OBSTRUCTIVE SLEEP APNEA (OSA)

Overview

Sleep apnea is a potentially serious disorder where breathing stops and starts many times during sleep.
(In this condition, breathing typically stops for at least 10 seconds, more than 5 times per hour during the night.) These pauses in breathing are called apneas. Apnea cuts off the oxygen supply to the body and the rise in carbon dioxide eventually awakens the patient who gasp for air making a snorting sound. Snoring frequently occurs with sleep apnea. Excessive daytime sleepiness is often another telling sign of the condition. Adults or children may not even know they have the condition.

OSA, the most common form of apnea, occurs when the tissues in the back of the upper throat collapse during sleep, blocking the air passage even though the action of breathing continues. In most cases, the person is unaware and may wake up gasping or snoring.

Obstructive Hypopnea
Obstructive hypopnea, is another less severe form caused by incomplete airway obstruction. Breathing is continuous but shallow and is accompanied by snoring and decrease in blood oxygen.

Negative Effects of Sleep Apnea

• Heart and Circulation - Sleep apnea is strongly associated with high blood pressure, coronary artery disease and heart attack, stroke, heart failure, and irregular heartbeats.
• Obesity - Obesity is often a risk and possibly a cause of sleep apnea. It is also likely taht sleep apnea increases the risk for weight gain.
• Sleep Partners - Because the sleep apnea so often includes noisy snoring, the condition can adversely affect the sleep quality of a patient's bed partner. Spouses or partners may also suffer from sleeplessness and fatigue.
• Infants and Children - Young children with undiagnosed sleep apnea may "fail to thrive", by not gaining weight or grow at a slower rate with low levels of growth hormone. In severe cases, this may affect the heart and central nervous system. Inattention and hyperactivity are common in children with sleep apnea. Evidence suggest thats some children may be misdiagnosed with attention-deficit hyperactivity disorder when in fact, sleep apnea is the root cause.
• Driving Safety - Some researchers believe that sleepiness associated with sleep apnea is a great risk factor for car accidents. Many studies report that drowsy driving is as risky as drunk driving, causing a large number of traffic accidents and death.

Symptoms

In Adults

• Snoring with pauses in breathing (apnea)
• Restless sleep
• Excessive daytime sleepiness
• Morning headaches
• Poor judgement and memory loss
• Irritability and impaired mental or emotional functioning
• Frequent visits to the bathroom at night

In Children
Sleep apnea in children can present with symptoms different from adults:

• Longer total sleep time than normal in some children
• Snoring (not all of them have sleep apnea)
• More effort in breathing during sleep
• Behavioral difficulties without any obvious cause, such as hyperactivity and inattention. (Some could be misdiagnosed with attention-deficit hyperactivity disorder ADHD)
• Irritability
• Bed-wetting
• Morning headaches
• Failure to grow or gain weight

Diagnosis
If you think you may have sleep apnea, see a sleep specialist who can take a detailed history and perform a head and neck examination. If the doctor suspect a sleep disorder, then you will be referred for an overnight sleep study(polysomnography).

The sleep study is the gold standard for diagnosing snoring and sleep apnea. It tracks the patient's brain, heart and eye activity as well as the breathing and blood oxygen level patterns. In patients who may have sleep apnea, the sleep expert will track episodes where breathing is shallow or stops for longer than 10 seconds. In general, apnea is significant if more than five episodes per hour is reported. If there are more than 15 episodes per hour, the condition is serious.

Treatment
Given the long term complications of sleep apnea, it is important for patients to undergo treatment. Because of its association with heart problems and stroke, sleep apnea that does not respond to lifestyle measures should be treated by a physician, ideally a professional specifically trained to treat sleep disorders. Treatment may involve:

Continuous Positive Airway Pressure (CPAP)
At this time, the most effective treatments for sleep apnea are devices that deliver slightly pressurized air (CPAP) to keep the throat open during the night.

Oral Appliances/Special Dental Splints
Several oral appliances are available and are effective in treating mild to moderate obstructive sleep apnea.

Surgery
Surgery is sometimes recommended for severe obstructive apnea. They include procedures to remove obstructions in the airway and expand the airway. The apneas and hypopneas may be greatly reduced or completely resolved. Patients must be assessed by the sleep specialists to decide whether surgery is the preferred solution for them.