As a sleep specialist, have you seen improvements in sleep apnea awareness and strategies?
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Sleep apnea is still an underrecognized and underdiagnosed condition. Many people who have this disorder are not aware of it or never step forward to seek diagnosis and treatment.
However, our subspecialty has grown, and more colleagues are referring patients to us. First it was cardiologists and now ophthalmologists. An increasing number of studies are published on the numerous and severe consequences of obstructive sleep apnea, the media are helping us to disseminate this knowledge, and public awareness is growing.
Every person who has symptoms that suggest sleep-related breathing difficulties, including snoring, choking and gasping, should seek help from a sleep specialist. Sleep medicine is a subspecialty within a variety of fields, and a sleep specialist might be an otolaryngologist, a pulmonologist, a neurologist, a general practitioner or an internist.
The diagnostic process is now easier and more accessible because we have moved more toward home sleep devices. A home sleep apnea test is a portable monitor that patients wear overnight, and it can be as good as inpatient polysomnography devices.
As far as treatment is concerned, in recent years we have seen a proliferation of different options that we can choose from. According to the severity of the problem, we may suggest lifestyle and behavioral modifications that include weight loss, proper sleep hygiene, sleeping on the side, and even myofunctional exercises that help retrain the movement of the tongue, orofacial muscles and throat. We have good device-oriented therapies, such as positive airway pressure devices, and oral appliances, such as mandibular advancement devices that pull the jaw and tongue forward to stabilize the airway. We have soft tissue surgery to reconstruct the upper airway. We have skeletal surgery, such as maxillomandibular advancement that advances the jaw to expand the airway, and the hypoglossal nerve stimulation implant is a surgically implanted device that stimulates the hypoglossal nerve and helps to move the tongue forward, preventing obstruction and stabilizing the airway while the patient is sleeping.
We need to spread awareness on the options and provide better information and education, starting from sleep education programs in schools. Health authorities should also promote campaigns on sleep health and sleep hygiene, and physicians should be more willing to share their knowledge and help inform patients that sleep apnea can be the cause of serious problems but is also a highly treatable and modifiable condition. The media, of course, can play a critical role.
Song Tar Toh, MBBS, MRCS, MMED(ORL), MMED(Sleep Med), FAMS(ORL), senior consultant and chair in the department of otorhinolaryngology-head and neck surgery, Singapore General Hospital, and senior consultant SingHealth Duke-NUS Sleep Centre, SingHealth in Singapore, can be reached at toh.song.tar@singhealth.com.sg.
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