Snoring and Sleep Apnoea Treatment: Polysomnography, CPAP and Surgical Options

Snoring is the sound caused by vibration of upper airway soft tissues during breathing — simply, air passes through a narrowing and the tissue vibrates. About 40-50% of adults snore occasionally; 20-25% regularly. Most snoring is simple ("primary") snoring and is not life-threatening.

Sleep apnoea (particularly Obstructive Sleep Apnoea — OSA) is a real medical problem: breathing pauses or reduces for 10+ seconds during sleep, repeated tens to hundreds of times overnight. Blood oxygen drops, heart rhythm becomes disturbed, the sympathetic nervous system activates — over time these increase risks of hypertension, heart failure, stroke and diabetes.

Clinically watch for: witnessed apnoeas (spouse or partner), abrupt awakenings, morning headaches, excessive daytime sleepiness, poor concentration, uncontrolled hypertension. If more than one of these is present, polysomnography is essential. Related service: our general ENT services.

Polysomnography (PSG) simultaneously records multiple physiological parameters during sleep: EEG (brain waves), EOG (eye movements), EMG (muscle tone), ECG (cardiac rhythm), oronasal airflow, chest-abdomen respiratory effort, oxygen saturation, body position. It requires an overnight stay in a sleep laboratory.

The calculated AHI (Apnoea-Hypopnoea Index) reports average respiratory events per hour: <5 normal, 5-15 mild OSA, 15-30 moderate OSA, >30 severe OSA. ODI (oxygen desaturation index) and mean-minimum oxygen levels are also reported.

Home (portable) testing has become common — Type III (limited-channel home sleep apnoea test). Fewer parameters but may suffice for typical OSA. In complex cases (suspected central apnoea, cardiac comorbidity) full in-lab PSG is preferred.

CPAP (Continuous Positive Airway Pressure) is the gold-standard treatment for moderate-severe OSA. The device delivers constant positive pressure via a mask while the patient sleeps, keeping the upper airway open. Efficacy: in 95%+ of cases apnoeas resolve almost entirely.

The challenge: compliance. About 30-50% of patients struggle with long-term mask use. Issues: claustrophobic sensation, dry mouth, skin irritation, noise, disturbing the partner. Modern devices with automatic pressure (APAP), heated humidifier and quiet operation reduce these.

Compliance is critical: defined as 4+ hours/night on 70%+ of nights. Regular follow-up (months 1, 3, 6, 12) and mask/pressure adjustments improve adherence. For non-compliant patients, alternatives are evaluated.

Outcomes: CPAP reduces cardiovascular event risk, improves daytime sleepiness, helps hypertension control, lowers mortality risk in long-term studies.

MADs are intraoral devices that advance the lower jaw to increase upper airway dimensions. Custom-fitted by a dentist/orthodontist. Used in mild-moderate OSA, simple snoring or for CPAP non-compliant patients.

Advantages: portable, silent, does not disturb the partner, easy to use. Disadvantages: temporomandibular joint discomfort, dental movement, dry mouth, drooling. Patients usually adapt within 2-4 weeks.

Efficacy: insufficient for severe OSA; can reduce AHI by about 50% but full normalisation is rare. Therefore not the primary treatment in moderate-severe OSA. Good results in mild cases with suitable anatomy (lower jaw able to protrude). For the related clinical reference, see sleep apnoea page.

Surgical treatment is planned according to anatomical obstruction. Complete endoscopic evaluation (DISE — drug-induced sleep endoscopy) defines the level of obstruction: nasal, velopharyngeal (soft palate), oropharyngeal (tonsils, tongue base), hypopharyngeal.

Nasal surgery: septoplasty + inferior turbinate reduction. Not a standalone OSA cure, but improves CPAP compliance and is the base of hybrid approaches. Most OSA patients have associated nasal obstruction.

Tonsillectomy: especially effective in patients with large tonsils (in adults too). It is the primary treatment in paediatric OSA — apnoeas resolve in 85%+ of children.

UPPP (uvulopalatopharyngoplasty): removes a portion of soft palate and uvula + reshapes the pharyngeal wall. Classic treatment but success 40-60% — anatomical selection matters. Modern techniques (expansion sphincter pharyngoplasty, lateral pharyngoplasty) give better outcomes.

Multilevel surgery: in severe OSA, nasal + UPPP + hypopharyngeal or tongue base. Hypoglossal nerve stimulation (Inspire device) is a newer alternative — effective in selected CPAP-intolerant patients.

Paediatric sleep apnoea is a different disease. Prevalence 1-5% (not as common but important). The main cause is adenotonsillar hypertrophy — large adenoids and tonsils. Clinical findings: snoring, mouth breathing, night sweats, enuresis, growth failure, ADHD-like symptoms, poor school performance.

Diagnosis: paediatric polysomnography (AHI thresholds different from adults — AHI >1 is meaningful in children). Imaging includes lateral nasopharyngeal X-ray or endoscopic adenoid evaluation.

Treatment: standard approach is adenotonsillectomy (ATE) — removal of adenoids and tonsils together. Success 85%+. After surgery, growth rebound, behavioural improvement and better school performance are typical within 3-6 months. In obese children and syndromic cases, CPAP or additional surgery may be needed.

Basic recommendations apply to all OSA patients and should not be neglected. Weight loss: a 10% body-weight reduction lowers AHI by about 30%. Most effective treatment in obesity-related OSA (bariatric surgery if needed). BMI 35+ patients need multidisciplinary weight management.

Positional therapy: supine sleep worsens OSA. Lateral-position training devices (back pillow, vibrating neck strap) help in mild positional cases.

Alcohol: avoid for 3-4 hours before bed — lowers muscle tone and worsens apnoea. Smoking: nasal mucosal oedema contributes to nasal obstruction. Hypnotics (especially benzodiazepines): cause respiratory depression and worsen OSA.

Regular sleep schedule and sleep hygiene (dim light, quiet room, screen restriction in the last hour) improve overall sleep quality. These alone are insufficient but complement other treatments. Related reading: our Istanbul ENT services.