Socially - yes.
It can be, when it makes the snorer an object of ridicule and causes others sleepless nights and resentment.

Medically - yes.
Snoring can be a symptom of Obstructive Sleep Apnoea. It disturbs the sleep pattern and deprives the snorer of appropriate rest. It increases risks of heart disease, heart attack and high blood pressure in the future.

Obstructive Sleep Apnoea (OSA) is a serious, potentially life-threatening condition that is far more common than realised. Apnoea is a condition where cessation of breathing takes place for 10 seconds or more. Local prevalence study has estimated OSA to affect 15% of the population in Singapore. It leads to severe sleep disruption and fragmentation, with development of excessive sleepiness during the day. This causes sleep fragmentation and results in poor quality of sleep, leading to daytime sleepiness. OSA can cause high blood pressure, increased risk of heart problems, memory loss, poor concentration, poor work performance, motor vehicle accidents and even marital problems.

Risk factors for OSA include obesity, increasing age, male gender, anatomic abnormalities of the nose and throat such as deviated nasal septum, large tonsils and adenoids, large tongue, enlarged, floppy and elongated soft palate.

You probably have OSA when:

• Someone complains about your snoring
• You find yourself gasping or choking during sleep
• You experience excessive daytime sleepiness
• You experience poor concentration and poor job performance
  
  

Diagnosis of OSA is made from your history, clinical examination, investigations and sleep study.

• Your history provides information about aspects of your life that may affect
  your breathing during sleep.
• Your specialist will conduct an examination of your nose, mouth and throat for
  causes that might lead to breathing difficulties during sleep. Your general health
  status will be assessed (e.g. weight, blood pressure).
  

A Sleep Study is mandatory in the evaluation of snoring and OSA. A patient scheduled for a sleep study usually checks into the hospital after dinner, stays overnight and is discharged early the next morning.

During the study, special sensors record the activity of your heart, lungs and brain, the movement of your muscles, airflow from your nose and mouth and the level
of oxygen in your blood.

A sleep technologist will monitor the recordings when you sleep. The entire sleep study would be recorded and analysed.

Videoendoscopic Computer-assisted Measurement (CAM)
A sleep study helps us to diagnose the severity of OSA but is not able to pinpoint the degree of upper airway obstruction. To do so, CGH has developed a videoendoscopic computer-assisted measurement (CAM) of the upper airway. This can be done in the clinic and will enable your doctor to identify and measure the site of the obstruction accurately, which is important should you need any surgery to correct the problem. This is only available at CGH ENT Snoring and OSA clinic.

Causes of snoring and sleep apnoea are often multi-factorial. Treatment therefore varies with individuals and the severity of their conditions. There are various treatment options for OSA and a combination of treatments may sometimes be necessary.

Some of the treatments for OSA include:

• Lifestyle changes: Losing weight, reducing the intake of alcohol and avoiding smoking and observing sleep hygiene.
• Using Air Pressure Device: A person may need to use CPAP (Continuous Positive Airway Pressure) at night during sleep throughout his life. He would have to use the device for more than four hours every night.
• Surgery: Upper Airway surgery will depend on the level, sites and degree of obstruction. These include day surgery procedures for snoring and mild sleep apnoea as well as palatal, tongue and throat procedures.
  
  

• A temperature controlled radiofrequency is a surgical procedure that is performed as a day-surgery under local anesthesia. It effectively treats obstructive sleep apnoea, snoring and nasal obstruction in Sleep Disordered Breathing by shrinking excess floppy tissue in the upper airway.
• A temperature controlled radiofrequency with controlled temperature and energy will be delivered to sites of snoring/obstruction. Tissue shrinkage will be 20-30% by volume.
• Somnoplasty is performed as a Day-Surgery and is applied at the nasal turbinate, soft palate and tongue.
  
  

The Pillar Procedure involves the placement of three tiny woven polyester that stiffen the structure of the soft palate to help reduce both the vibration that causes snoring and the ability of the soft palate to obstruct the airway.

Other forms of surgical procedures will be discussed in detail during consultation.

ENT Snoring/OSA Service and all information is provided by Consultant ENT Surgeon Dr Hsu Pon Poh, MBChB, MD, FRCS (Edin), FRCS (Glasg), FAMS (ENT).