Obstructive Sleep Apnea (OSA) is a relatively common medical condition which affects between
one to five per cent of the population. OSA is more common in men than women and is found with greater frequency in people who are overweight and/or aging. This condition is best described as breathing that starts and stops during sleep. Periods of "no breathing" activity are called apneas. Partial obstructions to breathing are called hypopneas. These stoppages or obstructions take place when muscles in the back of the throat relax during sleep. This causes the airway to narrow or close. As many as five of these episodes per hour of sleep are considered normal. When more than five episodes occur per hour of sleep, a diagnosis of sleep apnea is usually made. Patients with severe OSA have more
than one apnea or hypopnea every minute they are asleep. While these pauses in breathing usually last between 20 and 30 seconds, they occasionally will last up to one minute. When breathing stops, the
level of oxygen in the bloodstream falls, sometimes to dangerously low levels. The brain senses this
decrease in oxygen and briefly rouses the person from sleep. At this point, the muscles in the back of the throat become more active and hold the airway open so that breathing can resume. These wakings make it very hard to get a good night's sleep.
What are the symptoms of OSA?
Soft, rhythmic snoring is not believed to have any significant adverse effects on health. However, when
snoring becomes loud with changes in its intensity, breathing may be impaired and sleep disrupted. Close observation often reveals pauses in breathing on periods where the individual appears to be struggling to breathe. These episodes usually end when the sleeper rouses for a moment and makes a loud snorting noise as breathing resumes. Occasionally individuals will awake from sleep feeling short of
breath. When these episodes happen often, fatigue and sleepiness during the day are the result. At first, this problem may be mild, with the individual falling asleep easily while reading or watching television.
As the apneas become more frequent, it will be more difficult to stay awake while doing active things such as driving a car or working at a job. It is well known that many patients have been involved in motor accidents. Because lack of sleep is very stressful, affected people may become irritable, undergo changes in personality, or have difficulty with memory. Occasionally they will experience headaches in the morning as well as sexual dysfunction. Sleep apnea is often associated with hypertension (high
blood pressure). When apnea is severe, heart failure may occur. There are also higher incidences of
ischemic heart disease and stroke in people with OSA.
Most people with sleep apnea are substantially overweight. Nasal congestion is often present, which means that breathing is done through the mouth. This produces dryness and soreness of the mouth in the morning. Any condition that contributes to the narrowing in the back of the throat such as enlarged tonsils or adenoids favors the development of sleep apnea.
How is OSA evaluated?
Consult your physician if you have loud snoring or excessive daytime sleepiness. The physician may
then refer you to a Sleep Disorders Center where experts will thoroughly evaluate the problem. This
usually involves overnight monitoring of sleep. A test called polysomnography is done to count
the number of irregular breathing events and measure their duration. The test notes oxygen levels in the blood and will tell if irregularities of the heartbeat go along with decreased breathing. The amount and quality of sleep are tested as well as the effect of sleeping positions on your breathing.
Prior to the test, wires will be attached to your body to record brain wave activity, movements of your eyes, muscle activity, heart beat and the movement of your chest and abdomen. The oxygen level in your blood will be recorded from a device clipped onto your ear or placed on your finger. A microphone is commonly used to record your snoring pattern. There is no pain or discomfort during the study.
In addition to overnight polysomnography, a thorough examination of the nose, mouth, throat and neck is performed. If surgery is being considered, x-rays of the upper airway are usually recommended.
What can be done to treat OSA and snoring?
Effective treatment is available for almost all patients. For patients with snoring and mild sleep apnea, a conservative approach to therapy is recommended. The following suggestions are often helpful:
o Reduce weight
o Avoid alcohol and medications such as tranquilizers and sleeping pills. These medications relax the muscles in the back of the throat and depress breathing.
o Sleep on your side or your stomach rather than on your back. Sleeping on your back can cause your tongue and soft palate to collapse against the back of your throat, blocking the airway.
o Use oral mediations prescribed or recommended by your physician to help you breathe through
your nose during sleep.
Nasal obstruction increases the frequency of snoring and disordered breathing during sleep. For patients with moderate to severe sleep apnea, therapy with a medical device called nasal continuous positive airway pressure (CPAP) may be recommended. This device delivers room air to the nose and back of the throat at a slightly elevated pressure to keep the airway from collapsing during sleep. This therapy is safe, generally well-tolerated and highly effective. This device must be worn nightly.
Dental appliances that reposition the lower jaw and the tongue have been helpful in some patients with mild sleep apnea.
For some individuals, surgery may be recommended. Surgery may range from procedures designed to
open the nose, enlarge the back of the throat or allow air direct access to the lungs via a tube placed into the windpipe. Medications are generally not very effective in treating sleep apnea.