Thank you for your questions. As your questions have been answered well by Dr Chua, I shall not be repetitious. However, I would like to elaborate on why snoring is a significant symptom and the assessments involved for a snorer.
Snoring is a common symptom and a local study has shown that up to 30% of Singaporeans snore. It is a significant symptom for 2 main reasons:
1. If the snorer has a bed partner, he/she will be frustrated and possibly sleep deprived from the constant or loud snoring.
2. Snoring may be just the tip of the iceberg and is a common symptom of a potentially serious health condition called obstructive sleep apnoea (OSA).
OSA occurs when the muscles around the upper airway (breathing passage around the mouth/throat) relaxes and obstructs/closes the upper airway for a short period of time during sleep.
Hence, the patient literally “chokes during sleep”. If this happens many times during sleep, it can lead to serious health consequences such as:
- High blood pressure
- Irregular heart beats
- Stroke
- Diabetes
- Poor concentration/tiredness during the day.
The assessment of a snorer includes:
1. A medical history (e.g questions to determine risk factors for OSA and potential complications from OSA)
2. Physical examination – this aims to determine the level of blockage in the upper airway and likely would include a:
i) Measurement of your height, weight and body mass index (BMI)
ii) Examination of the head & neck region – to look for possible causes/contributors of snoring/OSA (e.g. enlarged tonsils in the throat, thick neck, small or receded chin etc)
iii) Nasoendoscopy – Passage of a small scope (lighted tube with a camera) through the nose to assess the upper airway. This is a relatively painless procedure done in the clinic under local anaesthesia.
Examples of common causes of snoring or OSA seen on nasoendoscopy include:
- Enlarged inferior turbinates
- Deviated nasal septum
- Sinusitis with or without nasal polyps
- Enlarged adenoids in the nose
- Bulky back of tongue
- Large tonsils
3. Diagnostic test for OSA – the only way to confirm the presence or absence of OSA is to undergo an investigation called a Sleep Study.
This involves placements of sensors/wires on various parts of the body to assess the patient’s sleep. The test is an overnight study done in a hospital or at a patient’s home (at least 6 hours of sleep is usually recommended).
There are many different types of sleep study, and it is beyond the scope of this Q&A to address all of them.
Your ENT Specialist should be able to advise you on one that suits you best. Amongst the parameters measured during a sleep study may include:
- Your brain activity
- Heart activity
- Muscle activity
- Amount of snoring or “choking episodes”
- Oxygen level in the blood etc.
The medical index used to determine OSA is called Apnoea-Hypopnoea Index (AHI). If a patient “chokes” more than 5 times in an hour, he or she has OSA.
OSA is classified as mild, moderate or severe, depending on the amount of “choking”/hour or AHI.
Treatment of a patient with snoring or OSA includes lifestyle modifications, continuous positive airway pressure (CPAP) therapy, dental devices and surgery.
There is no quick fix to snoring or OSA and often a combination of the treatment modalities may be required.
Hope this helps!
