A patient suffering from OSA stops breathing for short periods of time during sleep, which creates arousals, affecting their ability to spend sufficient time in Rapid Eye Movement (REM) sleep and ultimately reducing the patient’s quality of rest.
Ear, Nose and Throat surgeon Dr Tom Slaughter said OSA most commonly affected middle-aged males, with approximately 40 per cent of men aged 30 to 50 suffering the condition, and up to 60 per cent of males within the 50 to 70 age bracket.
“OSA can be difficult to detect. Generally a patient that reports excessive daytime sleepiness could be a candidate, while others describe experiencing morning headaches. Partners can also be helpful in observing and reporting apnoeas and determining the severity of snoring,” he said.
“When we start talking about treatments we have to assess where the issue lies for patients. We conduct a clinical diagnosis through a polysomnogram (sleep study), which assesses snoring, sleep quantity and episodes of apnoeas.
“To determine the severity of OSA, we measure quality of sleep, time frames of sleep, and then arousals and oxygenation during sleep.”
Dr Slaughter said GPs should refer patients concerned about sleep symptoms to a specialist for a formal assessment and treatment, as there is significant evidence that shows sleep quality is important for long-term health.
Health risks associated with sleep apnoea include cardiovascular disease and diabetes, along with the increased risk of being in a motor vehicle or workplace accident.
“A Continuous Positive Airway Pressure (CPAP) device remains the gold standard of OSA treatment, which is a mask worn during the night to prevent a patient’s throat from closing. It is a safe, effective and non-invasive treatment, but an issue can be patient compliance, as some people unknowingly remove it during sleep,” he said.
“It’s important that patients seek appropriate specialist advice prior to purchasing machines to make sure there’s nothing that’s correctable in the first place.
“For example, there is good evidence that weight loss alone can improve the severity of OSA for obese patients, while surgical intervention can be helpful too.
“An ENT specialist can offer a complete airway assessment to establish whether the patient is a good candidate for surgical treatment.
“Pre-phase treatment involves the correction of the nasal airway, which can then assist with the use of a CPAP device.
“An endoscopic septoplasty, performed to correct the nasal septum, is a common ENT procedure which can achieve a good outcome for OSA patients.
“In severe cases, further assessment of the remainder of the upper airway might be necessary, to identify other possible causes of OSA including the dynamic collapse of the palate.
“A patient could benefit from other procedures including a tonsillectomy, or a modified uvulopalatopharyngoplasty (UPPP) – a procedure that involves removing damaged throat tissue to open the airway.”
Dr Slaughter believes the complete assessment of a patient is essential to determine the cause, and optimal treatment pathway, for OSA.
“Whilst surgery isn’t the primary treatment method, the correction of the nasal passage as a pre-phase treatment can provide significant benefits to many OSA patients,” he said.
“OSA is a very complex, dynamic and multi-faceted issue, and it is vital that patients adopt appropriate lifestyle modifications and ensure they’re properly assessed and treated for correctable problems that may significantly improve their outcome prior to long-term CPAP use.”