Obstructive sleep apnea is a condition in which a person stops breathing repeatedly during sleep. Over 18 million Americans suffer from Obstructive Sleep Apnea. About 85 percent of these people are still undiagnosed and unaware of the affects of Obstructive Sleep Apnea on their health. Obstructive Sleep apnea can lead to an increased risk of cardiovascular diseases, high blood pressure, diabetes, stroke, mood disorders, accident proneness and memory loss.
Answer the following questions to see if you are at increased risk of Sleep Apnea.
[ ] Does your partner/significant other or family member complain of your snoring?
[ ] Did anybody observe pauses in your breathing?
[ ] Are you overweight or Obese? (Body Mass Index of 33 or above)
[ ] Do you feel sleepy or tired during the day?
[ ] Do you wake up choking, gasping for air or short of breath during sleep?
Do you have a history of [ ] High Blood Pressure
[ ] Diabetes
[ ] Heart Disease
[ ] Stroke
[ ] Memory loss
[ ] Sexual dysfunction
[ ] Mood disorders such as depression or anxiety
If you answered yes to two or more of the above question, you are at increased risk of obstructive sleep apnea. Talk to your doctor about how you can be tested using non- invasive testing using an overnight sleep study and the treatment options.
What is Obstructive Sleep Apnea?
Obstructive sleep apnea (OSA) is a common sleep apnea caused by obstruction of the airway. It is characterized by pauses in breathing during sleep. These episodes, called apneas (literally, "without breath"), each last long enough that one or more breaths are missed, and occur repeatedly throughout sleep. In obstructive sleep apnea, breathing is interrupted by a physical block to airflow, despite the effort to breathe.
The individual with sleep apnea is rarely aware of having difficulty breathing, even upon awakening. Sleep apnea is recognized as a problem by others witnessing the individual during episodes or is suspected because of its effects on the body (sequelae).Symptoms may be present for years, even decades without identification, during which time the sufferer may become conditioned to the daytime sleepiness and fatigue associated with significant levels of sleep disturbance. Persons who sleep alone without a long-term human partner may not be told about their sleep disorder symptoms.
Since the muscle tone of the body ordinarily relaxes during sleep, and since, at the level of the throat, the human airway is composed of walls of soft tissue, which can collapse, it is easy to understand how breathing can be obstructed during sleep. Although a very low level of obstructive sleep apnea is considered to be within the bounds of normal sleep, and many individuals experience episodes of obstructive sleep apnea at some point in life, a much smaller percentage of people are afflicted with chronic, severe obstructive sleep apnea.
Many people experience episodes of obstructive sleep apnea for only a short period of time. This can be the result of an upper respiratory infection that causes nasal congestion, along with swelling of the throat, or tonsillitis that temporarily produces very enlarged tonsils. The Epstein-Barr virus, for example, is known to be able to dramatically increase the size of lymphoid tissue during acute infection, and obstructive sleep apnea is fairly common in acute cases of severe infectious mononucleosis. Temporary spells of obstructive sleep apnea syndrome may also occur in individuals who are under the influence of a drug (such as alcohol) that may relax their body tone excessively and interfere with normal arousal from sleep mechanisms
Signs and symptoms Common signs of obstructive sleep apnea include unexplained daytime sleepiness, restless sleep, and loud snoring (with periods of silence followed by gasps). Less common symptoms are morning headaches; insomnia; trouble concentrating; mood changes such as irritability, anxiety and depression; forgetfulness; increased heart rate and/or blood pressure; decreased sex drive; unexplained weight gain; increased urination and/or nocturia; frequent heartburn or Gastroesophageal reflux disease; and heavy night sweats.
Adults In adults, the most typical individual with obstructive sleep apnea syndrome suffers from obesity, with particular heaviness at the face and neck. Obesity is not always present with OSA; in fact, a significant number of adults with normal body mass indices (BMI) have decrease in muscle tone causing airway collapse and sleep apnea. The cause of the decreased tone is not presently understood. The hallmark symptom of obstructive sleep apnea syndrome in adults is excessive daytime sleepiness. Typically, an adult or adolescent with severe long-standing obstructive sleep apnea will fall asleep for very brief periods in the course of usual daytime activities if given any opportunity to sit or rest. This behavior may be quite dramatic, sometimes occurring during conversations with others at social gatherings.
The hypoxia (absence of oxygen supply) through OSA may cause changes in the neurons of the hippocampus and the right frontal cortex in the brain. Research through the use of neuro-imaging revealed evidence of hippocampal atrophy in people suffering from OSA. They found some OSA sufferers to have problems in mentally manipulating nonverbal information and executive function.
Children Although this so called "hypersomnolence" (excessive sleepiness) may also occur in children, it is not at all typical of young children with sleep apnea. Toddlers and young children with severe obstructive sleep apnea instead ordinarily behave as if "over-tired" or "hyperactive." Adults and children with very severe obstructive sleep apnea also differ in typical body habitus. Adults are generally heavy, with particularly short and heavy necks. Young children, on the other hand, are generally not only thin, but may have "failure to thrive", where growth is reduced. Poor growth occurs for two reasons: the work of breathing is high enough that calories are burned at high rates even at rest, and the nose and throat are so obstructed that eating is both tasteless and physically uncomfortable. Obstructive sleep apnea in children, unlike adults, is often caused by obstructive tonsils and adenoids and may sometimes be cured with tonsillectomy and adenoidectomy. This problem can also be caused by excessive weight in children. In this case, the symptoms are more like the symptoms adults feel: restlessness, exhaustion, and more. Children with OSA may experience learning and memory deficits. OSA has also been linked to lowered childhood IQ scores.
Risk factors Old age is often accompanied by muscular & neurological loss of ability of the airways. Premature aging is temporarily caused by chemical depressants; alcoholic drinks being the most common. Permanent premature airway aging may be caused by traumatic brain injury, or poor adherence to chemical and or speech-therapy treatments.
Individuals with decreased muscle tone, increased soft tissue around the airway, and structural features that give rise to a narrowed airway are at high risk for obstructive sleep apnea. Men, whose anatomy is typified by increased body mass in the torso and neck, are more typical sleep apnea sufferers, especially through middle age and older. Adult women suffer typically less frequently and to a lesser degree than men do, owing partially to physiology, but possibly to emerging links to levels of progesterone. Prevalence in post-menopausal women approaches that of men in the same age range.
Causes Most cases of OSA are believed to be caused by:
old age (natural or premature), brain injury (temporary or permanent), decreased muscle tone, increased soft tissue around the airway (sometimes due to obesity), and structural features that give rise to a narrowed airway. Decreased muscle tone can be caused by drugs or alcohol, or it can be caused by neurological problems or other disorders. Some people have more than one of these issues. There is also a theory that long-term snoring might induce local nerve lesions in the pharynx in the same way as long-term exposure to vibration might cause nerve lesions in other parts of the body. Snoring is a vibration of the soft tissues of the upper airways, and studies have shown electrophysiological findings in the nerves and muscles of the pharynx indicating local nerve lesions.
Severity Rating Apnea Hypopnea Index (number of times of stopping breathing per hour)<5 Normal 5-15 Mild 15-30 Moderate >30 Severe
How do you diagnosis Obstructive Sleep Apnea? Diagnosis is often based on a combination of lab tests and patient history.
Polysomnography Results of polysomnography in obstructive sleep apnea show pauses in breathing. As in central apnea, pauses are followed by a relative decrease in blood oxygen and an increase in the blood carbon dioxide. Whereas in central sleep apnea the body's motions of breathing stop, in obstructive sleep apnea the chest not only continues to make the movements of inhalation, the movements typically become even more pronounced. Monitors for airflow at the nose and mouth show efforts to breathe are not only present, but that they are often exaggerated. The chest muscles and diaphragm contract and the entire body may thrash and struggle.
Obstructive sleep apnea is the most common category of sleep-disordered breathing. The prevalence of OSA among the adult population in western Europe and North America has not been confidently established, but in the mid-1990s was estimated to be 3-4% of women and 6-7% of men.
An "event" can be either an apnea, characterised by complete cessation of airflow for at least 10 seconds, or a hypopnea in which airflow decreases by 50 percent for 10 seconds or decreases by 30 percent if there is an associated decrease in the oxygen saturation or an arousal from sleep (American Academy of Sleep Medicine Task Force, 1999). To grade the severity of sleep apnea, the number of events per hour is reported as the apnea-hypopnea index (AHI). An AHI of less than 5 is considered normal. An AHI of 5-15 is mild; 15-30 is moderate and more than 30 events per hour characterizes severe sleep apnea.
Home oximetry In patients who are at high likelihood of having OSA, a randomized controlled trial found that home oximetry may be adequate and easier to obtain than formal polysomnography. High probability patients were identified by an Epworth Sleepiness Scale (ESS) score of 10 or greater and a Sleep Apnea Clinical Score (SACS) of 15 or greater.
What are the Treatment options? There are a variety of treatments for obstructive sleep apnea, depending on an individual's medical history, the severity of the disorder and, most importantly, the specific cause of the obstruction. Obstructive sleep apnea in children is sometimes due to chronically enlarged tonsils and adenoids. Tonsillectomy and adenoidectomy is curative. The operation may be far from trivial, especially in the worst apnea cases, in which growth is retarded and abnormalities of the right heart may have developed. Even in these extreme cases, the surgery tends to cure not only the apnea and upper airway obstruction, but allows normal subsequent growth and development. Once the high end-expiratory pressures are relieved, the cardiovascular complications reverse themselves. The postoperative period in these children requires special precautions.
Continuous Positive Airway Pressure (CPAP): the most common and effective treatment for OSA. Each night a patient wears a mask that fits over the nose and/or mouth and gently blows air into the airway to keep the throat open during sleep. There are three different kinds of PAP Therapy:Continuous (CPAP): Air blows at a continuous pressure throughout the night. This type of PAP therapy is generally used the most.Automatic (APAP): the machine automatically adjusts the pressure needed to keep the airway open. Throughout the night, pressure will change depending on the automatic needs of the patient.Bilevel: Bilevel machines alternate between two different pressures throughout the night. During inhalation, the pressure is higher to keep the airway open; the pressure then drops to make it easier to exhale. This sequence of two different pressures continues throughout the night.
Dental Appliances: reposition the jaw and tongue to bring the lower jaw forward and open up the airway. This treatment option is most effective for those with mild to moderate sleep apnea.
Surgery: is another option for patients who do not feel comfortable wearing a CPAP mask at night. Common surgeries require removal of the uvula and soft palate to remove the extra skin that is blocking the airway. Other surgeries physically move the jaw forward and remove part of the tongue.
What is the Prognosis if I have sleep apnea? Although it takes some trial and error, most patients find a combination of treatments which reduce apnea events and improve their overall health, energy, and well-being. Without treatment, the sleep deprivation and lack of oxygen caused by sleep apnea increases health risks such as cardiovascular disease, high blood pressure, stroke, diabetes, clinical depression, weight gain and obesity.
The most serious consequence of untreated obstructive sleep apnea is to the heart. In severe and prolonged cases, there are increases in pulmonary pressures that are transmitted to the right side of the heart. This can result in a severe form of congestive heart failure (cor pulmonale).Elevated arterial pressure (commonly called high blood pressure) can be a consequence of obstructive sleep apnea syndrome. When high blood pressure is caused by OSA, it is distinctive in that, unlike most cases of high blood pressure (so-called essential hypertension), the readings do not drop significantly when the individual is sleeping. Stroke is associated with obstructive sleep apnea. Sleep apnea sufferers also have a 30% higher risk of heart attack or death than those unaffected.
Many studies indicate that it is the effect of the "fight or flight" response on the body that happens with each apneic event that increases these risks. The fight or flight response causes many hormonal changes in the body; those changes, coupled with the low oxygen saturation level of the blood, cause damage to the body over time.
How common is Sleep Apnea?
OSA is a common condition in many parts of the world. If studied carefully in a sleep lab by polysomnography, approximately 1 in 5 American adults has at least mild OSA. OSA is more frequent than central sleep apnea. If you snore, feel tired during the day, have a history of high blood pressure, diabetes, heart disease, stroke, mood disorders or memory loss, you need to be tested for sleep apnea.