Definition
Repeated, prolonged episodes of cessation
of breathing during sleep.
Overview,
Causes, & Risk Factors
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 prolonged 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 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 exact
rate at which this condition occurs is unknown,
but it may be found in as many as 10 out of
100,000 people.
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 apneic periods 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 (cor pulmonale).
Obstructive
Sleep Apnea Symptoms & Signs
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.
- 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:
- swelling, overall (edema)
- confusion
- blood pressure, high
Obstructive
Sleep Apnea Prevention
Weight reduction and avoidance of alcohol use
and sedatives may help some individuals.
Children with massive adenoid and tonsillar
hypertrophy can develop obstructive sleep apnea
and its associated problems and should have a
tonsillectomy and adenoidectomy.
Obstructive
Sleep Apnea Diagnosis & 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
Obstructive
Sleep Apnea Treatment
The objective of treatment is to keep the airway
open to prevent apneic episodes during sleep.
Weight management (or intentional weight
loss) and the avoidance of 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 are being studied
as a form of treatment. Surgery to remove excess
tissue at the back of the throat (called a
uvulopalatopharyngoplasty or UPPP), to remove
enlarged tonsils or adenoids (see
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.
Obstructive
Sleep Apnea Complications
- Hypertension
- Right-sided heart failure
- Abnormal heart rhythm (arrhythmia)
- Excessive carbon dioxide levels
(hypercapnia)
- Sleep deprivation
Call Us
If you have excessive daytime sleepiness, or
if you or your family notice symptoms of
obstructive sleep apnea call us for an
appointment. If you have this condition, call if
symptoms do not improve with treatment or if new
symptoms develop.
Decreased consciousness, extreme
somnolence, hallucinations, personality changes,
and persistent confusion can indicate an
emergency. |
