Reviewed by: Professor Bhik Kotecha

What is sleep apnoea?

Sleep apnoea is a condition in which a patient stops breathing momentarily, but repeatedly, during sleep.

Snoring is one of the commonest presenting symptoms of sleep apnoea. Snoring can disrupt the quality of sleep of both the patient and their partner. More than 10% of patients who experience snoring may have a condition known as obstructive sleep apnoea whereby they have breath-holding episodes in their sleep which can cause oxygen deprivation.

If sleep apnoea is left untreated then the chances of developing other disorders such as ischaemic heart disease, diabetes, memory problems, dementia and stroke can increase. In addition to having higher risks of developing the above problems, intrusive snoring can play a detrimental role in relationships.

What causes snoring and sleep apnoea?

Snoring occurs as a result of a turbulent airflow and can affect both children and adults. If the airway becomes constantly obstructed then the patient could develop sleep apnoea.

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. More commonly it is the redundant, floppy soft palate in the throat that is the culprit.

What are the symptoms of sleep apnoea?

Symptoms of sleep apnoea include:

  • Snoring
  • Poor and fragmented sleep
  • Periodic gasping for breath
  • Morning headaches
  • Daytime sleepiness.

How is sleep apnoea diagnosed?

Sleep apnoea can be diagnosed using ambulatory home sleep studies. The outcome of this test will determine the best treatment.

What happens during an ambulatory home sleep study?

During a home sleep study you will be given equipment to take home for 2-3 nights in order to track your sleep in your normal environment. The data is then downloaded and evaluated for number of episodes of breath-holding and oxygen deprivation.

What is the treatment for sleep apnoea?

Sleep apnoea treatment options include:

  • Nasal CPAP (Continuous Positive Airway Pressure)
  • Oral appliances such as mandibular advancement device or novel device such as eXciteOSA
  • Medical treatment with nasal sprays and antihistamines - these may help patients with allergic rhinitis by improving breathing through the nose and thus improve snoring
  • Lifestyle changes such as weight loss and reduction of alcohol intake.

Patient compliance with medication and appliances can be poor and therefore surgery in carefully selected patients could offer a good alternative.

Surgery involves a range of procedures including:

  • Minimally invasive radiofrequency surgery  to improve the upper airway by shortening and stiffening the soft palate, reducing the bulkiness of the tongue and improving nasal patency
  • Soft palate, tongue and nasal surgery
  • Tonsillectomy
  • Laser or robotic surgery.

Surgery may also help improve utilisation of appliances, or alleviate the need to use them.

Patient selection is crucial and this is achieved by performing drug-induced sleep endoscopy whereby a hospitalised patient is given sedative agents to mimic sleep, snoring and obstruction and a fibre optic endoscope inserted through the nose and in to the throat allowing a three dimensional evaluation of the upper airway anatomy in the dynamic mode.

Obstructive Sleep Apnoea in children (OSA)

Children with large adenoids and tonsils are regular mouth breathers during sleep and sometimes even when they are awake. You can hear them snoring at night and suddenly the snoring stops for a few seconds (this happens when they stop breathing) and then they suddenly start snoring again with a snorting type of noise. This can happen many times in an hour.

As a result, they have disturbed sleep at night. You might find them breathing hard with a recession of neck and chest muscles. They also sweat at night. They move a lot during sleep in an effort to find a comfortable position to breathe. It is difficult to wake them up in the morning. Because of lack of sleep, they are tired during the daytime (some children are hyperactive). They lack the ability to concentrate at school and perform badly in their studies.

Treatment for obstructive sleep apnoea

Once children are diagnosed with enlarged adenoids and/or tonsils, treatment consists of surgery in the form of adenoidectomy or tonsillectomy or a mixture of both. Most often a camera test through the nose is required to diagnose enlarged adenoids. Tonsil examination is possible through the mouth.

Coblation tonsillotomy is a form of tonsil reduction surgery that produces minimal postoperative pain and bleeding. Children resume their normal diet almost the same day itself. It is indeed a life-changing surgery for those children with obstructive sleep apnoea.