Obstructive sleep apnoea (OSA): explained

The most vital part of our day is somewhat ironically the night- when we relax and recover from the stresses and strains of a days work which prepares us for the next day. Most of us will fall asleep without much delay and wake thoroughly refreshed and raring to go the next morning. But 10% of adults have a disrupted poor quality of sleep, punctuated throughout the night by intermittent blockage of the breathing passage, resulting in sleep disturbance which ultimately leads to a tired, groggy and at times irritable person. They may find it difficult to concentrate during the day and are prone to dozing which can be dangerous if working with machinery or driving. There can also be other psychological and physical issues which affect health and wellbeing.

In some people the impact on breathing may lead to heart and lung problems. The strain generated by this can also cause more serious conditions such as heart attacks, strokes or other debilitating conditions. This can affect their quality of life, to the extent they can reduce performance at work or school, increase accidents and result in low self-esteem. The no less significant impact on the psyche of people is much more difficult to quantify but no less important than the physical signs of ill health.

Some people may find their sleep disruption may coincide with other factors that alter the breathing passages such as a blocked nose from hay fever, or enlarged tonsils after throat infections. Others may find weight gain, alcohol consumption worsens the quality of their sleep due to multiple site narrowing of the breathing passages. Treating the cause for the blockage or narrowing of the airway might reverse the obstruction. Some people find they have sleep apnoea affecting more than one member of their family and this could be related to the shape of the persons’ airway – which may be similar in family members.

The breathing passages may respond to external appliances that open the airway physically- strips applied to the outer nose, or jaw advancement devices- which bring the mouth structures forward, both of which ultimately open the airway. These can be successful but may not be tolerated by all users. The gold standard treatment for this condition is to wear a mask over the face- either the nose or nose and mouth, which helps to push air into the throat and prevent blockage of the airway during sleep breathing. A number of surgical options are considered for those people who do not tolerate the above treatments or wish for a longer lasting solution.

It is not always clear that a person has sleep apnoea as there may be many other causes to account for daytime tiredness. Some people can snore loudly asleep and have no other issues with the airway. It can be very obvious in those who have excessive sleepiness, witnessed gasping and obstruction during sleep breathing indicating sleep apnoea. A sleep study can diagnose the likely cause of poor-quality sleep – a home study where the machine is attached by the person to their body or a hospital based polysomnographic sleep study might diagnose the severity of the airway problem, but the latter can also identify behavioural or other types of sleep disorder. Most patients will be seen by a surgeon or doctor with an interest in sleep related breathing problems. They will conduct a full assessment and look at the airway and decide on how best to manage and investigate.

Treatment for simple causes of airway blockage can help improve symptoms. Nose sprays or antihistamines, the use of an oral appliance, weight reduction as 60% of sleep apneas who are overweight, might improve matters. Treatment is best started after knowing the severity of the problem because this allows for monitoring of the efficacy of treatment. Those with moderate or severe sleep apnoea might need the continuous positive airway pressure (CPAP) face mask device.

The current guidelines advocate non-surgical approaches described but if this fails a surgical opinion is required.

When the above methods aren’t enough to control symptoms it’s worth seeking a sleep airway specialist’s surgical opinion. The doctor can make sure that the diagnosis is correct and that there aren’t other issues such as nasal or throat issues that might contribute to the breathing disorder. They can perform specialist endoscopy assessment in the clinic and assess the sleep airway to determine which sites are causing the blockage and formulate alternative surgical treatment strategies including for those people suffering simple non obstructive but socially disruptive snoring.

For most patients this broad and comprehensive approach will be enough to achieve excellent control.