Your loud snoring might be more dangerous than you think

If you or your partner are guilty of snoring, don't sleep on it any longer as it could be a wake-up call for serious health issues.

Those nightly noises are often caused by obstructive sleep apnea (OSA), and research indicates it increases the risk of heart failure by 140 per cent, risk of stroke by 60 per cent and risk of coronary heart disease by 30 per cent.

OSA is a common sleep disorder affecting 10 to 20 per cent of adults, and is two to three times more common in men than in women.

It is characterised by prolonged, persistent and very loud snoring and repeated interruptions (apneas) in breathing throughout the sleep cycle, caused by the relaxing and sagging of soft tissue in the airway which can prevent oxygen from reaching the lungs.

The apneas can last from 10 to 30 seconds, or even longer, before breathing resumes - often with a start or jerk and throat-clearing noises or gasping for air.

This may be followed by a change of position, rolling over or moving pillows.

Surprisingly, sufferers not only sleep through their snoring but are often unaware they stop breathing for long periods.

Frequent morning headaches and waking up with a very dry or even sore throat are indicators of OSA.

Apart from feeling tired, irritable and being prone to dozing off during the day, many have no idea they have a sleep condition.

Typically, it is their partners who become aware of the problem because their own sleep is disturbed by the symptoms.

OSA is dangerous because when the apneas occur, they cause sudden drops in blood oxygen levels that increase blood pressure and strain the cardiovascular system.

The stopping and starting of breathing can also disrupt the heart's beating, causing it to slow down and speed up, or be startled out of sync into an arrhythmia (abnormal rate or rhythm of the heartbeat).

This can happen up to hundreds of times each night. In severe cases of OSA, it might be as often as once or twice per minute.

Dr Reginald Liew, a senior consultant cardiologist at the Harley Street Heart & Vascular Centre, and Dr Jeeve Kanagalingam of The ENT Clinic, which are both at Mount Elizabeth Novena, tell The New Paper more about OSA, its link to cardiovascular health and how it can be treated.

What is the connection between OSA and atrial fibrillation (AF), an irregular and often rapid heart rate?

DR LIEW: Both have common effects on one's health, such as hypertension and obesity. An estimated 50 per cent of AF patients also have OSA and patients with OSA have four times the risk of developing AF.

Studies also indicate that untreated OSA impairs the ability to control AF as it reduces the effectiveness of many AF treatments and medications.

New research suggests that when a patient has both AF and OSA, addressing the sleep apnea issues first, or at least together with the AF, makes both medical and procedural AF treatments more effective and improves overall health.

What are the causes and risk factors for OSA?

DR LIEW: If you are an obese male over 60 who smokes and likes an alcoholic drink before bed, you are very high-risk.

Fat deposits around your upper airway can obstruct breathing.

Drinking alcohol before bed and using sedatives or sleeping pills can increase the risk of developing sleep apnea or worsen existing sleep apnea as these substances relax the muscles in the throat.

Smokers are three times more likely to have OSA. Apart from increasing the amount of inflammation and fluid retention in the upper airway, smoking is also a major risk factor for cardiovascular disease and many forms of cancer.

If you suffer from nasal congestion and have difficulty breathing through your nose - whether from an anatomical problem or allergies - you're more likely to develop OSA.

How can OSA be treated or cured?

DR KANAGALINGAM: Usually the first things a doctor will recommend, especially for mild and recent onset cases, are lifestyle changes such as losing weight, quitting smoking, not drinking alcohol before bed and perhaps changing your style of pillow.

The next step for moderate to severe cases would be a machine that provides continuous positive airway pressure through a mask while you sleep.

There are also a variety of oral devices which can be put in the mouth at bedtime, rather like a boxer's gum shield, which are designed to keep the airways open.

If all other methods fail, there are several surgical options such as uvulopalatopharyngoplasty, in which the tonsils are removed.

A slightly less invasive option is to shrink the tissues in the rear of the mouth and back of the throat using radiofrequency ablation.