What are snoring and obstructive sleep apnoea (OSAS)?
Snoring is the noise made by the soft tissues of the throat, such as the soft palate and the uvula, vibrating as air passes through a narrow space during sleep. It is very common and, on its own, is not always a sign of disease.
Obstructive sleep apnoea syndrome (OSAS) is when the airway partly or completely closes, many times each night. Breathing stops for a few seconds (apnoea) or becomes shallow (hypopnoea), oxygen levels in the blood fall and sleep is broken up again and again, often without the person noticing.
The narrowing can occur at several levels: the nose, the palate, the tonsils or the base of the tongue. This is why an assessment by an otolaryngologist, the ear, nose and throat (ENT) specialist, is important.
Snoring and sleep apnoea: when should you see an ENT surgeon in Bari?
A consultation is worthwhile if snoring is loud and happens every night, or if your bed partner notices pauses in your breathing. Often it is the partner who first raises the alarm.
These are the signs not to ignore. On their own they are not enough for a diagnosis, but they show that further assessment is needed.
- Pauses in breathing or waking up with a choking sensation
- Sleepiness during the day, including while driving
- Feeling tired on waking and morning headaches
- Poor concentration and memory, irritability
- Needing to pass urine several times during the night
- A chronically blocked nose or breathing through the mouth
Is sleep apnoea dangerous?
Untreated OSAS is not just a problem of noise. Broken sleep causes daytime sleepiness and poor attention, and it affects quality of life, including relationships.
Repeated drops in oxygen during the night are associated with a higher cardiovascular risk: high blood pressure, heart rhythm problems, heart attack and stroke. Sleepiness also increases the risk of road and workplace accidents.
How is sleep apnoea diagnosed?
Diagnosis comes before any treatment. The first test is a sleep study: polysomnography or overnight cardiorespiratory monitoring. These recordings measure breathing, blood oxygen, snoring and body position during the night; cardiorespiratory monitoring is often done at home with a small device.
The test shows how many apnoeas and hypopnoeas occur per hour of sleep. This distinguishes simple snoring from mild, moderate or severe OSAS.
Alongside the sleep study, an ENT assessment of the upper airway is needed. The specialist examines the nose, palate, uvula, tonsils and tongue, often with an endoscopy: a thin fibre-optic scope passed through the nose, which is usually well tolerated. In selected cases, an endoscopy during drug-induced sleep may be advised, to show where the airway closes while you sleep.
What are the treatments for snoring and OSAS?
There is no single treatment that suits everyone. The choice depends on how severe the OSAS is, where the airway narrows, body weight and the patient's preferences. Options are often combined.
- Lifestyle: weight loss if needed, no alcohol or sedatives in the evening, stopping smoking, regular sleep times.
- Positional therapy: avoiding sleeping on your back, if the apnoeas occur mainly in that position.
- CPAP: a machine that delivers air at gentle pressure through a mask and keeps the airway open. It is often the first-line treatment for moderate or severe OSAS.
- Oral appliances: custom-made devices, fitted by a dentist, that hold the lower jaw forward during the night.
- Surgery: for selected patients, when the obstruction is anatomical and clearly located.
What is uvulopalatoplasty and when is it done?
Uvulopalatoplasty is the surgical reshaping of the soft palate and the uvula, the small flap of tissue that hangs at the back of the throat. It widens the space behind the palate and reduces upper airway resistance during sleep. It is performed through the mouth, with no external incisions, usually under general anaesthesia.
It may be advised for severe snoring and in some cases of OSAS, when tests show that the narrowing is mainly at the level of the palate. If the tonsils are very large, they can be removed during the same operation (tonsillectomy).
When the nose is blocked, for example by a deviated septum or enlarged turbinates, nasal surgery may also help. On its own it rarely cures sleep apnoea, but it improves breathing and can make CPAP easier to use.
Dr Nicola De Candia has been an ENT specialist since 1991, with advanced training in endoscopic surgery of the nose and sinuses. He teaches endoscopic sinonasal techniques at the University of Bari's ENT specialist school.
What is recovery like after palatal surgery?
After an operation on the palate, the main symptom is a sore throat. It usually lasts from a few days to about two weeks and is controlled with the prescribed painkillers. When you swallow, the pain may also be felt in the ears.
For the first few days a soft, cool diet is advised, with plenty of fluids. It is best to avoid hard, crunchy, spicy or very hot foods, as well as strenuous physical effort.
The hospital stay is usually short, and most people return to work after roughly 10–14 days. The specialist gives personalised advice after the consultation.
What are the risks of uvulopalatoplasty?
Like any operation, palatal surgery carries possible risks and complications. These are discussed in detail at the pre-operative consultation.
- Bleeding, especially in the first few days or when the scabs come away
- Wound infection
- Fluids passing into the nose when drinking, usually temporary
- A dry throat or a feeling of something stuck in the throat
- Slight changes to the voice
- Snoring or apnoea that persists or returns over time
- Risks related to anaesthesia
The information on this page is for general education and does not replace a specialist consultation: indications, recovery times and risks are assessed case by case.