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Sleep apnoea is a continuous process that ranges from simple, quiet snoring (very common) to severe onstrucive or central apnoea (very rare). The treatment is essentially the same, as the condition becomes more severe, more intrusive therapies are required. Not all simple snorers develop into apnoeics, although there is often a slow progression unless the condition is stopped early.

Sleep apnoea means “stopping breathing whilst asleep”. It can be “central”, caused by an abnormality in the respiratory centre in the brain, perhaps drug induced or secondary to conditions like multiple sclerosis, or more commonly, it is obstructive (OSA), when there is a blockage in the neck/throat/mouth/nose. In fact we all stop breathing at night periodically, usually for a few seconds – this is not significant. True pathological sleep apnoea occurs when there is a prolonged stopping of breathing, such that the levels of oxygen in the blood begin to fall. This causes the brain to alert, and either wake the patient, or change the level of sleep. Because this is a stress type response, the patient may wake up in a state of panic, shouting or screaming, thrashing around. True OSA patients may have hundreds of episodes like this each night. This means that they have very poor quality sleep, constantly awakening. This leads to a number of systemic manifestations, in particular high blood pressure, heart disease and rhythm disturbance, loss of memory, concentration, libido, an increase in irritability etc.

Once a patient contacted us with possible OSA, an opinion from one of our ENT surgeons is required, to determine the site and cause of obstruction. At this consultation it is useful to know the patient’s Body Mass Index (BMI) and Epworth score – a sleepyness index. These can be worked out thus:

BMI

Weight (kilogrammes) divided by the height in meters, squared, so if you weigh 70 kg, and are 2m tall, then your BMI is 70 divided by 2 squared (4) = 17.5

The Epworth Sleepiness Scale

How likely are you to doze off or fall asleep in the following situations, in contrast to feeling just tired? This refers to your usual way of life in recent times. Even if you have not done some of these things recently try to work out how they would have affected you. Use the following scale and circle the most appropriate number for each situation. Add the total of each circled number to get your score.

0 = Would never doze
1 = Slight chance of dozing
2 = Moderate chance of dozing
3 = High chance of dozing

Sitting and reading
0 1 2 3

Watching TV
0 1 2 3

Sitting inactive in a public place (for example a theatre or meeting)
0 1 2 3

As a passenger in a car for an hour without a break
0 1 2 3

Lying down to rest in the afternoon when circumstances permit
0 1 2 3

Sitting and talking to someone
0 1 2 3

Sitting quietly after a lunch without alcohol
0 1 2 3

In a car, while stopped for a few minutes in traffic
0 1 2 3

TOTAL SCORE:_______________

The ENT surgeon will then thoroughly asses your whole upper airway, and will perform flexible endoscopy (not painful) and the Muller manouevre. At this stage he/she will have a good idea as to whether you are a true apnoeic, or a simple snorer, or somewhere in between. If your Epworth score is >10 we recommend admission for an overnight sleep study to assess underlying apnoea and its severity. If your BMI is above 30, weight loss via a dietican will be required, or we can refer you to our associated doctors who run weight loss clinics in The Algarve. Any ENT problems can be corrected, such as a blocked, stuffy nose, large tonsils, parapharyngeal space tumours etc.

If your BMI is below 30 and you Epworth score is 10 or below, we will correct any ENT pathology as above, and consider referral for a Mandibular Advancement Splint (MAS) – see elsewhere on this site, or we will offer palatal surgery, either laser palatoplasty or somnoplasty. This will be treatment for simple snoring. If your sleep study shows severe obstructive apnoea, you will be referred to a chest physician for possible CPAP (continuous positive airway pressure) therapy, although nose unblocking treatment may be required before this will work. Alternatively you can be referred to our maxillofacial surgeon for tongue advancement surgery, although this is rarely used. If your sleep study shown mild OSA, this can be treated as per simple snorers (above). If your sleep study shows moderated OSA, we will arrange to see you in our joint clinic with your ENT surgeon, a chest physician and orthodontist, to discuss all of the above therapies and which one is best for you.