Snoring and obstructive sleep apnoea

Snoring is the sound caused by the vibration of the walls of the air passages and throat when it partially collapses during sleep (airway muscles keep the air passage open when you’re awake). In people who snore, the upper airway is narrow. This produces vibrations which are heard as snoring. Snoring without significant stopping of breathing is called primary snoring. Different sleep positions may affect snoring, eg. sleeping on the back may make snoring worse. A sleep study should be able to tell if a change in sleeping position will make any difference.

However, snoring when associated with choking, unrefreshing sleep, daytime sleepiness or fatigue is a symptom of Obstructive Sleep Apnoea (OSA). This is a condition where there is repeated upper airway collapse during sleep. This causes breathing to stop and the brain needs to wake up temporarily to open the airway to breathe again before falling back to sleep. On returning to sleep the obstruction occurs again and this cycle repeats. This causes poor sleep quality.

Causes of sleep apnoea

  1. Abnormal shape of the facial bones, inherited or developed over time (this may include nasal problems that narrow the nose passage).
  2. Tonsils
  3. Adenoid enlargement
  4. Obesity
  5. Increasing age (when tissues in the air passage become more lax).

Treatment of sleep apnoea

  1. Positive Airway Pressure (PAP)

  2. The most common way of delivering it is CPAP (continuous positive airway pressure). PAP is positive pressure delivered by a machine that blows out air and is connected to a mask (via a hose) worn during sleep. This column of air pressure prevents the airway from collapsing.

  3. Dental splints

  4. Dental splints are devices (also worn during sleep) that protrude the lower jaw by keeping the lower teeth in a more forward position. By maintaining the lower jaw in a protruded position it enlarges the air space behind the tongue and puts the air passage tissues in greater tension. This decreases the tendency for the airway walls to collapse.

  5. Surgery

  6. Performed on the areas (eg, soft palate) that contribute to narrowing in the air passage. Surgery works by repositioning or removing tissues in or around the airway to enlarge it. Besides surgery done under general anaesthesia, there are also minimally invasive surgical procedures like Pillar Implants and a radio frequency treatment that can be performed under local anaesthesia. But these procedures are more effective for simple snoring and mild obstructive sleep apnoea.

The Department of Otolaryngology at Singapore General Hospital​ offers a complete range of ENT clinical and paraclinical services dealing with problems of the ear, nose and throat. Services include rhinology/endoscopic sinus surgery, head and neck surgery, otology/neuro-otology, voice disorders, sleep apnoea surgery and paediatric otolaryngology. The Sleep Disorders Unit adopts a multi-disciplinary approach in the treatment of sleep disorders, with specialists from Respiratory Medicine, ENT, Neurology as well as Psychologists and Psychiatrists.

Ref: W09