Obstructive Sleep Apnea
Definition
Sleep apnea is a condition characterized by episodes of stopped
breathing during sleep.
In normal conditions, the muscles of the upper part of the throat
keep this passage open to allow air to flow into the lungs.
These muscles usually relax during sleep, but the passage remains
open enough to permit the flow of air. Some individuals have
a narrower passage, and during sleep, relaxation of these muscles
causes the passage to close, and air cannot get into the lungs.
Loud snoring and labored breathing occur. When complete blockage
of the airway occurs, air cannot reach the lungs.
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.
CPAP Supplies Plus/Direct
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