Jonathan Alexander Abt is an experienced orthodontic consultant who worked on numerous complex cases during his time at Luton and Dunstable Hospital, including cleft lips and palates. This article will look at obstructive sleep apnoea, a fairly common condition that is one of the chief causes of snoring.
The leading cause of snoring is a partial closure of the airway while sleeping. When an individual falls asleep the muscles in their neck relax, which for some causes the soft tissues in the throat to vibrate, creating a sound.
Obstructive sleep apnoea (OSA) not only causes snoring but is a serious medical condition. When the airway is blocked during sleep, this causes pain when breathing. While simple snoring is caused by a partial closure of the airway and the vibration of soft tissue, OSA causes the airway to close completely, causing breathing to stop, in turn reducing oxygen levels in the blood. The condition is most prevalent in middle-aged adults but can affect people of all ages.
Fragmented sleep can cause people with OSA to experience excessive daytime sleepiness, impacting their ability to concentrate and affecting their mood, potentially triggering personality changes in addition to anti-social snoring. When participating in activities that require a highly alert mental state such as operating machinery or driving, OSA can cause significant problems. Research also reveals a correlation between repeated falls in oxygen levels and development of high blood pressure, diabetes, heart disease and strokes.
OSA can cause two types of breathing interruption. Firstly, it can cause apnoea, which is defined as a complete blockage of the airway for ten seconds or more. Secondly, it can cause hypopnoea, which is a partial blockage that reduces flow through the airway by over 50% for 10 seconds or more.
Individuals affected by OSA can experience multiple incidences of hypopnoea and apnoea through the night. In severe cases, they may experience them as frequently as every one or two minutes.
Known as obstructive sleep apnoea-hypopnoea syndrome where the patient has hypopnoeas and apnoeas throughout the night, OSA can impact the quality of life of patients significantly due to fatigue throughout the day along with various other issues.
Symptoms of OSA include:
- Daytime fatigue
- Pauses in breathing throughout the night that may be noticed by a partner, relative or friend
- Noisy or laboured breathing
- Loud snoring
- Repeated periods where breathing is interrupted by gasping, snorting or stops
Some people with OSA also experience night sweats. They may also find themselves waking up often in the night to go to the bathroom.
During an episode of OSA, the lack of oxygen triggers the brain to pull out of deep sleep, entering a lighter sleep or wakefulness. The airway then reopens, allowing the individual to breathe normally again. These repeated interruptions in sleep can make people very tired and more likely to fall asleep in the day, though they will usually have no memory of their interrupted breathing so may be unaware they have a problem.
The good news is that OSA can be better managed through simple lifestyle changes such as stopping smoking, losing weight, and reducing alcohol intake. Other clinically proven options include mandibular advancement splints (MAS) and continuous positive airway pressure (CPAP).
MAS are removable appliances that come in one or two parts to be attached to the upper and lower teeth. MAS are worn at night to treat OSA and snoring, holding the lower jaw in a forward position. They are usually prescribed by a sleep team or orthodontist.
CPAP is the most common and effective means of treating OSA. There are various different types of CPAP equipment and products. CPAP treatment is not recommended to treat simple snoring.
