What is obstructive sleep apnea?

What is Obstructive Sleep Apnea

Apnea means not breathing. Sleep apnea is a serious medical condition in which breathing repeatedly stops and starts. If you snore loudly and feel tired even after a full night’s sleep, you might have sleep apnea. People with Obstructive Sleep Apnea (OSA) may not be aware that they have this problem as they do not usually remember the waking times at night. 

Risk Factors

OSA can occur at any age, including children. However, it most commonly develops in middle aged men who are overweight or obese women after menopause and people who are over the age of 65.

• Overweight and obesity. Particularly if you have a thick neck.
  • Drinking alcohol in the evening. Alcohol relaxes muscles more than usual and makes the brain less responsive.
  • Enlarged tonsils and/or adenoids
  • Taking sedative drugs.
  • Sleeping on your back rather than on your side.
• Jaw problems such as micrognathia (small jaw) or retrognathia (a pulled back jaw)

What are the symptoms:

As per The National Institute for Health and Care Excellence (NICE) people having two or more of the following features can be suspected to have OSA:

• Snoring
• Witnessed apnoeas.
• Unrefreshing sleep.
• Waking headaches.
• Unexplained excessive sleepiness, tiredness, or fatigue.
• Daytime sleepiness. This is often different to just being ‘tired’. People with severe OSA may fall asleep during the day with serious consequences.
• Nocturia (waking from sleep to urinate).
• Choking during sleep.
• Sleeplessness
• Poor concentration and mental functioning during the day.
• Being irritable during the day.

Complications  include:

1. Daytime fatigue. You might have trouble concentrating and find yourself falling asleep at work or even when driving. People with sleep apnea have an increased risk of motor vehicle and workplace accidents.
2. Behavioural problems. You might feel quick-tempered, moody or depressed. Children and adolescents with sleep apnea might perform poorly in school.
3. High blood pressure or heart problems.  Having Obstructive sleep apnea increases your risk of high blood pressure, also known as hypertension. OSA might also increase your risk of recurrent heart attack, stroke and can lead to sudden death.
4. Type 2 diabetes. Having sleep apnea increases your risk of developing insulin resistance and type 2 diabetes.
5. Metabolic syndrome. This disorder, which includes high blood pressure, abnormal cholesterol levels, high blood sugar and an increased waist circumference, is linked to a higher risk of heart disease.
6. Complications with medicines and surgery.  People with sleep apnea might be more likely to have complications after major surgery.

Treatment

General measures

• Losing some weight if you are overweight or obese.
• Not drinking alcohol for 4-6 hours before going to bed.
• Sleeping on your side or in a semi-propped position.

Continuous positive airway pressure (CPAP)

This is used if other treatments are not successful. This treatment involves wearing a mask when you sleep. The slightly increased air pressure keeps the throat open when you are breathing at night and so prevents the blockage of airflow. However, over time upto 85% of patients have been reported to be nonadherent to treatment.

Surgery

Surgery is helpful to increase the airflow into your airway. For example, if you have large tonsils or adenoids, it may help if these are removed. If you have any nasal blockages, an operation may help to clear the blockage.

0-5 Lower Normal Daytime Sleepiness

8-10 Higher Normal Daytime Sleepiness

11-12 Mild Excessive Daytime Sleepiness

13-15 Moderate Excessive Daytime Sleepiness, you may want to consider seeking medical attention.

16-24 Severe Excessive Daytime Sleepiness and should consider seeking medical attention