Snoring - the Obstructive Sleep Apnoea Syndrome

Introduction
You visited your ENT specialist with complaints about snoring. The ENT specialist has told you that apart from the snoring you may also have the Obstructive Sleep Apnoea Syndrome. The Obstructive Sleep Apnoea Syndrome is the occurrence of repetitive apnoeas during sleep which last for a minimum of 10 seconds. If there are many of these apnoeas this may lead to:

• a disturbed sleep
• complaints of sleepiness during the day
• disorders of the heart and blood vessels

It is important to ascertain whether you indeed suffer from Obstructive Sleep Apnoea Syndrome. Further examination is advisable. The purpose of this leaflet is to inform you about snoring and about the Obstructive Sleep Apnoea Syndrome.

Snoring

What is snoring?
Snoring is the well-known "rattling" sound people make in their sleep. It arises when the gullet is not completely open and the breath cannot pass into the throat unhindered. Tissues, such as the soft palate and the uvula will then begin to vibrate. Such a vibration causes the well-known snoring sound.

The snoring sound varies from a soft gurgling sound to a volume even the neighbours can hear. The Guiness Book of World Records recorded 87.5 decibel for the loudest snore, which equals the sound of a motorcycle.

Twenty-five to forty-five percent of the population snores to a greater or lesser extent.

That is why snoring can be a large social problem. Sleeping apart, domestic tension and even divorce can be the result. Serious snorers and their partners may in a number of cases benefit from surgery.

Medical risks
Apart from being a social problem, snoring may also cause other problems. Research shows that snorers:

• are often too heavy
• have high blood pressure
• sometimes have an enlarged heart
• may suffer from angina pectoris (chest pain).

An important medical risk related to snoring is the Obstructive Sleep Apnoea Syndrome: regular interruptions in breathing during sleep (apnoea). Thus a shortage of oxygen in the blood may develop. There may even be complications such as unpredictable cardiac arrhythmias or a sudden cardiac arrest.

Symptoms of the Obstructive Sleep Apnoea Syndrome
These symptoms can be:

• snoring sleepiness during the day
• shortness of breath at night
• headaches when waking up in the morning
• chronic fatigue personality changes c
• oncentration disorders

An attentive partner can signal such apnoeas: restless sleep, occasionally a snore as soon as he or she starts to breathe again.

Research
Because it is suspected that you suffer from this Obstructive Sleep Apnoea Syndrome, your ENT specialist has referred you to the Outpatients’ Clinic for pulmonary diseases where you will be examined further.

Nocturnal sleep study
This study usually takes place at home.
The Pulmonary Function Department will give you a box to take home with extensive instructions. The next day you return the box to the Pulmonary Function Department. You will then make an appointment with the lung specialist who will discuss the results with you.
If necessary, the lung specialist will offer you advise on solutions for the Obstructive Sleep Apnoea Syndrome. After your visit to the lung specialist you make another appointment with the ENT specialist

It is possible that - after consultations with you - additional examinations will be performed.

Solutions to snoring
In less serious cases, the solution may be:

• more exercise and checking your weight. This will strengthen the tissue, also in the throat. This may prevent the annoying vibrating.
• no use of alcohol and/or tranquillisers and sedatives. This may prevent the weakening of the throat muscles that make the snoring increase.
• the patient may drink coffee or something similar before going to bed. The partner is then given the chance to fall asleep first.

In most cases, these or similar measures are sufficient. If this does not work, or not sufficiently, surgery may be considered.

Surgery may be considered in serious cases
The operative treatment of snoring stems from the fifties and was first performed in Japan and later on the was performed throughout the world.
The purpose of this surgery is to shorten the soft palate. In about 90% of the patients the snoring is completely cured. The apnoea periods disappear only in about half of the cases. An unpleasant side effect is the pain after the surgery which, on average, lasts for 10 days. The length of hospitalisation varies from 2 to 4 days. This is also why careful examination before surgery is advisable.
Since recently Bronovo Hospital has the facilities to perform this surgery under local anaesthetic with Laser equipment. The surgery is now done on an outpatient basis and only takes 10 minutes. Afterpains may also be experienced with this surgery.

Solutions to the Obstructive
Sleep Apnoea SyndromeThe above-mentioned measures may sometimes also be effective for the Obstructive Sleep Apnoea Syndrome. If there are many apnoeas per night, sleeping with a nose mask with positive pressure (CPAP) may also be very effective. Your lung specialist will give you further information about this.

If you have any questions, please contact the Pulmonary Outpatients’ Clinic. Telephone number: 070 - 312 43 76 (on working days from 09.00 to 16.00 hours).

Edition: April 2010/61