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Sleep Apnea

 - Hyderabad

Pulmonologist

Hyderabad   |   29 Jun 2023

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Sleep Apnea

What Is Sleep Apnea?

Sleep apnea is a medical condition with repeated stopping or extended periods of shallow breathing during sleep. It is characterized by repeated episodes of collapse of the upper airways during sleep and frequent episodes of arousal from sleep.

Is Sleep Apnea Condition a Medical Emergency?

It is a chronic disease that, when untreated, leads to severe complications of stroke etc. 

Types

Sleep apnea may be of the following types:

  • Obstructive Sleep Apnea (OSA): The most common type; When people have OSA, their airway becomes too relaxed while they sleep. This blockage causes their breathing to stop while they are asleep. It also frequently causes snoring and choking or gasping for air during sleep. This results in poor sleep quality and daytime sleepiness
  • Central Sleep Apnea: Due to defects in the brain's respiratory control centres that affect breathing during sleep, resulting from an abnormal response of the neurological feedback mechanisms.
  • Mixed Sleep Apnea/Complex Sleep Apnea: There is a combination of obstructive and central sleep apnea mechanisms

How OSA Affects Your Body

OSA can have many effects on your health and well-being. Because you wake up often during the night, you may complain of poor sleep and daytime sleepiness. This is because even though you may spend 7 to 9 hours asleep per night, you wake up frequently. You may feel as if you haven't slept at all. In addition, not getting enough sleep because of OSA will result in many other issues besides sleepiness. These may include daytime fatigue, poor concentration, poor memory, and mood instability (irritability). In children with OSA, instead of getting sleepy, they often become hyperactive.
OSA can negatively affect other conditions like high blood pressure, stroke, coronary artery disease, congestive heart failure, cardiac rhythm disturbances, and difficulty controlling blood sugar. Because of this, treatment of OSA, especially severe OSA, is essential.

Causes

The cause depends on the type of condition that is present and may include the following:

  • Obstructive Sleep Apnea: It can have structural and non-structural factors contributing to the condition and may include
    • Structural Factors
      • Defects in the jaw structure, such as a small lower jaw, large tongue etc
      • Nasal obstruction due to polyps, deviated septum, trauma 
    • Non-Structural
      • Obesity, hypothyroidism, stroke
      • Alcohol consumption
      • Postmenopausal state
      • Sedative use, smoking
  • Central Sleep Apnea
    • Diabetes. Hypothyroidism
    • Neuromuscular disorders
    • Heart failure

Risk Factors

Factors that increase the risk include the following:

  • Overweight/obesity: Obesity increases a person's risk for sleep apnea because fatty tissue in the airway results in a smaller opening for air to pass. This fatty tissue is more likely to block the airway. However, those who have a healthy weight can have sleep apnea.
  • Gender: Men have a 2 to 3 times higher risk than women. Older women have a similar risk for OSA as men.
  • Age: OSA becomes more frequent as a person ages, from young adulthood until the 60s and 70s. After this time, the risk appears to level off.
  • Upper airway crowding: People with small chins, large tongues, or large tonsils have a higher risk for sleep apnea.

Symptoms & Signs

  • Snoring: This is a common symptom of OSA. Most people with sleep apnoea snore, although not everyone who snores does not have OSA. Episodes of stopping breathing which end the snoring with a snort
  • Because it results in poor sleep quality, people with sleep apnoea are often sleepy during the day and may doze off or take daytime naps. Car accidents may also occur in people with sleep apnea because they can fall asleep at the wheel.
  • Pauses in breathing followed by abrupt awakenings with snoring, gasping, or choking. A bed partner may observe this symptom.
  • Difficulties with memory and concentration.
  • Changes in mood or irritability.
  • Frequent trips to the bathroom at night.
  • Morning headaches and dry mouth, fatigue

Investigations

Some investigations that are advised for the evaluation of the condition include:

  • Laboratory tests (Thyroid profile, 2d echo, lipid profile etc.)
  • Polysomnography (in sleep lab)
  • Home sleep tests

Diagnosis

OSA is diagnosed with a sleep test in a laboratory, called a polysomnogram (PSG), or a portable sleep apnoea test that can be done at home, called a home sleep apnea test, or HSAT. The most common test is the HSAT.

Treatment

The treatment depends on the type of condition present, the underlying cause, and the individual's general health. Mild forms are managed conservatively with lifestyle changes, while moderate to severe types are managed with medical or surgical interventions and the underlying cause.

  • Positive Airway Pressure (CPAP/BiPAP therapy): It is useful in both obstructive and central sleep apnea; it helps to keep the upper airways open during sleep
  • Supplemental Oxygen
  • Oral Appliances: These are dental appliances designed to open your throat by bringing your jaw forward when sleeping and increasing airspace to prevent it from complete closure during sleep
  • If other treatment options do not work for you, consider surgical options. Surgeries include removing or stiffening the tissue in the back of the throat. This includes the back part of the roof of the mouth, tonsils, and uvula. i.e, Uvulopalatopharyngoplasty (UPPP) and Craniofacial Reconstruction Surgeries in a few patients. 
  • Tracheostomy: Done in individuals with very severe obstructive sleep apnea.

Role of Diet/ Exercise/ Lifestyle Changes/ Preventive

  • Change of sleeping position: Avoid sleeping face down, and practice sleeping on the side. Some people have worse sleep apnea when they lay on their backs. Instead, try sleeping on your side to see if it reduces OSA symptoms.
  • Losing excessive weight (losing weight will improve your OSA. Losing just 10% of your body weight can improve your sleep apnoea. In some cases, losing a significant amount of weight can even cure the disease.)
  • Eating a healthy diet and maintaining an ideal body weight
  • Getting regular exercise
  • Avoiding smoking
  • Avoid alcohol and certain medications. Drinking excessive alcohol or taking some pain medicines or sleeping pills before bedtime can worsen OSA

When To Contact The Doctor or Hospital? / How To Identify The Emergency Or Complications?

  • Loud, disruptive Snoring
  • Pauses in breathing during sleep
  • Daytime sleepiness
  • Difficulty controlling medical problems, such as blood pressure or blood sugar
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