Obstructive sleep apnoea in adults

What is Obstructive Sleep Apnoea?

Obstructive sleep apnoea (OSA) is a condition where a patient can’t breath in enough air while they are asleep. Most people with OSA have the problem every night and may wake in the morning not feeling as though they have slept at all. OSA is a potentially serious medical condition which you should seek treatment for.

How common is OSA?

OSA is very common. At present estimates are that 4% of males and 2% of females suffer from OSA.

What is an apnoea?

An apnoea is where a patient doesn’t breath for longer than 10 seconds while they are asleep. If you suspect that your partner has OSA then watch them sleeping. If they stop breathing for longer than 10 seconds then chances are they have some degree of OSA. If you are in doubt, take a video recording of them sleeping and then look at it the next day.

What are the symptoms of OSA?

Patients with OSA can have a variety of symptoms, some which are obviously associated with the OSA and others which may not be so obvious. Obvious symptoms include:

• Restless sleep
• Snoring
• Sleepiness during the day
• Bed wetting
• Waking unrefreshed

Some of the less obvious symptoms and medical conditions include:

• Morning headache
• Poor concentration
• Impotence
• Mood changes
• High blood pressure

Obviously some of these symptoms or medical conditions may be due to other underlying conditions but if you have OSA it will certainly contribute to these conditions.

Is OSA a serious condition?

OSA is a very serious condition. It needs to be treated because it can lead to problems with blood pressure and heart disease. OSA is also associated with being very tired during the day which can lead to very serious problems when you are driving.

What causes OSA?

There is no one cause for OSA and the condition is multifactorial in almost all cases. The following are contributing factors and risks for OSA:

• Male
• Obesity – BMI > 25
• Blocked nose
• Large tonsils
• Redundant soft palate
• Large tongue
• Sedative medication
• Alcohol
• Smoking

There are other causes and risk factors for OSA however the ones mentioned are the more common.

What investigations do I need?

To accurately diagnose OSA you should have a sleep study. This helps quantify the degree of OSA. Sometimes after having a sleep study you may be offered a CPAP machine

How is OSA measured?

OSA is measured with a number called the respiratory disturbance index [RDI]. This is also sometimes called the apnea hypopnea index. What this number represents is the number of times per hour that a patient has either a decrease in breathing or no breathing. This number then allows us to classify whether someone has mild, moderate or severe OSA. The classification of mild moderate and severe is as follows:

• Mild – AHI 5 – 15
• Moderate – AHI 15-30
• Severe – AHI > 30

What can be done medically for OSA?

Medical treatment for OSA involves using a CPAP machine. In addition to this if you have a blocked nose then treatment will also focus on improving your breathing through your nose.

Dr Dan Robinson and Dr Sam Dowthwaite start most people on combination intranasal steroids and salt water nasal washes for a total of 6 weeks to see if there is an improvement in the quality of sleep as well as an improvement in the breathing through your nose.

Other medical options include:

• Weight loss
• Decrease alcohol
• Decrease sleeping tablets

What are the surgical options of OSA?

A lot of people can’t tolerate the CPAP machine because they feel their nose blocks up when they wear it or alternatively would prefer to see if there is an operation which might improve their sleep.

If you have a blocked nose then fixing this is the first surgical procedure in the treatment of OSA. The operation is either a rhinoplasty or a septoplasty and turbinoplasty depending on the cause of your nasal obstruction.

The success in improving the quality of sleep from improving the breathing through the nose is high. Associated with this a lot of patients also notice that they can tolerate the CPAP machine much better if their nose has been opened up.

If you are still having problems with the quality of sleep and OSA then you may need a second procedure which is called a modified uvulopalatopharyngoplasty (UPPP)

The UPPP procedure has changed dramatically over the last 5 years, changing from an operation with limited success to a procedure which has a much higher success rate. Dr Dan Robinson has been taught how to perform a modified UPPP procedure by one of the leading sleep surgeons in Australia, Dr Stuart Mackay. This procedure is not as painful and has a higher success rate than the previous UPPP procedure. Dr Sam Dowthwaite has also been training in this procedure.

If you are still having problems with OSA then you may need surgery on your tongue. Dr Sam Dowthwaite has had international experience in transoral robotic surgery on the base of tongue for snoring which may be the next step in the treatment of your OSA.

What to do from here?

If you would like to see Dr Dan Robinson or Dr Sam Dowthwaite about your OSA then make an appointment. It is helpful if you know the names of any nasal sprays which you have trialed and bring along any results from a sleep study which you may have had. We look forward to seeing you and hopefully improving your sleep.