Sleep apnoea: killing me softly with my snoring

(With apologies to The Fugees)

As an Ear, Nose and Throat surgeon, I frequently see patients who present with snoring at the behest of their partner. Snoring is a major contribution to marital disharmony. A simple test I use to gauge the severity of the problem is to ask if the couple are still sleeping in the same bed. Not infrequently, the snorer has been banished into a separate room!

Whilst snoring is a problem, the main killer amongst snorers is a condition called sleep apnoea. People with apnoea stop breathing for up to 10 seconds multiple times during the night. Often they start choking, become aroused and then start breathing or snoring once again. This cycle or breath-holding, choking, and arousal occurs over and over again, causing severe disruption or fragmentation of sleep. The poor sleep quality leads to the patient to feel lethargic and sleepy during the day. Excessive day time sleepiness or hypersomnolence is a key feature of sleep apnoea.

Not all snorers have sleep apnoea, and curiously the severity of snoring does not always correlate with the severity of sleep apnoea.

Recently, a 38 year old oil and gas executive came to see me with a history of mild snoring. He was slightly overweight with a body mass index of 29.8. Despite his young age, he had already suffered from high blood pressure for 5 years. He reported some nasal blockage, but nothing else. When I examined him, I found his turbinates to be swollen contributing to his nasal congestion. I did a simple painless clinic procedure called a turbinate reduction with radiofrequency, and this eased his breathing. We then did a sleep study and to my utter surprise found severe sleep apnoea.

Sleep apnoea is the ‘silent’ killer amongst snorers. When the snoring stops and breathing is obstructed. Oxygen levels in your blood plummet and your heart races to help deliver more oxygen to your vital organs. At a time when your heart should be resting, it is doing the exact opposite. In my 38 year old patient, his heart rate reached 130 beats per minute at 4 am!

The evidence of risks of sleep apnoea are as follow:

• Even mild sleep apnoea doubles your risk of high blood pressure (Wisconsin Sleep Cohort Study)
• Men with moderate sleep apnoea are twice as likely to suffer a heart attack (Schafer H et. al. Cardiology 1999; 92: 79-84)
• People with even mild sleep apnoea are 1.5 times more likely to suffer a stroke than those without it (Sleep Heart Health Study)
• Patients with diabetes have a higher incidence of sleep apnoea and should be investigated for this (International Diabetes Federation Consensus Statement, 2008)

So, if you snore, ask your partner to listen out for the silent apnoeas when breathing stops. Seek a medical opinion and treatment soon, and stop apnoea from killing you softly as you sleep!

Now I lay me down to sleep
I pray the Lord my soul to keep
Should I snore before I wake
I pray the Lord my life (and wife) not take!

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