What is obstructive sleep apnea?

Obstructive sleep apnea (OSA), or sleep apnea, is a disorder that causes involuntary breathing disorders for short periods of time during sleep. Air usually flows smoothly from the mouth and nose into the lungs. Periods in which breathing stops is called apnea or apnea. In OSA, normal airflow stops repeatedly throughout the night. Air stops flowing because the airway space in the throat area is too narrow. Snoring is a characteristic of obstructive sleep apnea. Snoring is caused by airflow through narrow airway spaces. Untreated sleep apnea can lead to serious health problems, such as:

• Hypertension
• Heart disease
• Stroke
• Diabetes

Proper diagnosis and treatment are crucial to preventing complications.

Symptoms of sleep apnea

Sleep apnea causes a reduction in the supply of oxygen to the brain and other parts of the body. Lack of deep sleep results in poor sleep quality and long sleep duration. Insufficient sleep leads to daytime sleepiness and lack of clarity in the morning. People with sleep apnea may also experience the following symptoms:

• Headache that is difficult to treat
• Grumpy
• Forgetfulness
• Drowsiness

Other symptoms include:

• ADHD in children
• Depression worsens
• Poor performance at work and school
• Loss of interest in sex
• Swelling of the legs (called edema, which occurs when sleep apnea is severe)

Daytime sleepiness puts people with sleep apnea at risk for motor vehicle collisions and industrial accidents. Treatment can help completely relieve daytime sleepiness caused by sleep apnea.

What causes sleep apnea?

There are several types of sleep apnea, but OSA is the most common. OSA is more likely to occur in older people and people who are overweight. There is evidence that weight loss can significantly improve symptoms. Sleeping face up can worsen sleep apnea.

Types of sleep apnea

The three types of sleep apnea are:

• Obstructive sleep apnea: This is the most common type in which the airways become narrow, blocked, or floppy.

• Central sleep apnea: The airway is not blocked, but the brain does not send signals to the breathing muscles to breathe.
• Mixed sleep apnea: This is a combination of obstructive and central sleep apnea.

Who is at risk for obstructive sleep apnea?

Your risk of OSA is increased if you have a condition or characteristics that narrow your upper airway. Risk factors for OSA include:

• Children with large tonsils and adenoids
• Men with a collar size of 17 inches or larger
• Women with a collar size of 16 inches or more
• A large tongue may block the airway
• Mandibular retrognathia, when your lower jaw is shorter than the upper jaw
• Narrow palate or airway, more likely to collapse

Heart disease is more common in people with obesity, which is a risk factor for heart disease, high blood pressure and sleep apnea.

How is sleep apnea diagnosed?

The diagnosis of sleep apnea begins with a complete history and physical examination. Daytime sleepiness and a history of burping are important clues. Your doctor will examine your head and neck to detect any physical factors related to sleep apnea. Your doctor may ask you to fill out a questionnaire about daytime sleepiness, sleeping habits, and sleep quality. Tests that can be performed include:

Polysomnography

A polysomnogram usually requires you to stay overnight in a hospital or sleep study center. The test lasted overnight. While you sleep, a polysomnogram will measure the activity of different organ systems involved in sleep. It may include:

• Electroencephalography (EEG), which measures brain waves
• Electrooculogram (EOM), used to measure eye movements
• Electromyography (EMG), which measures muscle activity
• Electrocardiogram (EKG or ECG), which measures heart rate and rhythm
• Pulse oximetry test, which measures changes in oxygen levels in the blood
• Arterial Blood Gas Analysis (ABG)

Electroencephalogram and Electrooculogram (EOM)

During an EEG, electrodes are attached to your scalp to monitor brain waves before, during, and after sleep. EOM records eye movements. Place one small electrode 1 cm above the outer corner of your right eye and another electrode 1 cm below the outer corner of your left eye. This movement is recorded when the eyes move away from the center.

Brain waves and eye movements tell doctors the timing of different stages of sleep. The sleep stages are non-rapid eye movement (rapid eye movement) and rapid eye movement (rapid eye movement). Dreams, reduced muscle tone and movement, and paralysis occur during REM sleep.

EMG

During an EMG, two electrodes are placed on the chin: one above and one below the jawline. Place another electrode on each tibia. EMG electrodes absorb the electrical activity generated during muscle movement. Deep muscle relaxation should occur during sleep. EMG is restored when your muscles relax and move during sleep.

Electrocardiogram

A 12-lead electrocardiogram can help your doctor determine whether heart disease is present. Long-term hypertension can also cause electrocardiogram changes. Monitoring heart rate and rhythm allows doctors to see if heart disease is developing during an apnea episode.

Pulse Oximeter

In this test, a small device called a pulse oximeter is clipped to a thin area with good blood flow, such as a fingertip or earlobe. A pulse oximeter uses a tiny transmitter with red and infrared LEDs to measure the amount of oxygen in the blood. During an episode of apnea, the amount of oxygen in the blood, or oxygen saturation, decreases. Typically, oxygen saturation is about 95-100%. Your doctor will explain your results.

Arterial blood gas (ABG)

In this study, a syringe is used to obtain blood from an artery. Arterial blood gases measure several factors in arterial blood, including:

• Oxygen content
• Oxygen saturation
• Oxygen partial pressure
• Partial pressure of carbon dioxide
• Bicarbonate level

This test will give your doctor more detailed information about oxygen, carbon dioxide, and the acid-base balance of your blood. It will also help your doctor know if and when additional oxygen is needed.

Treatment

The goal of treating sleep apnea is to ensure that airflow is not blocked during sleep. Treatment options include:

Lose weight

Weight loss can greatly relieve OSA symptoms.

Nasal decongestant

Nasal decongestants are more likely to be effective in mild OSA. They can help relieve snoring.

Continuous positive airway pressure (CPAP)

Continuous positive airway pressure (CPAP) therapy is the first line of treatment for sleep apnea. CPAP is administered by wearing a sleep apnea mask at night. The mask gently provides positive airflow to keep your airway open at night. Positive airflow supports the airway opening. CPAP is a highly effective method of treating sleep apnea. Dental equipment may also be needed to keep the jaw positioned forward.

Bilevel positive airway pressure (BiPAP or BPAP)

If CPAP therapy doesn't work, a bilevel positive airway pressure machine is sometimes used to treat OSA. BiPAP machines have high and low settings that respond to your breathing. This means the change in pressure between inhalation and exhalation.

Position therapy

Because sleeping on your back (supine position) can worsen sleep apnea in some people, positional therapy can help people with sleep apnea learn to sleep in other positions. Positional therapy and the use of CPAP can be discussed with a sleep center professional.

Surgery

UvulopalatopharyngoplastyPlasty (UPPP) involves the removal of excess tissue from the back of the throat. UPPP is the most common type of surgery for OSA, and it can help relieve burping. However, this surgery has not been proven to completely eliminate sleep apnea and may cause complications.

Tracheotomy can be performed as a last resort. A tracheostomy bypasses the obstruction in the throat by puncturing an opening in the windpipe.

When sleep apnea does not respond to treatments such as CPAP, other surgical procedures may be needed to correct structural problems in the face and elsewhere. About 75 percent of children with OSA can get relief with surgery due to enlarged tonsils or adenoids. The American Academy of Pediatrics has approved surgical removal of tonsils and adenoids as the preferred treatment for children who have sleep problems due to enlarged tonsils or adenoids, according to the American Sleep Apnea Association (ASAA).

What is the future of sleep apnea?

If you feel sleepy during the day or have ongoing sleep problems, be sure to talk to your doctor. There are many different treatment options for OSA that can make symptoms manageable. Your doctor will create a treatment plan that combines lifestyle changes with other therapies.