breathing and blood oxygen level patterns. Sleep experts will track episodes where breathing is shallow or stops for longer than 10 seconds.
Apnoea is significant if more than five episodes per hour are reported. If there are more than 15 episodes per hour, the condition is serious.
Given the long-term complications of sleep apnoea, it is important for patients to undergo treatment. Due to its association with heart problems and stroke, sleep apnoea that does not respond to lifestyle measures should be treated by a physician, ideally a professional specifically trained to treat sleep disorders.
1. Continuous Positive Airway Pressure (CPAP) At this time, the most effective treatments for sleep apnoea are devices that deliver slightly pressurised air (CPAP) to keep the throat open during the night. CPAP is done through a mask applied to the nose during sleep.
2. Oral Appliances/Special Dental Splints
Several oral appliances are available and are effective in treating mild to moderate obstructive sleep apnoea.
a. Mandibular Advancement Splint
It looks similar to a sports mouth guard and is worn over the upper and lower teeth during sleep to push the lower jaw forward, opening up the airway at the back of the tongue. Adjustments may be necessary in the first few months.
b. Tongue Retaining Device
The device pulls and retains the tongue in a forward position to prevent the tongue from collapsing and obstructing the airway during sleep.
Surgery is sometimes recommended
for severe obstructive apnoea. They include procedures to remove
obstructions in the airway and expand the airway, and the apnoeas and
hypopnoeas may be greatly reduced
or completely resolved. Patients
must be assessed by sleep specialists
to decide whether surgery is the
preferred solution for them.
1. Genioglossus advancement surgery is surgery at the chin.
This pulls the tongue muscle forward and creates a larger airway
between the back of the tongue and the throat. The tongue is also less
likely to fall backwards, resulting in easier breathing during sleep.
2. Maxillomandibular advancement (MMA) is a more invasive surgical
procedure that brings forward both the upper and lower jaws. This pulls
on the soft tissues attached to the jaw bones, tightening up the lax tissue
at the back of the nose, mouth and voice box.
The airway also becomes bigger. The procedure is done using wellestablished
orthognathic (jaw) surgery techniques. Long-term studies
have shown a 90 percent success rate with this procedure.
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