Sleep Apnoea: Why It Matters and How It Can Be Treated

Treatment depends on severity, anatomy, and patient preference.

CPAP (Continuous Positive Airway Pressure)

CPAP is the gold-standard treatment for moderate to severe OSA. A CPAP machine gently blows pressurised air through a mask, keeping the airway open at night. CPAP has been shown to significantly reduce Apnoea and Hypopnoea events, OSA severity, sleepiness scores and high blood pressure.

CPAP therapy is generally expected to be a long term or life-long therapy, unless an underlying contributing cause can be identified and treated. For example, a patient who is overweight may have improvement in his sleep apnoea after losing sufficient weight, and CPAP may be able to be weaned off. However, some patients may have multiple underlying factors contributing to sleep apnoea, and may not be able to be weaned off the machine easily.

Oral appliances

Custom-made dental devices that reposition the jaw or tongue to keep the airway open. Suitable for first line treatment for simple snoring and mild OSA, or second line treatment for moderate-severe OSA patients who are unable to tolerate CPAP.

Surgery

For patients with structural issues:

• Nasal surgery (to clear blockages)
• Tonsillectomy / adenoidectomy (removing enlarged tissues)
• Soft palate surgery (to stiffen floppy tissue and widen the airway)
• Maxillomandibular advancement (moving the jaws forward)

Advanced surgery: Robotic tongue base reduction

A cutting-edge option where robotic instruments trim excess tissue at the tongue base, creating more airway space. The surgical robot is controlled in real-time by a specialist surgeon, which allows magnified and 3-dimensional visualization of the tongue base structures, and precise control of instruments beyond the limitations of movements of traditional instruments, to allow removal of tissue with minimal trauma.

Advanced surgery: Upper Airway Stimulation / Hypoglossal Nerve Stimulation

Upper airway stimulation (UAS) or hypoglossal nerve stimulation (HGNS) involves the surgical implantation of a device to treat sleep apnoea. HGNS works by sending small amounts of electrical signal to the nerve of the tongue, causing it to stiffen and protrude forward slightly, thus preventing the tongue from collapsing into the throat, and widening the airway. The device is only switched on by the patient for use at night, and does not affect speech or swallowing when turned off in the day.

The device has been widely used in the United States of America (USA) since 2014 but has only recently been introduced in Singapore. The first case was performed by the team at Singhealth in 2022 and is currently being offered to patients with moderate to severe OSA who are unable to tolerate or accept CPAP treatment.

Beyond medical devices and surgery, simple daily exercises can strengthen throat and tongue muscles, helping reduce airway collapse.

Dr Phua Chu Qin, Senior Consultant from the Department of Otolaryngology (Ear, Nose & Throat) at Sengkang General Hospital (SKH), explains:

“Performing myofunctional therapy exercises can help to increase the tone and strength of the upper airway muscles, thereby reducing the collapse of the upper airway during sleep. In addition, doing nasal breathing exercises can reduce mouth breathing during sleep which can help stabilise the upper airway in some patients.”

Being overweight is a major risk factor for obstructive sleep apnoea, due to deposition of fat within the neck and muscles of the tongue and throat. For patients who are overweight, losing weight is an important adjunctive treatment for sleep apnoea. A 10% reduction in body weight can reduce the apnoea-hypopnoea index by more than 40%.

However, some patients who are of normal weight may still have OSA for other reasons such as structural abnormalities or weaker muscle tone. Sustained weight loss may also take several months to years to achieve. Thus, patients should still consider concurrent forms of therapy to address their OSA while embarking on their weight loss journey. 

Some patients only have snoring and OSA when they sleep in certain positions, particularly when on their back (supine), and may have control of their symptoms and OSA with sleeping on the side or propped up. However, sustained response to positional therapy should be monitored and evaluated by a doctor.  

Consult your doctor if you:

• Snore loudly and regularly with choking/gasping
• Experience pauses in breathing during sleep
• Feel excessively tired in the day despite “sleeping” at night

Early diagnosis and treatment of OSA can greatly improve quality of life and reduce the risk of heart disease and other complications.

• Sengkang General Hospital (SKH): Multidisciplinary Sleep Clinic with ENT surgeons, respiratory physicians, orthodontists, psychiatrists, psychologists, and sleep technologists.
• Singapore General Hospital (SGH): SingHealth Duke-NUS Sleep Centre offers full diagnosis and treatment options, from CPAP to surgery.
• National Heart Centre Singapore (NHCS): Works closely with SGH for cardiac assessment in severe OSA patients.
• Changi General Hospital (CGH): The Department of Sleep Medicine, Surgery & Science at CGH is one of the largest sleep centres in Singapore dedicated to the management of sleep disorders, promotion of sleep health and research.
• KK Womens’ and Children’s Hospital (KKH): The team in KKH specializes in evaluation and management of snoring and OSA in children.

Answer “yes” or “no” to the following:

• Do you snore loudly (louder than talking, heard through closed doors)?
• Do you feel tired, fatigued, or sleepy in the daytime?
• Has anyone observed you stop breathing during sleep?
• Do you have high blood pressure (treated or untreated)?
• Is your BMI >35 kg/m²?
• Are you age 50 or older?
• Is your neck circumference >40 cm?
• Are you male?
• ≥3 “yes” answers → intermediate risk of moderate to severe OSA.
• ≥5 “yes” answers → high risk of moderate to severe OSA.

In either case, medical consultation is advised.

Obstructive sleep apnoea is a hidden but serious condition that affects up to a third of Singaporeans. Left untreated, it damages the heart, blood vessels and overall health. With effective treatments ranging from CPAP and oral appliances to advanced robotic surgery, help is available — and recovery is possible.

Ref: F26