Obstructive sleep apnea (OSA) is the most common sleep-related respiratory disorder. Let’s first understand what obstructive sleep apnea is?
Normally, inhaled air flows smoothly from the nose into the lungs constantly, even during deep sleep. In obstructive sleep apnea, the recurrent collapse of the muscles supporting the upper respiratory tract during sleep occurs, which causes narrowing of the airway passage. It results in a stoppage of breathing for a moment. These momentarily periods of no breathing are called apnea or apneic episodes.
A person suffering from OSA experience many episodes of apnea throughout the whole night. These episodes can lead you to a sudden awakening from sleep. Sometimes these apneic episodes are so brief that you cannot even notice them. But sometimes, your sleep may break with the shortness of breath, causing a snorting, choking, or gasping sound.
OSA can affect anyone, but it is common in older people. Men have a higher predisposition for sleep apnea than women. Some researchers have found that the incidence rate of OSA in postmenopausal women is similar to men.
Symptoms of obstructive sleep apnea
Sometimes people suffering from OSA cannot notice it. It is often detected during general health screening or as a comorbid condition during the diagnosis of another disease. Some signs and symptoms of obstructive sleep apnea are:
- Snoring: It is often the first sign noticed. Snoring with some period of silence is seen in OSA. But everyone suffering from OSA doesn’t show snoring as a symptom.
- Persons sharing the bed with the people suffering from OSA generally tell about choking, snorting, loud snoring, and disrupted breathing during sleep.
- Feeling sleepy and sluggish throughout the day
- Headache after waking up
- Restlessness during sleep
- Sore throat and dry mouth after waking up in the morning
- Easily forgetfulness, depression, and difficulty in concentrating
- Low libido
- Children with OSA may also suffer from bed-wetting, learning difficulties, teeth grinding, and unusual sleeping posture to curb restlessness.
Risk factors of obstructive sleep apnea
OSA can inflict anyone, even children. Some factors that can make you prone to sleep apnea are:
- Gender predisposition: Male are more prone to getting OSA
- Age: Older>younger people
- Hereditary: You have more chances of getting OSA if there is a family history of the disease
- Obesity: It is a prominent factor that may cause sleep apnea. The extra fat around the pharyngeal soft tissue reduces the lumen opening and increases the chances of the collapse of the muscles surrounding the respiratory tract.
- Adenoid and tonsil hypertrophy
- Craniofacial abnormalities: large tongue, retrognathia (lower jaw is shorter than upper jaw), narrow palate, and small airway
- Have a history of asthma
- Medical conditions, such as high blood pressure and diabetes can also increase the risk of OSA
Complications of obstructive sleep apnea
OSA is a serious medical condition. It can be the root cause of many other conditions such as:
- High blood pressure
- Cardiovascular problems: Obstructive sleep apnea increases the risk of coronary artery disease, arrhythmias, heart failure, and stroke.
- Difficulty in concentrating and drowsiness during daytime
- Ophthalmic problems: Dry eyes, and sometimes increases the risk of glaucoma
- Pregnancy: OSA can increase the risk of gestational diabetes
- Sleepiness during the day may pose a risk of road accidents
- Medications like sedatives, narcotic analgesics, and general anesthesia can worsen OSA. These medications relax our upper respiratory passage, which further aggravates sleep apnea.
Treatment of obstructive sleep apnea
Early diagnosis and treatment of OSA are necessary as it poses many health problems. Some treatment options are:
- Lifestyle modification: In the case of mild OSA, simple lifestyle modification can improve the condition
- Maintaining healthy body weight
- Regular exercise
- Quit smoking and limit the alcohol intake
- Avoid sleeping on the back
- Nasal decongestants also improve nasal blockage
- Avoid taking sedative medicines and narcotic analgesics
- Continuous positive airway pressure (CPAP): CPAP therapy is the first-line treatment option for moderate to severe OSA. During CPAP, the person wears a face mask during the night. This face mask supplies positive air pressure, which keeps the respiratory way open at night.
- Mouthpiece (oral device): Doctors prescribe mouthpieces to those who don’t show any positive recovery after CPAP therapy.
- Bilateral positive airway pressure (BPAP) therapy: Doctors recommend BPAP machines when CPAP and oral devices do not improve a patient’s condition. This machine delivers two pressures according to your breathing pattern: inhaled and exhaled pressure. Pressure change during inhalation and exhalation improves OSA condition.
- Surgery: Surgery is more effective when obstructing lesions are responsible for OSA and when CPAP and BPAP are ineffective. Surgical options may include:
- Surgical removal of tissues like adenoid, tonsils, or overgrowth.
- Maxillomandibular advancement to enlarge the space behind the soft palate and tongue to reduce the obstruction
- Tracheostomy; in case of life-threatening severe OSA
- Nasal surgery to remove the polyp and for a deviated septum
If you suspect obstructive sleep apnea in you and your near ones, consult your doctor. It is a curable disease if noticed at early stages.
Dr. Nitin Rathi, Senior Consultant – Pulmonology, Dharamshila Narayana Superspeciality Hospital, Delhi