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Obstructive Sleep Apnea

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Overview of Obstructive Sleep Apnea

Sleep apnea is a potentially serious sleep disorder in which breathing collapses repetitively. The condition arises because the muscles in your throat that support soft tissues in your throat region become relaxed. This relaxation narrows down your airways causing breathing difficulty.

The duration during which breathing stops is known as apnea. In OSA, breathing is completely stopped, it may cause death. Untreated OSA can cause serious health problems including high blood pressure, heart attack, diabetes etc. 

Signs and Symptoms of Obstructive Sleep Apnea

Most people with OSA have poor quality of sleep due to the low rate of oxygen supplied to the brain and rest of the body parts. Common OSA warning signs include:

  • Daytime sleeping
  • Loud snoring
  • Gasping
  • Choking
  • Snorting
  • Interruption in breathing while sleeping.
  • Nocturnal restlessness
  • Dry mouth or sore throat after waking up
  • Night sweats
  • Low sex drive
  • Worsening depression
  • Hyperactivity in children
  • Trouble getting up in morning
  • Forgetfulness and cranking
  • Gastroesophageal reflux disease (GERD)
  • High blood pressure

In children signs are not as clear. These may be:

  • Bed wetting
  • Choking and drooling
  • Excessive sweating at night
  • Ribcage moves inward when breath out
  • Learning and behavior problem
  • Sluggishness
  • Teeth grinding and snoring
  • Restlessness in bed
  • Breathing that pauses or stops
  • Unusual sleeping posture, mostly sleeping on hands or knees or far back neck bending

Types of Obstructive Sleep Apnea

Main types of sleep apnea are:

  • Obstructive sleep apnea: In case of obstructive sleep apnea the upper airway collapses during sleep. It is the common form that occurs when throat muscles relax.
  • Central sleep apnea:  In this case the brain cannot send signals to throat muscles which control breathing.
  • Complex sleep apnea syndrome: It consists of both obstructive and central sleep apnea.

Causes of Obstructive Sleep Apnea

OSA is caused when the muscles of the throat are too relaxed and narrowing the air passage. The patient wakes instantly to reopen the airway, but usually doesn’t remember to do so. It happens often within an hour.

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Risk Factors of Obstructive Sleep Apnea

The most common risk factors are:

  • Age and gender: Comparatively men are probably two to three times more likely due to OSA than women. Though a postmenopausal woman has same risk factors. From early adulthood to the 50s and 60s the risk factor increases but it becomes constant after that.
  • Obesity: There is great correction between body mass index (BMI) and obstructive sleep apnea. Obesity is thus one risk factor for sleep apnea
  • Upper airways and craniofacial abnormalities: People have high risk factors if abnormalities like: short mandible, large tonsils, or abnormal sized jaw bones are there.
  • Neck size: The people with a large size of neck, tongue or tonsils are more likely to get OSA due to blocked airway.
  • Family history: Members of family having OSA more likely have high risk to transfer it in the next generation.
  • Smoking: Heavy smokers have more than three times higher risk of OSA than non-smokers.
  • Nasal congestion: People who get nasal congestion more often have twice the risk of OSA.
  • Medical conditions: Pre-existing medical conditions have also been associated with an increased risk of exhibiting obstructive sleep apnea:

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Prevention

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Diagnosis

Diagnosis of OSA includes a complete history and physical examination. A record of daytime sleepiness and snoring are essential clues. The doctor examines the patient’s head and neck to see if there are any signs associated with OSA. Doctors may ask the patient to fulfill a questionnaire based on drowsiness, sleeping habits, and quantity of sleep. 

Depending upon the symptoms of the patient, the doctor may suggest an overnight sleep study, also known as a polysomnogram, a painless and non-invasive procedure. These studies are typically done at a sleep center.

Treatment of Obstructive Sleep Apnea | When to Consult a Doctor

Some of the common treatment options for OSA include:

  • Upper airway stimulator: The device is also known as inspire. It is a tiny pulse generator that is placed on the chest. A wire tracks natural breathing patterns in lungs while other wire leads to the neck, sending signals to nerves that control airway muscles and open them. A remote control can be used to switch on and off before bed and in the morning respectively.

  • Continuous positive airway pressure (CPAP) therapy: CPAP is considered the authentic type of therapy for patients with OSA or who have mild symptoms of sleep apnea as well. Sleepers put on a face mask and feel pressurized air from the CPAP machine via connective hose. Some machines are equipped with humidifiers to ease the breathing. The people who don’t respond to CPAP or CPAP-intolerant are recommended with Bi-level positive air pressure (BiPAP) therapy, which exerts pressure at a more variable rate.

  • Oral appliance: For moderate OSA symptoms such as snoring, a mouthpiece may be recommended. There are two categories of these appliances. Mandibular advancement devices (MADs) physically realign the jaw forward to broaden the airway. Tongue-retaining devices (TRDs) hold the tongue and inhibit it from blocking the airway.

  • Somnoplasty:  This includes use of radiofrequency energy to tighten the tissue at the back of the throat.

  • Surgery: Doctors may recommend surgery if other methods are not so useful. In many cases, surgery is needed to correct anatomical deformities that contribute to airway blockage. Removing tissue from the soft palate, uvula, tonsils, adenoids, and tongue can also be effective. Many children who experience OSA will have their tonsils and adenoids removed during a procedure known as an adenotonsillectomy.

 

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