Exploring the discontents of sleep apnea

Dr Toh Song Tar is the Head & Senior Consultant at the Department of Otorhinolaryngology--Head & Neck Surgery in Singapore General Hospital. He is also the Head of Singhealth Duke--NUS Sleep Centre.  He is an appointed Adjunct Associate Professor of the National University of Singapore, Yong Loo Lin School of Medicine, and Duke-NUS Medical School and a Clinical Physician Faculty for the Singhealth Residency Program (ENT, General Surgery, and Family Medicine). He is appointed National Examiner by Ministry of Health, Singapore, and sits on the exam committee for both Master of Medicine (ORL), NUS Graduate Medical School and Exit Exam, Joint Commission Specialist Training.

Dr Song Tar visited Bangladesh a few days back, and was happy to share some of his thoughts and perspectives on sleep apnea, a major disorder related to sleep which is starting to affect a large portion of society.

What is obstructive sleep apnea?

Obstructive sleep apnea is a condition that affects a patient during sleep. Due to obstruction of the airways, it can lead to turbulence of airflows and vibration of tissues. As a result of the obstruction, the oxygen level in the body can drop.  People affected by this condition snore, have observed stoppage in breathing, choking and gasping episodes, and their sleep quality can be severely affected due to frequent arousals to open the upper airway to overcome the obstruction.

What are the major causes?

The major causes are related to the tissues of the throat obstructing during sleep. It occurs in people with large tonsils, redundant and lax soft palate, and bulky tongue. Allergies, causing nasal and upper airway inflammation can narrow the airway as well.  If the upper and lower jaw structures are small, the upper airway will be small and that can predispose to obstruction during sleep. People with obesity have more fatty deposits in the tongue, soft palate and region surrounding the upper airway, hence narrowing the air passage. As a person ages, the upper airway tissue can become laxed as well. Benign or cancerous tumor can obstruct the upper airway (nose, mouth, throat).

What are the symptoms?

Patients can present with loud snoring, stoppage of breathing, choking and gasping episodes. They have unrefreshed sleep and excessive daytime sleepiness, and often take large amounts of caffeine to stay awake. They often feel tired and may have difficulty concentrating during work, doze off during meetings and experience sleepy driving.

What are the dietary and lifestyle choices that should be followed and avoided?

Patients should  sleep  7-8  hours per night, at scheduled time. Dietary intakes should be maintained, with low intakes of carbohydrate and fatty food. Weight loss should be a top priority, as it contributes to obstructive sleep apnea. Regular exercises of 20-30 minutes can help to reduce weight. Tongue and throat exercises have been shown to help with obstructive sleep apnea as they tone up throat muscles.

What are the treatments?

There is CPAP (Continuous Positive Airway Pressure), which acts like a pneumatic splint to open up the airway. Oral appliances can be used to position the jaw forward to open up the posterior airway space. Surgery is another option when it comes to treatment. This is done to reduce the size of tissue in the nose, throat tissue, and tongue area. There is also skeletal surgery, which pulls the upper and lower jaws forward to open up the airways. A new treatment called hypoglossal nerve stimulator has shown success in opening up the airway by stimulating the nerve that controls the tongue muscles.

How does one cope with sleep apnea?

You should see a doctor if you suspect you have obstructive sleep apnea. The doctor can carry a sleep test to confirm the diagnosis. The sleep test will show the number of times the upper airway obstructs during sleep, and how low the oxygen drops during sleep.

Is obstructive sleep apnea related to other diseases?

Yes, it is associated with hypertension, heart attack, stroke, neurocognitive decline, and type 2 diabetes.

What is the prevalence rate of sleep apnea in Bangladesh?

According to research in Dhaka, 1 in 10 people have obstructive sleep apnea. The incidence of prevalence is expected to increase.

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