Snoring and obstructive sleep apnoea

Patients are usually referred to the snoring and sleep apnoea clinic to aid the diagnosis and treatment for snoring and/or sleep disorders.

The clinic at Frimley Park Hospital runs on a Thursday morning every week and is located in the ENT outpatients department which is located to the left of the main entrance.

One of the main diagnoses made is Obstructive Sleep Apnoea (OSA).

Obstructive sleep apnoea (OSA) is a condition where your breathing stops for short spells when you are asleep.

Treatments include mandibular advancement devices, continuous positive airway pressure (CPAP), and occasionally surgery.

If you need technical support with a CPAP machine supplied by Frimley Park Hospital, telephone support is available on Mondays and Thursdays from 9am to 12 noon (OSA specialist nurses only available between these times). Please telephone 01276 604604 and ask the operator to bleep the OSA specialist nurse.

Specialist nurses
Iain Wheatley and Michelle Ferguson

Website links:
http://www.cpap.co.uk/
http://www.apnoea.org.uk/thefacts.htm
http://www.sleep-apnoea-trust.org
http://www.cpap-europe.com/

http://www.brake.org.uk/index.php?p=555
http://remstarautomseries.respironics.eu/

What are the symptoms of obstructive sleep apnoea?

People with OSA may not be aware that they have this problem as they do not usually remember the waking times at night. It is often a sleeping partner or a parent of a child with OSA that is concerned about the loud snoring and the recurring episodes of apnoea that they notice.
One or more of the following also commonly occur.

• Daytime sleepiness. This is often different to just being 'tired'. People with severe OSA may fall asleep during the day with serious consequences. For example, when driving, especially on long monotonous journeys such as on a motorway. A particular concern is the increased frequency of car crashes involving drivers with OSA. Drivers with OSA have a 2-12 increase risk of having a car crash compared to average.
• Poor concentration and mental functioning during the day. Morning headaches.
• Depression.
• Being irritable during the day.
• People with untreated OSA also have an increased risk of developing high blood pressure, heart attack, heart failure, and stroke.

How is OSA diagnosed?

If you have symptoms that suggest OSA, or a high score on the Epworth Sleepiness Scale, there are various types of test that can be done whilst you sleep. For example:

• Airflow may be measured whilst you sleep by using a probe placed under your nose.
• Sensors may be used to record snoring volume and body movement whilst you sleep.
• The oxygen level in your blood can be monitored by a probe clipped onto your finger.
• Breathing can be monitored and recorded by the use of special belts placed around the chest and abdomen.

OSA and driving

If you are diagnosed with OSA and you are a driver, you must not drive and you must inform the DVLA (Driver and Vehicle Licensing Agency). For normal car drivers, you will usually be allowed to resume driving after you no longer have daytime sleepiness with treatment. However, special rules apply if you have an HGV or similar license.

What is the treatment for OSA?

General measures

Things that can make a big difference include:

• Losing some weight if you are overweight or obese.

• Not drinking alcohol for 4-6 hours before going to bed.

• Sleeping on your side or in a semi-propped position.

Mandibular advancement devices

The mandible is the lower jaw. There are devices that you can wear inside your mouth when you sleep. They work by pulling the mandible forward a little, which means the throat may not narrow as much in the night.

These devices look a bit like gum shields that sports-people wear. Although you can buy these devices without a prescription, it is best to get one properly fitted by a dentist if one is recommended.
These devices can work well in some cases.

Continuous positive airway pressure (CPAP)

This is the most effective treatment.

This treatment involves wearing a mask when you sleep. A quiet electrical pump is connected to the mask to pump room air into your nose at a slight pressure. The slightly increased air pressure keeps the throat open when you are breathing at night and so prevents the blockage of airflow.
Continuous positive airway pressure (CPAP)
The improvement with this treatment is often very good, if not dramatic. If CPAP works, (as it does in most cases) then there is an immediate improvement in sleep. Also, there is an improvement in daytime wellbeing as daytime sleepiness is abolished the next day. Snoring is also reduced or stopped.

The device may be cumbersome to wear at night, but the benefits are usually well worth it. Comments like "I haven't slept as well for years" have been reported from some people after starting treatment with CPAP.

Surgery

Surgery is not often useful. However, sometimes an operation may be helpful to increase the airflow into your airway. For example, if you have large tonsils or adenoids, it may help if these are removed. This is more commonly done in children with OSA. If you have any nasal blockages, an operation may help to clear the blockage.