Dr. Mohamed Hisham Mohamed Jali @Yunos
Dr. Mohamed Hisham Mohamed Jali @YunosPensyarah Pergigian Fakulti Pergigian

Don’t ignore the snore

Many people may not realize why they become so sleepy in the day time instead of walking to bed early a night before. To make it worst, they might just fall asleep at any time regardless of the locations and situations. While delivering a lecture in class, watching exciting movies, sitting for an important examination or while driving a car, just to name a few. Unfortunately, in spite of those events, the exact cause remains mysterious. Many of them claim they walk to bed as early as 8 pm, but get up in weak and fatigue state. Clearly, it is a major problem. but they just never know what it is. It is like living in a fog.

Well, they may suffer from a condition which is usually under recognised and under diagnosed which is known as Obstructive Sleep Apnea or commonly known as OSA. What is that? Is this condition treatable? Would this ‘disease’ spread to the others? Will it disappear by itself? Besides getting sleepy in the day time, will it harm our general health, beauty, appearance or our invaluable relationship? The answer is Yes and No.

So, what is Obstructive sleep apnea (OSA)?

During sleep, a person may snore. Snore happens when there is a partial obstruction in upper airway, yet he is still able to breath. This sounds normal to you as many healthy people also snore. But in a person with OSA, the airflow in upper airway is completely blocked during sleep hence the inhaled air cannot go into the lungs. It is due to collapse of the soft tissue in the upper airway. When OSA occurs, you may stop breathing for short period of time. You will gasp for air and occasionally produce a choking sound before starting to breath again. This occurs on and off during sleep and will wake you up from a sleep.

During sleep, persons with OSA may have the followings (witnessed by partner, family members or housemate):

  1. Loud and irregular snoring
  2. Restless sleep (frequent tossing and turning)
  3. Nycturia (frequent urination at night)
  4. Enuresis (Involuntary urination, bet wetting)
  5. Jerky body movement
  6. Frequent productions of chocking sound and gasping for air.
  7. Sudden infant death syndrome may occur (in infant/neonate)

Because of those events, they may show have these following symptoms while awake:

  1. Morning headache
  2. Personality changes
  3. Loss of libido and impotence
  4. Hypersomnolences (unusual daytime sleepiness). May lead to dangerous event e.g. road traffic accident, injuries at workplace.
  5. Depression
  6. Struggle to pay attention or concentrate at work
  7. Shows performance problem at work
  8. Have poor concentration and impaired memory
  9. Mood swings
  10. Cardiopulmonary dysfunction:
    1. hypertension
    2. cardiac arrhythmias
    3. heart failure
    4. polycythaemia
  11. Sudden infant death syndrome

OSA is common in:

  1. Snorers
  2. Male, woman past menopause
  3. Overweight or obese
  4. Person with large neck size (17 inches or more)
  5. Small airway (small lower jaw, abnormal face shape)
  6. Nasal blockage
  7. Congenital syndromes e.g. Down’s syndrome, Pierre Robin Sequence ,Treacher Collins, Goldenhar/Hemifacial microsomia
  8. Large tongue


OSA is diagnosed by a sleep study (polysomnogram). A sleep study can be conducted at a hospital centre or at your home. During this study, certain body functions will be measured and recorded throughout your overnight sleep.

How to treat this?

The treatment modalities will depend on what has caused the apnea. But all the modalities share the same objective; to expand the blocked/narrowed airway. It can be classified into non-surgical and surgical therapy:

Non-surgical therapy:

  1. Weight loss
  2. Sleep hygiene
  3. pharmacotherapy
  4. CPAP (continuous positive airway pressure)
  5. Oral appliances (e.g. Somnodent)

Surgical therapy

  1. Tonsillectomy & adenoidectomy
  2. UPPP (Uvulopalatopharyngoplasty)
  3. Hyoid bone suspension
  4. Tongue reduction surgery
  5. Nasal surgery
  6. Tracheostomy
  7. Orthognathic surgery
  8. Distraction osteogenesis
  9. Combination

In many centres/hospitals, OSA management is a multidisciplinary team approach which usually consists of:

  1. Respiratory physician
  2. Ear, Nose and Throat surgeon
  3. Dietitian /nutritionist
  4. Orthodontist
  5. Oral & maxillofacial Surgeon
  6. Cardiologist
  7. Paediatrician


If you have the signs as described above, please seek for assessment and treatment. Early treatment will help to minimize the detrimental effects and complications which can be damaging not only to persons with this problem but also to their relatives or the loved ones. Quality of life will be jeopardized. OSA will be a life -threatening condition if remains untreated. In Malaysia, the health care facilities and services are ready at your disposal. Please take this opportunity before it’s too late. Remember, don’t ignore the snore.




AMERICAN THORACIC SOCIETY: Patient information series

Dimitroulis, G. (1997). Obstructive sleep apnoea: the role of the oral and maxillofacial surgeon. Australian dental journal, 42(1), 25-29.