Sleep apnea - obstructive
Episodes
of cessation of breathing lasting 10 seconds or longer during sleep.
Sleep
apnea is a serious, potentially life-threatening condition that is far more
common than generally understood. First described in 1965, sleep apnea is a
breathing disorder characterized by brief interruptions of breathing during
sleep. Its name came from a Greek word, apnea, which means "want of
breath."
Early
recognition and treatment of sleep apnea is important because it may be
associated with irregular heartbeat, high blood pressure, heart attack, and
stroke.
People
who…
 |
are
middle age |
|
snore
loudly |
|
are
overweight |
|
have
high blood pressure |
|
have
some physical abnormality in the nose, throat, or other parts of the upper
airway |
| During sleep, relaxation
of the muscles at the base of the throat cause obstruction of the airway,
with extremely loud snoring and labored breathing. |
| When complete blockage of
the airway occurs, breathing stops. |
| The obstruction to
breathing prevents a person from reaching deeper stages of sleep, causing
the symptoms of daytime drowsiness. |
| Obstructive sleep apnea
occurs most frequently in obese middle-aged men. Contributing factors may
include use of alcohol or sedatives before sleep, anatomically narrowed
airways, and massively enlarged tonsils and adenoids. |
| The incidence is 6 out of 100,000 people. |
1.
Shortly after going to sleep, the person affected by obstructive sleep
apnea snores at a regular pace for a period of time, often becoming louder.
2.
It is then interrupted by a long silent period during which no breathing
is taking place (apnea).
3.
The apnea is then interrupted by a loud snort and gasp and the snoring
returns to its regular pace.
4. This behavior may recur repetitively and frequently throughout the night. During the apneic periods the oxygen level in the blood falls dramatically.
Weight reduction and avoidance of alcohol use and sedatives may help some individuals risk.
| loud snoring |
| snoring interrupted by
periods of not breathing (apnea) |
| breath cessation during
sleep |
| frequent night awakening |
| awakening not rested in
the morning |
| abnormal daytime
sleepiness |
| headaches |
| recent weight gain |
| limited attention |
| memory loss |
| poor judgment |
| personality changes |
| depression |
| irritability |
| sexual dysfunction |
| learning difficulty |
| falling asleep while at work, on the phone, or driving |
Additional
symptoms that may be associated with this disease:
| hallucinations |
| confusion |
| high blood pressure |
Tests
may include:
| Polysomnography Polysomnography is a test that records a variety of body functions during sleep, such as the electrical activity of the brain, eye movement, muscle activity, heart rate, respiratory effort, air flow, and blood oxygen levels. These tests are used both to diagnose sleep apnea and to determine its severity. |
| The
Multiple Sleep Latency Test (MSLT)
The Multiple Sleep Latency Test (MSLT) measures the speed of falling asleep. In this test, patients are given several opportunities to fall asleep during the course of a day when they would normally be awake. For each opportunity, time to fall asleep is measured. People without sleep problems usually take an average of 10 to 20 minutes to fall asleep. Individuals who fall asleep in less than 5 minutes are likely to require some type of treatment for sleep disorders. The MSLT may be useful to measure the degree of excessive daytime sleepiness and to rule out other types of sleep disorders. |
The
objective of treatment is to keep the airway open to prevent apneic episodes
during sleep.
| Behavioral changes are an important part of the treatment program, and in mild cases behavioral therapy may be all that is needed. |
| The individual should avoid the use of
alcohol, tobacco, and sleeping pills, which make the airway more likely to
collapse during sleep and prolong the apneic periods. |
| Overweight
persons can benefit from losing weight.
Even a 10 percent weight loss can reduce the number of apneic events
for most patients. |
| In some patients with mild sleep apnea, breathing pauses occur only when they sleep on their backs. In such cases, using pillows and other devices that help them sleep in a side position is often helpful. |
| It is the most common effective treatment for
sleep apnea. |
| In this procedure, the patient wears a mask
over the nose during sleep, and pressure from an air blower forces air
through the nasal passages. |
|
The air pressure is adjusted so that it is just enough to prevent the throat
from collapsing during sleep. |
| The pressure is constant and continuous.
Nasal CPAP prevents airway closure while in use, but apnea episodes return
when CPAP is stopped or it is used improperly. |
| Variations of the CPAP device attempt to
minimize side effects that sometimes occur, such as nasal irritation and
drying, facial skin irritation, abdominal bloating, mask leaks, sore eyes,
and headaches. |
| Some versions of CPAP vary the pressure to coincide with the person's breathing pattern, and other CPAPs start with low pressure, slowly increasing it to allow the person to fall asleep before the full prescribed pressure is applied. |
| It
repositions the lower jaw and the tongue have been helpful to some patients
with mild sleep apnea or who snore but do not have apnea. |
| Possible side effects include damage to teeth, soft tissues, and the jaw joint. A dentist or orthodontist is often the one to fit the patient with such a device. |
|
|
|
More
than one procedure may need to be tried before the patient realizes any
benefits. |
|
Some of the more common procedures include removal of adenoids and tonsils
(especially in children), nasal polyps or other growths, or other tissue in
the airway and correction of structural deformities. |
| Younger patients seem to benefit from these surgical procedures more than older patients. |
| It
is a procedure used to remove excess tissue at the back of the throat
(tonsils, uvula, and part of the soft palate). |
| The
success of this technique may range from 30 to 60 percent. |
| The
long-term side effects and benefits are not known, and it is difficult to
predict which patients will do well with this procedure. |
| Laser-assisted
uvulopalatoplasty (LAUP) is done to eliminate snoring but has not been shown
to be effective in treating sleep apnea. |
| This
procedure involves using a laser device to eliminate tissue in the back of
the throat. |
| Like
UPPP, LAUP may decrease or eliminate snoring but not eliminate sleep apnea
itself. |
| Elimination
of snoring, the primary symptom of sleep apnea, without influencing the
condition may carry the risk of delaying the diagnosis and possible
treatment of sleep apnea in patients who elect to have LAUP. |
| To identify possible underlying sleep apnea, sleep studies are usually required before LAUP is performed. |
| It is a procedure that
uses radiowaves to reduce the size of some airway structures such as the
uvula and the back of the tongue. |
| This technique is being investigated as a treatment for apnea. |
| It is used in persons with severe, life-threatening sleep apnea. |
| In this procedure, a
small hole is made in the windpipe and a tube is inserted into the opening. |
| This tube stays closed
during waking hours, and the person breathes and speaks normally. |
| It is opened for sleep so
that air flows directly into the lungs, bypassing any upper airway
obstruction. |
| Although this procedure
is highly effective, it is an extreme measure that is rarely used. |
Treatment
is not always successful. Frequently, people are unable to lose weight and are
not always compliant with therapy.