Persistent snoring may be more than a nighttime inconvenience.

In some patients, loud snoring, choking during sleep, repeated pauses in breathing, disturbed sleep and excessive daytime sleepiness may indicate Obstructive Sleep Apnea (OSA).

At our Snoring & Sleep Apnea Clinic, we focus on identifying why the airway is narrowing during sleep and selecting treatment according to the individual patient.

Our approach includes:

• Detailed sleep and airway evaluation
• Review of sleep study findings
• Nasal and upper-airway endoscopy
• Assessment of tonsils, palate, tongue base and jaw structure
• Drug-Induced Sleep Endoscopy (DISE) in selected patients
• Non-surgical and surgical treatment planning
• Follow-up after treatment

Treatment for obstructive sleep apnea depends on several factors, including:

• Severity of sleep apnea
• Body weight and metabolic factors
• Site of airway obstruction
• Tonsil size
• Nasal obstruction
• Palatal collapse
• Tongue-base obstruction
• Jaw and facial anatomy
• Ability to tolerate CPAP

Treatment may therefore include lifestyle modification, weight optimisation, positional therapy, CPAP, oral appliances or surgery.

The objective is not simply to stop snoring.

The objective is to identify the cause of airway obstruction and select the most appropriate treatment for that patient.

 Obstructive Sleep Apnea occurs when the upper airway repeatedly narrows or collapses during sleep.

This can result in repeated drops in oxygen levels and brief awakenings throughout the night.

Patients may not remember waking up, but the repeated disruption can significantly affect sleep quality.

Common symptoms include:

• Loud habitual snoring
• Pauses in breathing noticed by a partner
• Choking or gasping during sleep
• Excessive daytime sleepiness
• Morning headaches
• Poor concentration
• Irritability
• Unrefreshing sleep
• Frequent nighttime urination
• High blood pressure

OSA should not be diagnosed from snoring alone. Proper clinical evaluation and sleep testing are important.

We begin by understanding your symptoms, sleep pattern, medical conditions, weight, nasal breathing and previous treatments.

A sleep study helps determine whether obstructive sleep apnea is present and how severe it is.

Important parameters include the Apnea–Hypopnea Index, oxygen levels and sleep-related breathing disturbances.

The nose, tonsils, palate, throat, tongue base and other airway structures are evaluated to identify possible areas of obstruction.

In selected patients, DISE may be advised to assess the airway dynamically while the patient is in a sleep-like state.

DISE can help identify whether obstruction occurs predominantly at the:

• Soft palate
• Lateral pharyngeal walls
• Tongue base
• Epiglottis

or at multiple levels.

Treatment is selected according to the severity of OSA, airway anatomy, symptoms, medical conditions and patient preference.

 Awake examination does not always demonstrate what happens to the upper airway during sleep.

During DISE, carefully controlled sedation creates a sleep-like state while a flexible endoscope is used to observe the airway.

The pattern and level of collapse can then be assessed.

DISE may be particularly useful when:

• Sleep apnea surgery is being considered
• CPAP cannot be tolerated
• Previous surgery has not adequately controlled OSA
• Multilevel airway obstruction is suspected
• The site of obstruction is uncertain

DISE does not replace a sleep study. The two tests answer different questions.

Sleep study: How severe is the sleep apnea?

DISE: Where and how is the airway collapsing?

 Surgery may be considered in carefully selected patients when anatomical obstruction contributes significantly to OSA.

Depending on the patient, treatment may involve one or more airway levels.

Possible procedures may include:

Septoplasty or turbinate procedures may improve nasal breathing in selected patients.

Improved nasal airflow may also help some patients tolerate CPAP more comfortably.

Large tonsils can significantly narrow the throat.

Tonsil surgery may provide substantial benefit in appropriately selected adults and children.

Selected patients with palatal obstruction may benefit from procedures designed to improve the retropalatal airway.

When significant tongue-base obstruction is demonstrated, treatment may need to address this level.

Some patients have obstruction at more than one anatomical level.

For these patients, treatment may need to be planned according to the complete airway pattern rather than focusing on a single structure.

 CPAP remains one of the most effective treatments for moderate and severe obstructive sleep apnea.

Surgery is not automatically a replacement for CPAP.

However, surgical evaluation can be useful when:

• CPAP is poorly tolerated
• A major anatomical obstruction is identified
• Very large tonsils are present
• Significant nasal obstruction interferes with CPAP
• The patient wants to understand alternative treatment options
• Persistent OSA remains after previous treatment

The best treatment should be chosen after understanding both the severity of the disease and the patient's airway anatomy.

 Not every person who snores has obstructive sleep apnea.

Simple snoring may occur because of vibration of tissues within the nose, soft palate, throat or tongue-base region.

However, particularly loud or progressive snoring should be evaluated when associated with:

• Witnessed breathing pauses
• Choking during sleep
• Excessive daytime sleepiness
• Obesity
• High blood pressure
• Morning headaches
• Poor concentration

 Children can also develop obstructive sleep apnea.

Common signs include:

• Loud snoring
• Mouth breathing
• Restless sleep
• Pauses in breathing
• Unusual sleeping positions
• Poor attention
• Hyperactivity
• Bed-wetting
• Difficulty waking in the morning

Enlarged tonsils and adenoids are common contributors to pediatric OSA.

Children with persistent snoring should therefore be appropriately evaluated rather than assuming that snoring is harmless.

 Consider an assessment if you or your partner notices:

✓ Loud snoring most nights
✓ Pauses in breathing during sleep
✓ Gasping or choking at night
✓ Persistent daytime sleepiness
✓ Morning headaches
✓ Difficulty concentrating
✓ Resistant high blood pressure
✓ Poor-quality sleep despite adequate sleep duration