Snoring and sleep apnoea

What is the difference between snoring and sleep apnoea?

Primary snoring is the term used for noisy breathing at night without significant airway obstruction. In adults it is mainly a social issue as it interferes with other’s sleep and is often treated for this reason, but it doesn’t necessarily cause health issues otherwise. At the other end of the spectrum is obstructive sleep apnoea (OSA), which is when the throat collapses periodically while sleeping (these episodes are called apnoeas).

What sort of problems does this cause?

The main symptoms of obstructive sleep apnoea are loud snoring, often with witnessed apnoeas, waking unrefreshed and daytime sleepiness. However, it has effects on many systems in the body including high blood pressure, heart disease, type 2 diabetes, difficulty concentrating and headaches.

What causes OSA?

In kids, OSA is usually due to large tonsils and adenoids. However, in adults it is usually due to a combination of factors and is more difficult to treat. Common physical causes are being overweight, blocked nose, large tonsils or tongue, reflux and floppy tissues in the upper airway.

How is it assessed?

ENT surgeons are trained in assessment of the upper airway and the examination usually includes examination with an endoscope passed through the nose which allows us to see the entire upper airway from the nostrils to the larynx.

If sleep apnoea is suspected, at some point a sleep study is usually performed to diagnose the presence and severity of sleep apnoea.

How is it treated?

Treatment depends on the severity of the sleep apnoea and whether there are reversible causes found on the ENT examination. CPAP (continuous positive airway pressure, delivered using a mask attached to a pump at night) is usually recommended for moderate or severe sleep apnoea and mandibular advancement splints (MAS) are also effective in some people. General measures such as avoiding sleeping on your back and avoiding alcohol before bed can make a surprisingly large difference in some people. For those who are overweight, weight loss can make a big difference.

Surgery is used for two main reasons. The first is if there is significant nasal obstruction as having a clear nasal airway improves sleep quality and makes a big difference in CPAP and MAS use.

The other is when there is an obvious anatomic problem in the throat (typically large tonsils) or CPAP isn’t working or isn’t tolerated. Surgery can be helpful in some patients in this situation, and your ENT surgeon can assess the upper airway and advise you on whether surgery is likely to be helpful. There are anatomic factors in the throat which affect the likelihood of surgery being effective, and in general surgery is less effective with worsening obesity.