ENT specialist Dr Gan Chon Chean who is also the department head of Otorhinolaryngology Department (ORL), conducting an OSA seminar at Miri Hospital on Saturday.
MIRI: While sonorous snoring comes across as a blissful sign of deep slumber, the stop-start gasps in breathing could be a life threatening risk if left untreated. Hence the first question: How do you know if you have Sleep Apnoea? Unless your spouse is not dead asleep, the answer is: the ‘Stop Bang’ questionnaire form from ENT department to give you a diagnosis.
Specialist of Ear, Nose and Throat (ENT), Dr Gan Chon Chean, pointed out that the episodes of snoring can be categorized into several types and the most severe condition called Obstructive Sleep Apnoea (OSA), could endanger one’s health.
“Snoring is defined as breathing during sleep with harsh sounds caused by the vibration of soft palate through open mouth and the nose when asleep. The condition is due to partial airway obstruction.
“Sleep apnoea, on the other hand, is a condition whereby during sleep, there is an absence of airflow through the nose or mouth for more than 10 seconds at a time. Generally, the person under such condition stops breathing when asleep,” Gan told The Borneo Post in an interview during ENT open day held by Otorhinolaryngology Department (ORL) last Saturday.
Obstructive sleep apnoea, he pointed out, is the worst among all sleep breathing syndrome because during this period of apnoea, important organs of the body are seriously affected in the long run.
“The longer it goes untreated, the brain will be deprived of oxygen leading to the increasing of heart rate and blood pressure,” he said.
Guests and interested members of the public listen as they were briefed on CPAP device.
Mechanism of Snoring versus OSA
Gan reiterated that during deep sleep condition, the upper airway muscles tend to relax.
“However, it will worsen as age increases, or as with obesity, as well as the use of alcohol. The use of barbiturates and sedatives are also contributing factors that can worsen the condition.
“In the case of obstructive sleep apnoea, it is a syndrome caused by the obstruction of the upper airway tract that is made up of the nose, throat (pharynx and larynx) and windpipe (trachea) that carries crucial oxygen air into lungs for respiration.
“Based on research conducted by specialists in Western countries, such condition is likely to be found in 4 per cent of the population and male population has higher risk than female.”
Signs and possible symptoms of OSA
Early signs of OSA, he revealed, is usually a consistent snoring habit that happens almost every day and worst, in a very loud noise.
“For those experiencing apnoea, their spouse might notice them on persistent apnoea (stops breathing) which is pretty scary.
“Usually those who suffer from this would have difficulty to wake up in the morning, experiencing dry mouth, tiredness and also headache. Worst, apnoea makes one unable to sleep well at night, which results in them being unable to properly organise a task or activity.”
Gan further reiterated that those suspected to have OSA might suffer from hypertension, frequently involved in accidents due to trouble in concentration and poorer neurocognitive function, obese, and obvious breathing pauses.
Depending on each individual case, the OSA diagnosis could vary from mild to severe condition.
“In mild condition, the apnoea occurs between five to 15 times per hour and the severity could result in the patient who stops breathing more than 30 times in an hour, with each apnoea lasting more than 10 seconds.”
Factors and condition associated with OSA
According to Dr Gan, who is also the head of ORL department, obesity is said to be the major factor contributing to OSA.
“Among people who are overweight, 65 per cent of them snore. For those who are obese, the risk is higher.
“In Malaysia, a statistic revealed by National Health & Morbidity Survey (NHMS) shows that the percentage of adult aged 18 years old and above who are overweight (BMI more than 25) has increased from 29.1 per cent in 2006 to 33.3 per cent in 2011 (which is equivalent to 5.4 million people).
“Meanwhile, obese adults aged 18 years old and above with BMI more than 30, has increased from 14 per cent in 2006 to 27.2 per cent in 2001 which is equivalent to 4.4 million people.
“It is certainly a worrying phenomenon as it was revealed in 2011 that Malaysians have the highest rate of obesity in Asian region,” he said.
Other factors, he said, includes allergic rhinitis, Adenotonsillar Hypertrophy, Laryngomalacia, Syndrome Child/ Craniofacial anomalies and Airway tumours.
Allergic Rhintis is a condition of persistent sneezing due to the inflammation of mucous membrane of nose.
Adenotonsillar Hypertrophy (ATH) is a condition whereby unusual growth of the adenoid tonsil in the nasal airway. ATH is said to be the leading cause for obstructive sleep apnoea syndrome in children.
Laryngomalacia is the most common cause of stridor in infancy, in which immature cartilage of the upper larynx collapses inward during inhalation, and could result in obstruction of the airway.
Syndrome Child/ Craniofacial anomalies or generally known as cleft lip and palate condition.
Airway tumours such like nasopharyngeal cancer (NPC) and retropharyngeal tumour are also factors contributing to OSA.
Meanwhile, he pointed out that diabetes mellitus, hypertension, cardiac arrhythmias, pulmonary hypertension and strokes are the conditions associated with OSA.
“In the long run, OSA could result in mood swings, loss of libido (loss of interest in sexual relationship with spouse), to the extent of compromising work performance that could cause danger to the person and his/her surroundings.
“In certain cases, there are possibilities that patients, particularly young adults who have health problems such as above are caused by OSA, however relevant tests and assessment are required to prove this,” he said.
Diagnosis for OSA
For those who suspect themselves or a family member of this condition, Gan revealed that they could either get a ‘Stop Bang’ questionnaire form from ENT department or simply download it from any relevant websites link.
Stop Bang, is an abbreviation for ‘Snoring, Tired, Observed, Blood Pressure; BMI, Age, Neck, Gender’ – a simple snoring questionnaire that is easily understood.
“After answering the questionnaire, consult doctor or specialist for further diagnosis.”
When consulting a specialist or ENT surgeon, the focus will be on nose, mouth and throat examination, to look for any abnormalities and site of obstruction in the airway, he says.
As the issue could cost a lot in healthcare expenditure to a country, to treat all those with disease-related OSA, the Malaysian government has drafted a protocol on sleep facility.
“We are fortunate that Miri Hospital also has sleep facility, though not a gold standard, but it’s good enough to identify an OSA patient through partial sleep study. This shows that our government is actually alerted and concern on this issue which left untreated could affect not only the person, but also the country’s economy.
Possible treatment for OSA
Change of lifestyle, that shall include practising healthy and balance diet, abstaining from alcohol as well as avoiding medicines like sedatives and sleeping pills before sleep could at least ease the condition.
“So far, the most effective treatment that is said to able to resolve the condition is known as CPAP (continuous positive airway pressure), a method of delivering air at positive pressure into airway via a mask to keep the airway from collapsing through the night.
“Even though it has a high cure rate, the need to persistently use the contraption might be a problem to those unable to comply, and often up to 33 per cent of people would stop using it within six months.”
Meanwhile, he added, though other devices are available on the market such as saline nasal sprays, nasal splints, posture pillows, mouth guard that claims to ease the snoring problem; eventually switching the sleep position is often the most economic solution.
“By sleeping in side-way position, the snoring could ease and the whole condition becomes better.”
There are also surgical procedures, depending on individual cases, namely Septoplasty (correction of a deviated nasal septum), Tonsillectomy (removal of tonsils), Palatoplasty (refreshing of the soft palate), Radiofrequency (stiffening and shrinking the soft palate, tongue or turbinate’s of the nose) and Maxillomandibular surgery – that moves the upper jaw (maxilla) and the lower jaw (mandible) forward, which often almost gives 100 per cent success rate in the treatment of sleep apnoea.
The ENT Open Day which was held at Miri Hospital on Saturday was attended by some 110 members of the public. It discussed on the snoring and OSA symptoms, its management as well as briefing on balance by a dietician Noor Taufikhiah Harun. Deputy director of Miri Hospital Dr Irene Tiong Min Lee was also there to grace the opening ceremony.