16.MAY.2019 4 MIN READ | 4 MIN READ

Sleep apnoea is at best an inconvenience, and at worst, puts you at risk of medical problems. Could sinus surgery be the solution?

Sleep apnoea is a condition that affects far more people than you might realise. Researchers found during an international study conducted in 2018 that almost 1 billion people suffer from sleep apnoea worldwide. Because it occurs during sleep, you may not be aware that you have it, but it can have a significant impact on your health.

What is sleep apnoea?

Sleep apnoea is a disorder that is characterised by interrupted breathing during sleep. This can happen hundreds of times during one sleep session. When your breathing is interrupted, your body is deprived of oxygen, and your brain can be deprived of oxygen too.

There are 2 types of sleep apnoea. Central sleep apnoea occurs when your brain fails to trigger your muscles to breathe regularly. Obstructive sleep apnoea occurs when your airways, including your nasal passages and throat, become blocked.

Sleep apnoea is linked to a host of medical issues, including an increased risk of stroke, diabetes, mental health conditions, heart failure or high blood pressure. Severe sleep apnoea can be dangerous, so it’s important to get a proper diagnosis if you suspect you might have it.

Symptoms of sleep apnoea

Symptoms of sleep apnoea
You may notice the following symptoms:

  • Snoring, often loudly
  • Restlessness during sleep
  • Waking up suddenly
  • Waking up with a choking sensation
  • Insomnia
  • Dry or sore throat
  • Fatigue during the day
  • Headaches
  • Depression or irritability
  • Loss of libido

Your partner may also notice you snoring or breathing irregularly if you share a bed.

Treating sleep apnoea

If your sleep apnoea is obstructive, treatment will usually focus on the ear, nose and throat. While there are many different medical and surgical options for sleep apnoea, recent studies have suggested that sinus surgery may offer an improvement in symptoms, if the problems are in the nose/sinuses.

Sinus surgery

Your sinuses are cavities within your skull and are a part of your airway system. Sinus surgery is typically carried out to clear your sinuses, reduce inflammation and limit the occurrence of sinus infections. This is achieved by removing blockages such as polyps or cysts. As sleep apnoea is often caused by obstructions to your airways, sinus surgery may be an effective way to improve airflow and prevent interruptions to your breathing during sleep.

Types of sinus surgery

Septoplasty
Sinus surgery can be performed using a number of different techniques. Your doctor will probably choose the least invasive option if they believe you are a good candidate for surgery. Common types of sinus surgery include:

  • Endoscopic sinus surgery, in which your surgeon uses rigid endoscopes and a small camera to remove blockages without an incision. This may include septoplasty and trifioplasty
  • A more invasive surgical procedure, which may need to be carried out if there are growths within your sinuses

Is sinus surgery the solution to sleep apnoea?

Although there is research to suggest that sleep apnoea can be improved with sinus surgery, you should be cautious. Whilst studies have shown an improved quality of life for patients post sinus surgery, this is also because of the improvement they feel in their sinuses in general. Not every patient with sleep apnoea will have blocked or inflamed sinuses, in which case it would not help their sleep disorder at all. Most researchers have finished their studies into sinus surgery and sleep apnoea by suggesting further clinical trials are required before a definitive conclusion can be reached. There are not at present enough statistics available to confirm that sinus surgery is the answer to treating sleep apnoea in most patients.

Surgery of any kind, especially one that requires anaesthetic, poses risks. Some of the risks of sinus surgery include:

  • Infection
  • Eye injury
  • Brain injury
  • Reaction to anaesthesia
  • Tissue damage
  • Bleeding
  • Loss of smell

Because of these risks, the decision to have surgery should not be taken lightly. If you think sinus surgery may have significant benefits to you, you should talk to your doctor and weigh up these risks.

The benefits of surgery

Despite the need for further research, if you have a history of sleep apnoea and problems with your ear, nose and throat, you may still be a good candidate for sinus surgery. Your ENT surgeon may also suggest performing more than one procedure at once, such as correcting a deviated septum or reducing tissue in other areas to improve airflow. A combination of surgical approaches may offer you a better quality of life.

The benefits of sinus surgery include:

  • Improved breathing
  • Fewer colds and infections
  • Reduction in snoring
  • Improved quality of sleep
  • Fewer headaches
  • General feeling of wellness

Alternative treatment options

Alternative treatment - CPAP
While surgery might sound like a quick fix, there are other treatment options that may be more suitable. Common sleep apnoea treatments include:

  • Medications
  • Nasal sprays
  • An oral device for wearing during sleep
  • A continuous positive airway pressure (CPAP) machine, which keeps your throat open with a steady stream of air as you sleep

Your doctor may also recommend that you quit smoking, increase your exercise levels, lose weight and improve your general health to try to combat your sleep apnoea before resorting to surgery.

If you have sleep apnoea or any condition that you believe affects your ability to breathe normally, make an appointment to see your doctor for a referral to an ENT specialist. They will be able to discuss your symptoms and your alternative treatment options, as well as the possibility of surgery.

 

Article reviewed by Dr Ravi Seshadri, ENT surgeon at Parkway East Hospital

Reference

Martin, L.J. (2018, July 7) Do I Need Surgery for Sinusitis? Retrieved 9/4/19 from https://www.webmd.com/allergies/sinusitis-do-i-need-surgery#2

Ratini, M. (2018, March 4) Obstructive Sleep Apnea Explained. Retrieved 9/4/19 from https://www.webmd.com/sleep-disorders/guide/understanding-obstructive-sleep-apnea-syndrome#3

Sleep Apnoea (ND) Health Direct. Retrieved 9/4/19 from https://www.healthdirect.gov.au/sleep-apnoea

Willingham, E. (2015, Sept 10) Sinus Surgery May Also Ease Sleep Apnea. Retrieved 9/4/19 from https://www.webmd.com/sleep-disorders/sleep-apnea/news/20150910/sinus-surgery-may-also-ease-sleep-apnea#1

Wu, J., Zhao, G., Li, Y., Zang, H., Wang, T., Wang, D., Han, D. (2017, Feb 3) Apnea–hypopnea index decreased significantly after nasal surgery for obstructive sleep apnea, A meta-analysis. Retrieved 9/4/19 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5293463/

Nearly 1 Billion People Worldwide Have Sleep Apnea, International Sleep Experts Estimate. Sleep Review. (ND) Retrieved 9/4/19 from http://www.sleepreviewmag.com/2018/05/nearly-1-billion-people-worldwide-sleep-apnea-international-sleep-experts-estimate/

16.MAY.2019
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Ravi Seshadri @ Srinivasan
ENT Specialist
Mount Elizabeth Hospital

Dr Ravi Seshadri is an ear, nose, throat (ENT) surgeon with more than 20 years of experience, and currently practises out of his clinic at Mount Elizabeth Novena Hospital. He specialises in caring for patients with nasal allergy, snoring and throat and voice problems. He also sees a wide variety of paediatric patients with ear, nose and throat problems.