Behind All that Snoring

If your answer is yes to any of the above; you may be suffering from obstructive sleep apnea (OSA), a common i sleep disorder. In a study performed by the National University of Singapore, the prevalence of OSA in Singapore was estimated to be 4.3 per cent among females and 13.6 per cent among males. It is more common among men, obese individuals as well as those with habitual snoring, daytime sleepiness and hypertension.

About Obstructive Sleep Apnea (OSA)

In OSA, the upper airway (throat) closes repeatedly during sleep. Each time, breathing stops for 10 to 30 seconds or longer, usually until a brief arousal occurs. The throat then opens, breathing resumes and patient falls back asleep, only to repeat the Some patients stop breathing hundreds of times ;each night without remembering any of these episodes because arousals from sleep, are so brief.

One of the most common effects of OSA Is excessive daytime sleepiness. Thinking ability, including concentration and decision--making ability, can also be affected. Left untreated, obstructive sleep apnea may lead to high blood pressure, stroke, heart attack, heart failure or shorter lifespan. In children, obstructive sleep apnea often occurs in association with large tonsils. Children with this condition may show inattention, hyperactivity, sleepiness or other behavioral problems.

Diagnosing Obstructive Sleep Apnea (OSA)

Make a trip to the doctor if you suspect that you are suffering from a sleep disorder. The doctor will spend much of the first visit asking you about your medical and sleep history, and perform a physical examination. Often, but not always, an overnight sleep study (polysomnogram) in a sleep laboratory will be recommended. The purpose is usually to confirm the presence of a sleep disorder or to help assess how severe it is.

If OSA is suspected, the doctor will order a sleep study to confirm the diagnosis. It requires an overnight stay in a private room or in a sleep laboratory. On the day of the study, the patient can continue his usual daily activities but is encouraged to avoid naps, caffeine and alcohol. The patient is usually requested to arrive at the laboratory around 8 or 9pm, bringing along sleepwear, toiletries and any medications - similar to what one would do on a trip away from home. In the room or lab; monitoring devices will be used to collect the information requested by the doctor. Sensors used will monitor the patient's brain waves (EEG activity), heart rate (EKG), eye movements, leg muscle activity as well as chest and stomach movements. Air flow from the nose and mouth, and oxygen level will be recorded. The amount of oxygen in the blood is monitored by a sensor that is clipped onto a finger. Other monitors may be required to collect other specific information requested by the doctor. Usually, a polysomnogram ends around 6am the next day and the patient can return to his usual daytime routine.

Treatment Options

Once identified, OSA can be successfully treated in most instances. The most common form of treatment is continuous positive airway pressure (CPAP), where the patient sleeps with a mask over the nose. The mask is connected by a long flexible tubing to a machine about the size of a large shoebox. The CPAP unit transmits pressurised air through the nose and into the throat, where the walls of the airway are splinted open. The patient can then breathe normally, without apneic pauses. Patients will be reviewed a few weeks after commencement of CPAP to assess their response to the treatment. The CPAP therapy is usually highly effective if used properly every night.

Alternative forms of treatment include surgery and use of oral devices. Children are often treated by removal of the tonsils and adenoids. Our Sleep Clinic a two-bed, modern sleep laboratory with equipment for digital polysomnography, specialised studies of breathing and abnormal behaviors during sleep, and CPAP titration (overnight study for treatment) is available at NUH.

Source: National University Hospital- (National Healthcare Group) Singapore.

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