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Integrated Sleep Services: Changi General Hospital
Different types of sleep disorders, including snoring, obstructive sleep apnoea and insomnia, can be assessed, diagnosed and treated at CGH.
Changi General Hospital’s (CGH) Integrated Sleep Service (ISS) provides a comprehensive assessment, diagnosis and treatment service to patients with different types of sleep disorders under one roof.
Located at Specialist Clinic R, CGH ISS combines the expertise of specialists from the following departments:
• Ear, Nose and Throat (Otolaryngology)
• Respiratory Medicine
• Sports Medicine
• General Surgery
• Psychological Medicine
CGH ISS offers our patients coordinated care by bringing together a diverse group of healthcare professionals to deliver the best medical attention and care for you. With these specialists located under one service, it saves inter-referral time. For GPs and family physicians, CGH ISS is a one-stop referral centre.
At our sleep clinic, we put you at the centre to deliver positive clinical outcomes and a high quality of service. With proven technologies and techniques, we offer an environment in which your sleep disorders are cared for by the most appropriate experts with the most advanced equipment.
The Sleep Laboratory has five beds and is equipped with advanced wireless transmission capability, conducting over 700 sleep studies a year.
Designed to simulate the home environment, our sleep clinic is conducive to peaceful sleep and relaxation. The rooms are quiet and furnished with light-blocking curtains, attached toilets, television sets and magazines. We have installed infrared synchronised cameras that work in the dark to capture your sleep positions and behaviour without disturbing you.
In addition to diagnostic sleep tests, our laboratory also conducts tests such as the CPAP (Continuous Positive Airway Pressure) titration sleep study, MSLT (Multiple Sleep Latency Test) and MWT (Multiple Wakefulness Test), using modern sleep test machines.
Snoring and obstructive sleep apnoea (OSA) are medical conditions that are common in people who are obese and who consume a lot of alcohol. More than 60 percent of men over 60 years old snore, as do more than 10 percent of men under 30 years old. Snoring affects men twice as often as women. Incidence of both snoring and OSA increases with age.
Diagnosis of OSA is made from the patient’s history, clinical examination, investigations and sleep study. Aspects of your life may affect your breathing during sleep. ENT specialists will examine your nose, mouth and throat via a nasopharyngoscopy for causes that might lead to breathing difficulties during sleep (for example, obstructive lesions such as polyps, tumours and cysts). Your general health status will also be assessed (such as weight and blood pressure).
A sleep study is necessary in the evaluation of snoring and OSA. If you are scheduled for a sleep study, you will most likely check into the hospital after dinner, stay overnight and be discharged the next morning.
During the sleep study, special sensors will record the activity of your heart, lungs and brain, the movement of muscles, airflow from nose and mouth and the level of oxygen in your blood. As you sleep, a sleep technologist will monitor the recordings. The entire sleep study will be recorded and analysed.
A sleep study helps to diagnose the severity of OSA but is not able to pinpoint the degree of upper airway obstruction. CGH has developed and pioneered a videoendoscopic computer-assisted measurement (CAM) of the upper airway.
Dr Hsu Pon Poh, Chief and Senior Consultant of the ENT department, developed and pioneered this new method. He was awarded the 10th Yahya Cohen Memorial Lectureship by the College of Surgeons, Singapore, on July 3, 2005, for his work.
A CAM can be carried out in the ENT clinic and enables our doctors to identify and measure the site of the obstruction accurately, which is important should you need any surgery to correct the problem.
There are often many causes to snoring and sleep apnoea. Treatment, therefore, will depend on the individual and the severity of the patient’s condition. There are various treatment options for OSA and a combination of treatments may be necessary.
Combining expertise from various specialities, CGH ISS offers the following services:
• Assessment of OSA, including computer-assisted airway analysis
• Sleep study (PSG) and other sleep tests (MSLT and MWT)
• Airway pressure device (CPAP, BiPAP) treatment
• Somnoplasty of upper airway
• Palatal pillar implant procedure
• Surgery for snoring/OSA, including palatal, tongue and pharyngeal procedures
• Bimaxillary mandibular advancement surgery
• Dental splints and orthognathic surgery
• Weight management, including dietary and exercise intervention
• Weight loss (bariatric) surgery
• Psychiatric and psychological evaluation
Along with surgical and medical evaluations, oral and maxillofacial dental evaluation is also required to assess associated functional (speech, airway, sleep) and structural jaw conditions. This will help your doctor to determine your treatment for OSA without comprising functional balance and aesthetics.
For some patients with mild OSA, dental appliances can be fitted to reposition the lower jaw and the tongue, helping to open up the airway at the back of the throat. Moderate to severe OSA is usually treated with oral and maxillofacial surgery/procedures.
Since 2003, our multidisciplinary team of specialists at Changi Sports Medicine Centre (CSMC) has helped many obese patients lose weight successfully through the evidence-based weight loss programme. This six-month programme combines diet, physical activity / exercise and behaviour modification to help patients safely achieve significant and sustainable weight loss. It includes consultations with our sports physicians, dietitians, and supervised gym sessions with our physiotherapists and/or sports trainers, using the latest exercise equipment.
Weight loss surgery has been found to be effective in helping obese patients lose weight. After surgery, we have seen an improvement in patients’ various associated medical illnesses and a complete or partial resolution of OSA.
Patients suitable for the surgery must be motivated and must have previously failed other attempts at weight loss. They should be moderately obese (BMI ≥ 35) with significant OSA or have other serious medical complications associated with obesity.
The types of surgery available include laparoscopic adjustable gastric banding and the Roux-en-Y gastric bypass. To be effective, the surgery should be undertaken together with changes to your diet and a regular exercise programme. Patients are advised to consult our bariatric surgeon to obtain more information about the weight loss surgery.
For some patients, the cause of their sleep complaints may be due to psychiatric and psychological problems. These patients will be referred to the psychiatrist and psychologist who will conduct a comprehensive evaluation. Some of the commonly seen conditions include:
• Excessive daytime sleepiness
• Abnormal behaviour during sleep
• Circadian rhythm problems related to shift-work and jet lag
Appropriate pharmacological and behavioural treatment strategies will be offered.
In addition to OSA, very obese individuals (BMI > 40) are at risk of developing obesity hypoventilation syndrome (OHS). Patients with OHS not only suffer from OSA and stop breathing intermittently, they also suffer from poor breathing. This can have long-term consequences such as sleepiness, breathing difficulties, and can also affect the heart. Treatments for these patients include weight loss measures and bi-level positive airway pressure.
Restless Legs Syndrome (RLS) affects between five to 10 percent of the population. This disorder causes patients to experience abnormal sensations in their legs and calves, which can be very distressing. Due to the abnormal feelings, patients are forced to move their legs constantly to get some relief. This affects the person’s quality of life as well as disrupts their sleep, as these abnormal sensations worsen at night.
Often, there is no obvious cause. In some cases, RLS may be due to iron deficiency, pregnancy, kidney failure and other neurological problems affecting the legs. While this disease cannot be cured, your doctor can prescribe some oral medication for you to control it.
Although uncommon, narcolepsy can be a frightening condition. It can produce “sleep attacks” during the day and vivid dreams through the night, disrupting your sleep. A diagnostic sleep study and a MSLT study are needed to diagnose this disorder. Like RLS, oral medication is available to control narcolepsy.
Other disorders, such as sleep walking and Rapid Eye Movement (REM)-behaviour disorders, will need individual treatments, depending on the underlying cause and severity. A sleep study, often accompanied by video monitoring, is essential in making a diagnosis.
This article was last reviewed on
Wednesday, November 28, 2018
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