What are the steps to get Sleep Apnea diagnosed and treated in Singapore?

Thank you for your questions. As your questions have been answered well by Dr Chua, I shall not be repetitious. However, I would like to elaborate on why snoring is a significant symptom and the assessments involved for a snorer.

Snoring is a common symptom and a local study has shown that up to 30% of Singaporeans snore. It is a significant symptom for 2 main reasons:

1. If the snorer has a bed partner, he/she will be frustrated and possibly sleep deprived from the constant or loud snoring.

2. Snoring may be just the tip of the iceberg and is a common symptom of a potentially serious health condition called obstructive sleep apnoea (OSA).

OSA occurs when the muscles around the upper airway (breathing passage around the mouth/throat) relaxes and obstructs/closes the upper airway for a short period of time during sleep.

Hence, the patient literally “chokes during sleep”. If this happens many times during sleep, it can lead to serious health consequences such as:

1. High blood pressure
2. Irregular heart beats
3. Stroke
4. Diabetes
5. Poor concentration/tiredness during the day.

The assessment of a snorer includes:

1. A medical history (e.g questions to determine risk factors for OSA and potential complications from OSA)

2. Physical examination – this aims to determine the level of blockage in the upper airway and likely would include a:

i) Measurement of your height, weight and body mass index (BMI)

ii) Examination of the head & neck region – to look for possible causes/contributors of snoring/OSA (e.g. enlarged tonsils in the throat, thick neck, small or receded chin etc)

iii) Nasoendoscopy – Passage of a small scope (lighted tube with a camera) through the nose to assess the upper airway. This is a relatively painless procedure done in the clinic under local anaesthesia.

Examples of common causes of snoring or OSA seen on nasoendoscopy include:

1. Enlarged inferior turbinates
2. Deviated nasal septum
3. Sinusitis with or without nasal polyps
4. Enlarged adenoids in the nose
5. Bulky back of tongue
6. Large tonsils

3. Diagnostic test for OSA – the only way to confirm the presence or absence of OSA is to undergo an investigation called a Sleep Study.

This involves placements of sensors/wires on various parts of the body to assess the patient’s sleep. The test is an overnight study done in a hospital or at a patient’s home (at least 6 hours of sleep is usually recommended).

There are many different types of sleep study, and it is beyond the scope of this Q&A to address all of them.

Your ENT Specialist should be able to advise you on one that suits you best. Amongst the parameters measured during a sleep study may include:

1. Your brain activity
2. Heart activity
3. Muscle activity
4. Amount of snoring or “choking episodes”
5. Oxygen level in the blood etc.

The medical index used to determine OSA is called Apnoea-Hypopnoea Index (AHI). If a patient “chokes” more than 5 times in an hour, he or she has OSA.

OSA is classified as mild, moderate or severe, depending on the amount of “choking”/hour or AHI.

Treatment of a patient with snoring or OSA includes lifestyle modifications, continuous positive airway pressure (CPAP) therapy, dental devices and surgery.

There is no quick fix to snoring or OSA and often a combination of the treatment modalities may be required.

Hope this helps!

You should definitely get a referral to see a specialist. You are right to say that you can obtain a referral at the polyclinic. They should refer you to an ENT specialist.

You will not be able to choose a specialist if you are referred from the polyclinic. However, you well can be assured that all our government hospitals are well equipped to diagnose and treat sleep apnea.

Your husband’s first visit at the specialist will involve a detailed consultation and full physical examination including a nasoendoscopy. There is little preparation needed and he will leave as he went. They may also schedule him for a sleep study depending on what they find. This is usually done on a separate occasion.

Hope this helps!