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TREATMENT FOR OBSTRUCTIVE SLEEP APNOEA (OSA)
The approach to treatment for OSA depends on the outcome of a sleep study and the prevalence of symptoms. Urgent intervention is called for when frequent and severe hypoxaemia during sleep induces physiological changes which are frankly life-threatening. However, many patients are only mildly symptomatic. There may be small fluctuations in oxygen saturation with negligible or minor physiological consequences, but essentially their problem remains a sociological one with the potential to develop clinical complications if snoring persists over many years. Treatment for these patients is directed at the cause of snoring, where simple measures such as weight loss and alcohol avoidance or surgical procedures, such as tonsillectomy, minimize the possibility of progressively worsening OSA.
There is no clear definition of what constitutes mild, moderate and severe OSA. Guidelines have been published by specialists in the field but there will always be some variation from one physician to another regarding the timing and nature of medical intervention. When a diagnosis of advanced OSA is made, the most popular and effective mode of treatment is the application of Continuous Positive Airway Pressure, or CPAP, a relatively new innovation developed in Australia in the early 1980\'s. The technique offers relief to the user by delivering a stream of air from a pump into a comfortably fitting nose mask via a length of flexible tubing. Air pressure introduced through the nose has been described as an airway \"splint\", preventing collapse by providing support in the form of positive pressure. CPAP does have some drawbacks. There are patients who never adapt to the sensation of air pressure applied through the nose mask and others who experience nasal irritation or excessive drying of the upper airway. CPAP has nevertheless proven to be extremely successful in the treatment of OSA, eliminating snoring and many of its debilitating symptoms.
When CPAP is not tolerated, or if circumstances make it impossible for the patient to use it effectively on a regular basis (e.g. the very young or mentally handicapped patients), then an operation called a tracheostomy would have to be considered. It involves the surgical formation of a hole into the windpipe (trachea), a procedure which had to be relied upon for urgent relief of airway obstruction before the advent of CPAP. The decision to have a tracheostomy is not made without due consideration of potential problems. It is not well tolerated by many patients because of the social and psychological adjustments that have to be made, particularly as normal speech is impaired.
Some of the more apparent symptoms which may be associated with obstructive sleep apnoea. Their incidence and severity will depend on the period of time over which snoring and airway obstructions have occurred.
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GENERAL HEALTH
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