Many people think snoring is simply the sound of “sleeping deeply”. However, if the snoring is loud and regular, accompanied by breathing that repeatedly stops and starts, daytime sleepiness or morning headaches, it should not be dismissed as nothing more than a blocked nose. These may be warning signs of obstructive sleep apnoea (OSA).
The core problem in OSA is repeated collapse of the upper airway during sleep, which restricts airflow. To restore breathing, the body triggers frequent brief arousals. As a result, you may appear to have “slept enough”, yet your sleep is fragmented and your blood oxygen levels drop repeatedly, placing long-term strain on the cardiovascular system, metabolism and the brain.
OSA does not always present with obvious choking episodes. Many people simply notice they have been feeling unusually tired, more forgetful, irritable or less able to concentrate. In some cases, the main complaint comes from a partner or family member disturbed by loud snoring.
Importantly, untreated OSA is closely linked to an increased risk of cardiovascular problems, including high blood pressure, abnormal heart rhythms, coronary heart disease, stroke and heart failure. It can also raise the likelihood of road-traffic accidents and reduce day-to-day functioning. For these reasons, it should never be dismissed as a trivial sleep issue.
Obesity is one of the major risk factors for OSA. The issue is not only overall body weight but also fat distribution. Fat deposits around the neck and upper airway narrow the throat. When muscle tone naturally relaxes during sleep, the airway is more likely to collapse, leading to snoring and episodes of breathing cessation.
In general, higher body weight is associated with greater OSA severity, and changes in weight can directly affect how easily the airway collapses. This is why weight management is often considered an important part of treatment and long-term control.
That said, OSA is not confined to people who are obese. Large analyses in recent years have shown that a significant proportion of individuals with OSA are not obese, highlighting the importance of anatomical factors in the nose and throat as well as individual differences.
The nose is the first gateway for breathing. Long-term nasal obstruction (such as a deviated nasal septum, enlarged turbinates, nasal polyps or chronic rhinitis) increases resistance to airflow. This often leads people to breathe through the mouth. Mouth breathing can dry the upper airway and make the soft tissues more prone to vibration and collapse, which typically makes snoring more noticeable.
Multiple studies show that nasal obstruction can contribute to or worsen snoring and sleep-disordered breathing, particularly when it occurs alongside other factors such as a narrow throat, enlarged tonsils or a retruded lower jaw.
However, it is important not to assume that “fixing the septum will cure OSA”. A deviated septum or turbinate enlargement rarely explains OSA on its own. In most cases, OSA results from several contributing factors acting together. Assessment therefore needs to consider the entire upper airway, rather than focusing on the nose alone.
If you experience any of the following, do not put it down to “hay fever” or “being run down”. Seek assessment, ideally with an ENT specialist:
A standard evaluation for suspected OSA usually involves a sleep study (such as overnight polysomnography). In addition, an ENT assessment of the nasal cavity and upper airway can help identify where the obstruction is most significant, whether the primary issue is nasal blockage, collapse at the level of the throat, or a combination of both, and guide the most appropriate treatment plan.
The hidden danger of sleep apnoea lies in the repeated cycles of oxygen dips and brief arousals night after night. Obesity increases the tendency for the upper airway to collapse, while nasal structural problems or chronic rhinitis can increase airflow resistance and promote mouth breathing, further raising the likelihood of OSA.
If you have long-standing snoring or any of the warning signs above, the most effective step is to arrange an ENT assessment of the nose and upper airway and, where appropriate, a sleep study. Early diagnosis and targeted treatment are key to reducing long-term health risks.
