One in three Singaporeans suffers from sleep apnoea: Study

A third of Singaporeans 'have sleep apnoea but most are unaware'
By Yeo Sam Jo, The Straits Times, 18 Mar 2016

One in three Singaporeans suffers from moderate to severe obstructive sleep apnoea (OSA), with most of these cases undiagnosed, a recent study has found.

People with this sleep disorder stop breathing repeatedly in their sleep because of a complete or partial blocking in their airway.

This leads to low oxygen levels, which causes symptoms such as daytime fatigue, intellectual impairment and headaches upon waking.

The study by public healthcare group JurongHealth also found that one in 10 Singaporeans has severe sleep apnoea, in which they stop breathing for more than 30 times an hour during slumber.

The study, done between October 2014 and May last year among 250 randomly chosen subjects, was published in the international journal Respirology in March.

Its principal investigator, Dr Adeline Tan, described the high prevalence of the disorder among Singaporeans as worrying. About 90 per cent of the subjects found to have moderate to severe sleep apnoea were unaware of their condition.

Dr Tan, a consultant in respiratory medicine at Ng Teng Fong Hospital, said: "This could be due to low awareness of OSA. The public needs to know the signs so that they or their loved ones know when to seek medical help."

Signs include snoring, choking and gasping during sleep, and frequent urination at night.

Dr Kenny Pang, an ear, nose and throat specialist at Asia Sleep Centre and Mount Elizabeth Hospital, said he diagnoses 30 to 50 cases of sleep apnoea every month.

Patients' airways are blocked because of structural obstructions such as huge tonsils or tongues.

Dr Pang said there has been a huge leap in cases in the past decade, partly due to increased awareness of the condition.

"There is also an increased prevalence in obesity, a risk factor of the disorder," he noted, adding that over half of his sleep apnoea patients are obese or overweight. Those who are obese have more fat in the neck, which extends into their pharynx, or part of the throat, he explained.

Dr Tan's study also showed that Chinese and Malays here have higher rates of moderate to severe OSA, with their estimated population prevalence hitting 32.1 per cent and 33.8 per cent respectively.

Dr Pang said this is partly genetic.

"Asians in general have small jaws. When the face is narrow, the tongue has no space in the jaw and falls backwards during sleep, blocking the airway," he said.

Experts said that if left untreated, the condition could lead to hypertension, heart failure, poor job or academic performance and even an increased risk of traffic accidents.

There are three treatment options: surgery of the blocked air passage, wearing an oral appliance to pull out the lower jaw during sleep, or sleeping with a Continuous Positive Airway Pressure (CPAP) machine. This compresses atmospheric air and forces it into the airway through a facial or nasal mask.

Losing weight and avoiding smoking and alcohol help, said Dr Pang.

Sales manager Kenny Tang, 39, was diagnosed with sleep apnoea a year ago. "My wife and reservist bunk mates would say, 'You're not snoring, you're roaring.' "

He removed his left tonsil as it was so huge that it blocked half of his airway. His doctor also said he has a big tongue and small jaw.

Mr Tang, who is overweight, now sleeps with a CPAP machine. "I used to doze off when looking at my laptop in the office. Now I'm not so tired any more."

What is sleep apnoea and are there any remedies for it?
Posted by The Straits Times on Thursday, March 17, 2016

Disorder caused him to lose his job and get into a traffic accident
By Yeo Sam Jo, The Straits Times, 18 Mar 2016

He has lost a job and caused a traffic accident, all because of a disorder in which he stops breathing repeatedly in his sleep.

Business designer Benjamin Pham, 29, was diagnosed with obstructive sleep apnoea about two years ago. A year earlier, he had started feeling sleepy during the day, and found himself dozing off in the office and at meetings.

Once in 2014, Mr Pham even fell asleep behind the wheel. "One moment I was driving, and the next moment I had collided into a car in front of me," he recalled.

It was only when some friends took a video of him sleeping as a prank, that he realised something might be wrong. "In the video, I could see myself gasping for air in my sleep," said Mr Pham.

He took a friend's advice and went for a sleep test, which monitors body functions during sleep, such as breathing patterns, brain activity and blood oxygen levels.

"The test showed that I woke up 17 to 25 times an hour. I was not really sleeping and not getting enough rest," said Mr Pham.

He has lost a job and caused a traffic accident, all because of a disorder in which he stops breathing repeatedly in his sleep.
Posted by The Straits Times on Thursday, March 17, 2016

In October 2014, he underwent surgery to widen his narrow nasal and throat passages, which his doctor said were the cause of his condition.

"It didn't really work. It got a bit better, but it was not the miracle cure I was hoping for," he said.

The persistent problem led to a poor performance review at work, which eventually cost him his job.

"My boss didn't understand my disorder and chose not to renew my contract."

His constant fatigue also left him with little energy for exercise. At one point, this caused the 1.71m- tall bachelor, who was already overweight, to balloon to 80kg.

Mr Pham later bought a Continuous Positive Airway Pressure machine, which pumps air into his air passage during sleep via a mask.

He used it diligently for four to five months, but found it inconvenient. "It's troublesome when I need to use the bathroom or when I stay over at a friend's place." Now, he uses it only once or twice a week, or when he has an important meeting the next day.

Mr Pham, who has a family history of sleep apnoea, is worried about the associated health problems, such as heart failure and diabetes.

"I try my best to diet, exercise and not be so stressed."

Sleep apnoea linked to higher risk of glaucoma
Local study finds those who have moderate to severe OSA more likely to have eye disease
By Ng Wan Ching, Mind & Body Editor, The Straits Times, 15 Mar 2016

In his 20s, Jay (not his real name) lived with a chronic neck ache for a few years.

When he finally decided to seek medical help, the results were not at all what he expected, given his relative youth. He was diagnosed with two medical conditions - obstructive sleep apnoea (OSA) and early glaucoma. He was only about 30 years old and the prospect of losing his sight was distressing.

OSA occurs when the throat intermittently relaxes and blocks the airway, causing breathing to repeatedly stop and start during sleep.

Glaucoma is a serious eye condition that damages the optic nerve, resulting in vision loss and blindness.

A recent study here showed that those with moderate to severe OSA are more likely to have glaucoma.

Jay was one of the 100 people who took part in a prospective study by Singapore General Hospital (SGH) and the Singapore National Eye Centre (SNEC) examining the prevalence of the eye condition in those with OSA.

The study, conducted between 2013 and 2014, showed that 8 per cent of patients here with moderate to severe OSA also had open angle glaucoma with normal pressure.

In comparison, the prevalence of glaucoma in the general population is 3.2 per cent for all forms of glaucoma and 1.4 per cent for open angle glaucoma.

The impetus for the study came from an increasing number of overseas studies linking OSA with glaucoma, said Dr Desmond Quek, a consultant at SNEC. "We wanted to see if the prevalence of glaucoma in OSA patients in Singapore was comparable to rates quoted in other publications, and if it was necessary to put in recommendations for screening of those with high risk."

Indeed, the findings came close to those of overseas studies published last year which showed that, overall, those with OSA were three times more likely to have glaucoma than those without OSA.

The Singapore study was presented during the 3rd Asean Sleep Congress last November at SGH.

Half of the local patients diagnosed with glaucoma have both structural and functional damage, and the other half have early glaucoma, with structural damage but no functional damage yet, said Dr Quek. Structural damage refers to the thinning of the nerve-fibre layer around the optic nerve head which precedes functional damage or loss of vision, he said.

Eyes with glaucoma also tended to be longer in length and are more myopic.

Crucial to detect glaucoma early

While the association between various eye conditions and OSA is clear, the reasons for this connection are not well understood.

One possibility is that OSA increases resistance to blood flow to the optic nerve, said Dr Quek. This creates a transient drop in oxygen supply, thus damaging the nerve.

Early detection and treatment can slow the progression of glaucoma, although vision already lost cannot be reversed, he said, hence the importance of screening, early detection and treatment.

The first-line treatment is using eye drops to lower the eye pressure and thus prevent further nerve damage. If eye drops fail to lower the pressure, more invasive forms of treatment like surgery may be required.

Based on published studies, OSA seems to have the strongest relationship in causing harm to eye health, among all the other sleep disorders, said Dr Toh Song Tar, director of the sleep disorders unit and consultant in the department of otolaryngology at SGH.

And given that OSA is one of the most prevalent sleep disorders here, affecting three in 10 of those aged 40 and above, such a relationship is worrying.

OSA is also associated with floppy eyelid syndrome, swelling of the optic disc and leakage of fluid under the retina, causing visual impairment, said Dr Toh. About 70 to 80 per cent of those who suffer a painless sudden loss of vision also have OSA, he added.

The cost-benefit ratio of any screening programme has to be carefully calculated before a widespread programme can be implemented. However, doctors encourage patients with confirmed moderate to severe OSA to have their eyes screened for glaucoma.

Jay, now 31, is keeping his glaucoma under control with eye drop medication. He was also advised to get a machine to help send pressurised air into his airway through the nose. This helps to prevent his airway from collapsing when he sleeps and improves sleep quality.

"I didn't know much about glaucoma, but I knew that, like cataracts, it was something to worry about only when you're much older," said Jay, an English teacher now living in Japan.

He had consulted a variety of specialists such as ear, nose and throat surgeons and neurologists, and even did some physiotherapy before ending up at the sleep disorder unit in SGH. "I did the sleep test and was diagnosed with OSA," said the bachelor.

He was then asked if he could participate in the study about glaucoma. He joined the research thinking it would be beneficial to do an eye test since he has myopia. He didn't think he would have glaucoma.

"I was rather distraught at first, thinking that I might go blind and I was only about 30 years old."

After some research and consultation with SNEC doctors, he felt better. "I realised that, though glaucoma is chronic and the damage to the optic nerves is permanent, it can be controlled with proper medication. What I can do is to prevent further damage," he said.

Eye-care professionals around the world dedicate the month of March to increasing glaucoma awareness through educational activities and the media.