RISKS OF OBSTRUCTIVE SLEEP APNOEA MORTALITY The cumulative effect of the various health risks associated with untreated severe OSA, such as cardiovascular disease and stroke, can increase the risk of death by up to 3 times compared to those without OSA. Reference: Terry Young 1, Laurel Finn, Paul E Peppard, Mariana Szklo-Coxe, Diane Austin, F Javier Nieto, Robin Stubbs, K Mae Hla. Sleep disordered breathing and mortality: eighteen-year follow-up of the Wisconsin sleep cohort. Sleep. 2008 Aug;31(8):1071-8. CARDIOVASCULAR DISEASE Studies have shown a strong correlation between OSA and cardiovascular problems such as hypertension, arrhythmias, and coronary artery disease. Long-term cardiovascular outcomes can be severely affected if OSA remains untreated. Reference: Marin JM, Carrizo SJ, Vicente E, Agusti AG. “Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study.” Lancet. 2005;365(9464):1046-1053. STROKE Research has shown that individuals with untreated OSA have a 2 to 4 times higher risk of experiencing a stroke compared to those without OSA. OSA is an independent risk factor for stroke, with research indicating a strong correlation between untreated OSA and increased risk of stroke. Reference: Yaggi HK, Concato J, Kernan WN, Lichtman JH, Brass LM, Mohsenin V. “Obstructive sleep apnea as a risk factor for stroke and death.” N Engl J Med. 2005;353(19):2034-2041. DIABETES Approximately 15-30% of patients with diabetes also have OSA. Additionally, individuals with severe OSA may have up to a 3-fold increased risk of developing insulin resistance, a precursor to type 2 diabetes. The intermittent hypoxia experienced in OSA can lead to insulin resistance, contributing to type 2 diabetes. Reference: Punjabi NM, Sorkin JD, Katzel LI, Goldberg AP, Schwartz AR, Smith PL. “Sleep-disordered breathing and insulin resistance in middle-aged and overweight men.” Am J Respir Crit Care Med. 2002;165(5):677-682. METABOLIC SYNDROME About 35-40% of people with OSA also have metabolic abnormalities like dyslipidemia, hypertension, and insulin resistance, which are components of metabolic syndrome. Reference: Sharma SK, Agrawal S, Damodaran D, et al. “CPAP for the metabolic syndrome in patients with obstructive sleep apnea.” N Engl J Med. 2011;365(24):2277-2286. COGNITIVE IMPAIRMENT Studies suggest that up to 50% of OSA patients show some form of cognitive impairment. OSA can contribute to cognitive decline affecting memory, attention, and executive function, impacting daily life and productivity. Studies suggest that up to 50% of OSA patients show some form of cognitive impairment. OSA can contribute to cognitive decline affecting memory, attention, and executive function, impacting daily life and productivity. MOOD DISORDERS Research has indicated that the prevalence of depressive symptoms in OSA patients can be as high as 45%. Moreover, the incidence of anxiety disorders in OSA patients has been reported to be significantly higher compared to the general population. Reference: Peppard PE, Szklo-Coxe M, Hla KM, Young T. “Longitudinal association of sleep-related breathing disorder and depression.” Arch Intern Med. 2006;166(16):1709-1715. DAYTIME FATIGUE AND ACCIDENTS Studies have shown that individuals with untreated OSA have up to a 7-fold increased risk of being involved in multiple motor vehicle crashes compared to those without OSA. Additionally, the rate of workplace accidents is notably higher among OSA sufferers. GASTROESOPHAGEAL REFLUX DISEASE (GERD) Studies indicate that approximately 60% of people with OSA also report symptoms of GERD, which is significantly higher than its prevalence in the general population. The relationship between OSA and GERD is thought to be due to the increased intra-abdominal pressure and negative intrathoracic pressure during apnoeic episodes, which can exacerbate GERD symptoms. Reference: Locke, G. Richard III, et al. “The Relationship Between Gastroesophageal Reflux Disease and Obstructive Sleep Apnea.” Journal of Clinical Gastroenterology, vol. 39, no. 3, 2005, pp. 225–237. SEXUAL DYSFUNCTION Research indicates that up to 70% of men with OSA experience some form of erectile dysfunction, compared to around 22% in the general population. Furthermore, women with OSA have reported reduced sexual satisfaction at a rate significantly higher than women without the sleep disorder. The relationship between sexual dysfunction and OSA is multifactorial. Factors such as decreased libido, hormonal imbalances, and daytime fatigue contribute to this association. Reference: Margel, Dov, et al. “Severe, but Not Mild, Obstructive Sleep Apnea Syndrome Is Associated with Erectile Dysfunction.” Urology, vol. 63, no. 3, 2004, pp. 545–549. PULMONARY HYPERTENSION Some studies suggest a link between untreated OSA and elevated blood pressure in the arteries of the lungs, known as pulmonary hypertension. Some studies suggest a link between untreated OSA and elevated blood pressure in the arteries of the lungs, known as pulmonary hypertension. CHRONIC KIDNEY DISEASE OSA is observed in approximately 30% of patients with chronic kidney disease. Research has shown a correlation between OSA and the progression of chronic kidney disease. Reference: Ahmed SB, Ronksley PE, Hemmelgarn BR, et al. “Nocturnal hypoxia and loss of kidney function.” PLoS One. 2011;6(4): e19029. LIVER DISEASE OSA may exacerbate liver conditions like non-alcoholic fatty liver disease. Reference: Norman D, Bardwell WA, Arosemena F, Nelesen R, Mills PJ, Loredo JS, Lavine JE, Dimsdale JE. “Serum aminotransferase levels are associated with markers of hypoxia in patients with obstructive sleep apnea.” Sleep. 2008;31(1):121-126. Given these associations, Dr Sandeep Uppal and his team prioritize the accurate diagnosis and effective treatment of OSA. Through a multi-disciplinary approach involving lifestyle modifications, medical devices, and potentially surgical interventions, they aim to prevent the onset or progression of these serious health conditions. Learn more about Obstructive Sleep Apnoea>> Read more about Management of Snoring and Obstructive Sleep Apnoea>> TAKE CONTROL OF SNORING AND OBSTRUCTIVE SLEEP APNOEA (OSA) Given the prevalence and potential complications associated with snoring and obstructive sleep apnoea (OSA), it’s essential to seek specialized care. Dr Sandeep Uppal and his dedicated team are here to provide expert assistance. Don’t wait any longer—take proactive steps to manage snoring and OSA effectively. Our multidisciplinary approach combines medical expertise with cutting-edge technology, offering a comprehensive range of services designed to diagnose and treat both snoring and OSA, addressing their underlying causes. Regain control over your sleep and overall health—act now. Contact us today to schedule your comprehensive consultation and

MANAGEMENT OF SNORING AND OBSTRUCTIVE SLEEP APNOEA CONSULTATION AND HISTORY TAKING During the initial consultation Dr Sandeep takes a detailed history, a crucial step that helps him and his team to arrive at an accurate diagnosis and differentiate between simple snoring and sleep apnoea, and formulate an effective treatment plan. Below are the key components involved in taking a detailed history from patients suspected of having sleep apnoea. CHIEF COMPLAINT The primary reason for seeking medical attention, often reported as snoring, daytime fatigue, or breathing interruptions during sleep. KEY OCCUPATIONAL FACTORS TO CONSIDER Work Schedule Those who work in shifts, especially night shifts, are more prone to disrupted sleep patterns, which can exacerbate symptoms of sleep apnoea. Stress Levels High-stress jobs can contribute to poor sleep quality and increased incidence of sleep disorders. Physical Demands Occupations that require minimal physical activity can contribute to weight gain, a significant risk factor for sleep apnoea. Travel Requirements Jobs that require frequent travel, especially across time zones, can disrupt natural circadian rhythms and worsen sleep quality. Workplace Environment Exposure to toxins, noise, or irritants at work can potentially impact sleep and respiratory health. SLEEP-RELATED HISTORY These additional factors allow for a more nuanced understanding of the patient’s sleep habits and lifestyle, which could be contributing to or exacerbating sleep apnoea symptoms. By integrating these elements into the history-taking process, Dr Sandeep Uppal and his team can formulate a more accurate diagnosis and develop a personalised treatment plan that addresses the root causes and contributory factors of the sleep apnoea condition. Severity of Snoring Inquire about the loudness and frequency of snoring. Sleep Disruptions Ask about episodes of choking, gasping for air, or waking up abruptly. Daytime Symptoms Examine the presence of excessive daytime sleepiness, irritability, or fatigue. Sleep Position Discuss the patient’s preferred sleep position, as certain positions may exacerbate apnoea. Bed Partner Observations Collect any observations made by the patient’s sleeping partner regarding snoring, restlessness, or pauses in breathing. Sleep Environment The condition of the bedroom, including lighting, noise levels, and temperature, as these factors can impact sleep quality. Pre-Sleep Routine Activities performed before bedtime such as reading or using electronic devices, which may affect the ability to fall asleep. Time to Sleep and Awake The usual time the patient goes to bed and wakes up, to evaluate the consistency in sleep schedule. Quality of Sleep Self-reported assessment of sleep quality, including whether the patient feels refreshed upon waking. Ease in Initiating Sleep Time it typically takes to fall asleep once in bed. Ease in Maintaining Sleep Frequency of waking up during the night and difficulty in returning to sleep. Caffeine Intake Amount and timing of coffee or other caffeinated beverages, as these can interfere with sleep patterns. Other Stimulants Use of energy drinks, nicotine, or other substances that could affect sleep quality. MEDICAL HISTORY Past Medical History Information about pre-existing medical conditions such as hypertension, diabetes, stroke or heart disease. Medications A list of current medications that could potentially affect sleep or airway muscle tone. Surgical History Any past surgeries, particularly those related to the upper airway, nose, or throat. LIFESTYLE AND SOCIAL HISTORY Alcohol Consumption Amount and frequency, as alcohol can relax the airway muscles and worsen apnoea. Tobacco Use Smoking can irritate and inflame the airway, potentially exacerbating symptoms. Diet and Exercise Discuss weight as obesity is a significant risk factor for sleep apnoea. FAMILY HISTORY Presence of sleep apnoea or related disorders in immediate family members. REVIEW OF SYSTEMS A general review of other body systems to identify any symptoms that might be linked to sleep apnoea, such as cardiovascular issues, endocrine abnormalities, or mental health concerns. After the history-taking, Dr  Sandeep Uppal and his team may proceed with a physical examination and potentially recommend further diagnostic tests to distinguish simple snoring from OSA. This comprehensive approach ensures that each patient receives a thorough evaluation, leading to targeted and effective treatment plans for managing sleep apnoea. PHYSICAL EXAMINATION For a comprehensive assessment and diagnosis of obstructive sleep apnoea (OSA), a detailed physical examination is crucial. Dr  Sandeep Uppal and his team employ a variety of diagnostic techniques to thoroughly evaluate the condition of their patients. COMPREHENSIVE HEAD AND NECK EXAMINATION Evaluation of the nose, throat, and neck to identify any anatomical abnormalities like deviated septum, enlarged tonsils, or a large tongue base that may contribute to airway obstruction. Mallampati Score A classification that helps predict the ease of intubation and may also indicate the risk of OSA. It assesses the visibility of the uvula, soft palate, and pillars. Nasal Endoscopy For some cases, a flexible endoscope may be used to visualize the upper airway and identify any obstructions or anatomical issues. Müller’s Manoeuvre This can help identify patients who are likely to benefit from surgical interventions for OSA. It is particularly useful for assessing the efficacy of potential surgeries like uvulo-palato-pharyngoplasty (UPPP) or genioglossus advancement (GA). BMI Measurement Obesity is a significant risk factor for OSA, so Body Mass Index (BMI) is usually calculated. Neck Circumference A larger neck circumference can indicate a higher risk of OSA. Epworth Sleepiness Scale A questionnaire that assesses daytime sleepiness, commonly used to gauge the severity of sleep apnoea symptoms. Blood Pressure Elevated blood pressure is often associated with OSA. DIAGNOSTIC TESTS Here are the primary tests employed to diagnose OSA: POLYSOMNOGRAPHY (SLEEP STUDY) The gold standard for diagnosing OSA. This test records multiple body functions during sleep, including brain activity, eye movement, heart rate, and blood oxygen levels. HOME SLEEP APNOEA TEST (HSAT) A simplified sleep study that can be done at home, which measures basic parameters like airflow, breathing effort, and oxygen levels. DRUG-INDUCED SLEEP ENDOSCOPY (DISE) A procedure where the airway is observed using an endoscope while the patient is under sedation, to identify the site of obstruction. MULTIPLE SLEEP LATENCY TEST (MSLT) Primarily used to diagnose narcolepsy, this test is performed in collaboration with our sleep medicine colleagues and can also provide information on the degree of

DIFFERENCES BETWEEN SNORING AND OBSTRUCTIVE SLEEP APNOEA Snoring and obstructive sleep apnoea (OSA) are often confused due to their similar manifestations involving the respiratory system during sleep. However, they are distinct conditions with different clinical implications. Dr Sandeep Uppal and his team are skilled in distinguishing between the two and providing appropriate treatment for each. SNORING Definition: Snoring is the sound produced by the vibration of soft tissues in the throat and nasal passages during sleep. It is typically continuous and occurs during the inhalation and exhalation of breath. Causes: It can result from various factors, including nasal congestion, obesity, alcohol consumption, and sleep position. Symptoms: The primary symptom is the snoring sound itself, which can vary in volume and pattern. There may be no other associated symptoms. Impact: While snoring can be disruptive to sleep quality for both the individual and their partner, it is generally not considered a medical emergency unless it is a symptom of OSA or another underlying condition. Treatment: Often managed through lifestyle changes, anti-snoring devices, or, in severe cases, surgical interventions. Learn more about snoring>> Learn more about management options for snoring>> OBSTRUCTIVE SLEEP APNOEA (OSA) Definition: OSA is a serious sleep disorder characterized by repeated interruptions in breathing during sleep due to a temporary blockage of the airway. Causes: Like snoring, OSA can also be caused by obesity, but it is often exacerbated by other factors like anatomical abnormalities, muscle relaxation, and other medical conditions. Symptoms: Apart from snoring, OSA is associated with symptoms like choking or gasping for air, long pauses in breathing, daytime sleepiness, irritability, and morning headaches. Impact: OSA can lead to a range of health complications, including cardiovascular disease, hypertension, and increased risk of accidents due to poor concentration and daytime sleepiness. Treatment: More complex and often requires the use of Continuous Positive Airway Pressure (CPAP) machines, Bi-Level Positive Airway Pressure (BiPAP) devices, or even surgical interventions. Learn more about Obstructive Sleep Apnoea>> Learn more about management of Obstructive Sleep Apnoea>> KEY DIFFERENCES Breathing Interruptions: Snoring is usually continuous, while OSA involves frequent pauses in breathing. Daytime Symptoms: OSA often leads to noticeable daytime symptoms like extreme fatigue and irritability, which are generally not present in cases of simple snoring. Health Risks: OSA carries significant health risks and often requires medical intervention, while snoring is generally less severe but may still warrant treatment to improve sleep quality. TAKE CONTROL OF YOUR SNORING AND OBSTRUCTIVE SLEEP APNOEA (OSA) Given the prevalence and potential complications associated with snoring and obstructive sleep apnoea (OSA), it’s essential to seek specialized care. Dr Sandeep Uppal and his dedicated team are here to provide expert assistance. Don’t wait any longer—take proactive steps to manage snoring and OSA effectively. Our multidisciplinary approach combines medical expertise with cutting-edge technology, offering a comprehensive range of services designed to diagnose and treat both snoring and OSA, addressing their underlying causes. Regain control over your sleep and overall health—act now.