Education

What Is Obstructive Sleep Apnea?

Obstructive sleep apnea (OSA) is a condition in which breathing stops involuntarily for brief periods of time during sleep. Normally, air flows smoothly from the mouth and nose into the lungs at all times. Periods when breathing stops are called apnea or apneic episodes. In OSA, the normal flow of air is repeatedly stopped throughout the night. The flow of air stops because airway space in the area of the throat is too narrow or the airway is obstructed by the tongue. Snoring is characteristic of obstructive sleep apnea. Snoring is caused by airflow squeezing through the narrowed airway space.

Untreated sleep apnea can cause serious health problems such as:

  • Hypertension
  • Heart disease
  • Stroke
  • Diabetes

Proper diagnosis and treatment are essential to preventing complications.

Symptoms of Sleep Apnea

Sleep apnea causes episodes of decreased oxygen supply to the brain and other parts of the body. Sleep quality is poor, which causes daytime drowsiness and lack of clarity in the morning. People with sleep apnea may also experience the following symptoms:

  • Headaches that are difficult to treat or waking up with a headache
  • Experiencing mood changes such as depression and irritability
  • Forgetfulness
  • Excessive daytime sleepiness or becoming drowsy while driving
  • Acid reflux
  • Nocturia (need to use the bathroom several times per night)
  • Abrupt awakening accompanied by gasping or choking
  • Night sweating
  • High blood pressure
  • Awakening with a dry mouth or sore throat frequently
  • Loud snoring

Other symptoms include:

  • Hyperactivity in children
  • Poor job and school performance
  • Loss of libido or low testosterone levels in men
  • Leg swelling (called edema, which can occur when sleep apnea is severe)
  • Teeth grinding or clenching

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

Who Is at Risk for Obstructive Sleep Apnea?

Risk for OSA increases if you have conditions or features that narrow the upper airway. Risk factors of OSA include:

  • Children with large tonsils and adenoids
  • Men with a collar size of 17 inches or more
  • Women with a collar size of 16 inches or more
  • Large tongue, which can block the airway
  • Mouth breathers
  • Retrognathia, which is when your lower jaw is shorter than your upper jaw
  • A narrow palate or airway that collapses more easily
  • Post-menopausal women or those with PCOS
  • Males over 50 or those with low testosterone levels
  • Anyone with Type II diabetes or hypertension
  • Obese people - heart disease is more common in obese people, and obesity is a risk factor of heart disease, high blood pressure, and sleep apnea.

How Is Obstructive Sleep Apnea Diagnosed?

A diagnosis of sleep apnea begins with a complete history and physical examination. A history of daytime drowsiness and snoring are important clues. Your doctor will examine your head and neck to identify any physical factors that are associated with sleep apnea. Your doctor may ask you to fill out a questionnaire about daytime drowsiness, sleep habits, and quality of sleep. A sleep study that is administered and interpreted by a physician board certified in sleep medicine will normally be required to meet medical insurance guidelines for reimbursement.

Polysomnogram

polysomnogram usually requires that you stay overnight in a hospital or a sleep study center. The test lasts for an entire night. While you sleep, the polysomnogram will measure the activity of different organ systems associated with sleep. It may include:

  • Electroencephalogram (EEG), which measures brain waves
  • Electro-oculogram (EOM), which measures eye movement
  • Electromyogram (EMG), which measures muscle activity
  • Electrocardiogram (EKG or ECG), which measures heart rate and rhythm
  • Pulse oximetry test, which measures changes in your oxygen levels in your blood
  • Arterial blood gas analysis (ABG)

Home Sleep Study

Portable equipment can be sent home to monitor your sleep.  This equipment normally monitors sleep disordered breathing events, blood oxygen level, sleep phases by actigraphy, snoring levels and duration, pulse rate and arousal indicators.  It’s a very effective test that is only interpreted by a physician board certified in sleep medicine.

Pulse Oximetry

In this test, a small device called a pulse oximeter is clipped onto a thin area of your body that has good blood flow, such as the fingertip or earlobe. The pulse oximeter uses a tiny emitter with red and infrared LEDs to measure how much oxygen is in your blood. The amount of oxygen in your blood, or oxygen saturation, decreases during episodes of apnea. Normally, oxygen saturation is around 95-100 percent. Your doctor will interpret your results.

Arterial Blood Gas (ABG)

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

  • Oxygen content
  • Oxygen saturation
  • Partial pressure of oxygen
  • Partial pressure of carbon dioxide
  • Bicarbonate levels

This test will give your doctor a more detailed picture about the amount of oxygen, carbon dioxide, and the acid-base balance of your blood. It will also help your doctor know if and when you need extra oxygen.

Treatment

The goal for treatment of sleep apnea is to make sure airflow isn’t obstructed during sleep. Treatment methods include:

Continuous Positive Airway Pressure (CPAP)

Continuous positive airway pressure (CPAP) therapy is administered through a facemask that’s worn at night. The facemask gently delivers positive airflow to keep the airways open at night. The positive airflow props the airways open. CPAP is a highly effective treatment for sleep apnea. A dental device may also be necessary to keep the lower jaw positioned forward.

Bilevel Positive Airway Pressure (BiPAP or BPAP)

Bilevel positive airway pressure machines are sometimes used for the treatment of OSA if CPAP therapy is not effective. BiPAP machines have settings, high and low, that respond to your breathing. This means the pressure changes during inhaling versus exhaling.

Oral Appliance Therapy

This appliance is a premium, custom-fitted dental device developed for the treatment of snoring and obstructive sleep apnea.  It is an effective, comfortable and durable alternative to CPAP or surgery.  Worn while sleeping, the appliance opens the airway vertically and moves the lower jaw (mandible) forward, allowing relaxation of the tissue at the back of the throat and ensuring the base of the tongue does not block or collapse the airway.  This method offers a safe, soundless, comfortable, convenient and effective form of treatment. 

Positional Therapy

Since sleeping on the back (supine position) can make sleep apnea worse for some people, positional therapy is used to help those with sleep apnea learn to sleep in other positions.

Surgery

Uvulopalatopharyngoplasty (UPPP) involves removal of extra tissues from the back of the throat. UPPP is the most common type of surgery for OSA, and it helps relieve snoring. However, this surgery hasn’t been proven to totally eliminate sleep apnea, and it can have complications.

Tracheostomymay be done as a procedure of last resort. Tracheostomy punctures an opening in the windpipe that bypasses the obstruction in the throat.

Other surgical procedures may be required to correct structural problems in the face and elsewhere when sleep apnea doesn’t respond to treatments such as CPAP. About 75 percent of children with OSA due to enlarged tonsils or adenoids get relief from surgery. The American Sleep Apnea Association (ASAA) says that the American Academy of Pediatrics has endorsed surgical removal of tonsils and adenoids as the treatment of choice for children with sleep problems due to enlarged tonsils or adenoids.

Weight Loss

Weight loss gives excellent relief from the symptoms of OSA.

Nasal Treatment

The ability to breathe through your nose if very important to treating OSA.  A referral to a physician specializing in the nose (ENT) is often made for an evaluation to determine if nasal airflow limitations are present and discuss how to best treat them.  There are a variety of surgical options and medications that can correct such issues.