For reasons that are still unclear, in deep sleep, breathing can
stop for a period of time (often more than 10 seconds). These
periods of lack of breathing, or apneas, are followed by sudden
attempts to breathe. These attempts are accompanied by a change
to a lighter stage of sleep. The result is fragmented sleep that
is not restful, leading to excessive daytime drowsiness.
Older obese men seem to be at higher risk, though as many as 40%
of people with obstructive sleep apnea are not obese. Nasal obstruction,
a large tongue, a narrow airway and certain shapes of the palate
and jaw seem also to increase the risk. A large neck or collar
size is strongly associated with obstructive sleep apnea. Ingestion
of alcohol or sedatives before sleep may predispose to episodes
of apnea.
The classic picture of obstructive sleep apnea includes episodes
of heavy snoring that begin soon after falling asleep. The snoring
proceeds at a regular pace for a period of time, often becoming
louder, but is then interrupted by a long silent period during
which no breathing is taking place (apnea). The apnea is then
interrupted by a loud snort and gasp and the snoring returns to
its regular pace. This behavior recurs frequently throughout the
night.
During the apneas, the oxygen level in the blood falls. Persistent
low levels of oxygen (hypoxia) may cause many of the daytime symptoms.
If the condition is severe enough, pulmonary hypertension may
develop leading to right-sided heart failure or cor pulmonale.
Symptoms
It is important to emphasize that often, the person who has obstructive
sleep apnea does not remember the episodes of apnea during the
night. The predominant symptoms are usually associated with excessive
daytime sleepiness due to poor sleep during the night. Often,
family members, especially spouses, witness the periods of apnea.
Symptoms that may be observed include:
• Loud snoring
• Periods of not breathing (apnea)
• Awakening not rested in the morning
• Abnormal daytime sleepiness, including falling asleep
at inappropriate times
• Morning headaches
• Recent weight gain
• Limited attention
• Memory loss
• Poor judgment
• Personality changes
• Lethargy
Additional symptoms that may be associated with this disease:
• Hyperactive behavior, especially in children
• High blood pressure
• Automatic behavior (performing actions by rote)
• Leg swelling (if severe)
Signs and tests
A complete medical history taken by a health care practitioner
is the most important diagnostic tool. Often, a survey that asks
a series of questions about daytime sleepiness, sleep quality
and bedtime habits is given.
A physical examination of the mouth, neck and throat (oropharynx)
is important to detect abnormalities that may predispose.
Tests may include:
• Sleep studies
• An ECG to show arrhythmias during sleep
• An arterial blood gases to show low oxygen or elevated
carbon dioxide
• Echocardiogram to evaluate the function of the heart
• Thyroid function studies
Treatment
The goal is to keep the airway open to prevent apneas during sleep.
Weight management (or intentional weight loss) and avoiding alcohol
and sedatives at bedtime may relieve sleep apnea in some individuals.
If these measures are unsuccessful in stopping sleep apnea, continuous
positive airway pressure (
CPAP), a form
of mechanical breathing assistance that involves the use of a
specially-designed mask worn over the nose or nose and mouth at
night, may be prescribed.
Mechanical devices inserted into the mouth at night to keep the
jaw forward may help relieve symptoms due to mild to moderate
cases.
Surgery to remove excess tissue at the back of the throat (uvulopalatopharyngoplasty
or UPPP), to remove enlarged tonsils or adenoids ( tonsillectomy),
or to create an opening in the trachea to bypass the obstructed
airway during sleep (tracheostomy), may be helpful if anatomical
causes are present. In some people, surgery to remove blockage
of the nose or upper throat may relieve sleep apnea.
A tonsillectomy may be all that is necessary in children to cure
obstructive sleep apnea.
Support Groups
Attending a support group with others who suffer from obstructive
sleep apnea or related disorders may help persons adjust to their
disease and adapt to the lifestyle changes necessary to treat
it.
Expectations (prognosis)
When treated correctly, obstructive sleep apnea may be controlled.
However, many persons are unable or unwilling to tolerate CPAP,
and the syndrome continues.
Complications
• Hypertension
• Right-sided heart failure
• Abnormal heart rhythm (
arrhythmia)
• Excessive carbon dioxide levels (hypercapnia)
• Sleep deprivation
• Stroke
• Heart
disease
Calling your health care provider
Call your health care provider if you have excessive daytime sleepiness,
or if you or your family notice symptoms of obstructive sleep
apnea. If you have this condition, call if symptoms do not improve
with treatment or if new symptoms develop.
Prevention
Weight reduction and avoiding alcohol and sedatives may help some
individuals. Children with very large adenoids and tonsils may
develop obstructive sleep apnea and its associated problems, and
should have a tonsillectomy and adenoidectomy.
Information used in this posting was obtained from MEDLINE PLUS.
A service of the U.S. National Library of Medicine.
