Overview

Mr. B, 42 years old, came to the hospital with chest pain and was found to have a heart attack. He was obese, smoked, consumed regular alcohol and had high blood pressure for the last three years. After medical stabilisation, he underwent coronary angiography, which revealed significant blockages in two arteries of the heart, which were successfully treated by stents. In view of obesity, short neck, irritability, snoring and poor sleep quality, we suspected obstructive sleep apnea in him. The sleep study done later confirmed severe obstructive sleep apnea.

Types of Sleep Apnea

Sleep apnea is a potentially serious sleep disorder in which breathing repeatedly stops and starts. If you snore loudly and feel tired even after a whole night's sleep, you might have sleep apnea. The primary types of sleep apnea are

Obstructive Sleep Apnea- The more common form when throat muscles relax.
Central Sleep Apnea- This occurs when your brain doesn't send proper signals to the muscles that control breathing.
Complex Sleep Apnea Syndrome- occurs when someone has both obstructive sleep apnea and central sleep apnea.

Symptoms of Sleep Apnea

The signs and symptoms of obstructive and central sleep apneas overlap, sometimes making it difficult to determine which type you have. The most common signs and symptoms of obstructive and central sleep apneas include:

Loud snoring
Episodes in which you stop breathing during sleep — which another person would report
Gasping for air during sleep
Awakening with a dry mouth
Morning headache
Difficulty staying asleep (insomnia)
Excessive daytime sleepiness (hypersomnia)
Difficulty paying attention while awake
Irritability

Causes of Sleep Apnea

Obstructive Sleep Apnea

This occurs when the muscles in the back of your throat relax. These muscles support the soft palate, the triangular piece of tissue hanging from the soft palate (uvula), the tonsils, the side walls of the throat and the tongue. When the muscles relax, your airway narrows or closes as you breathe in. You can't get enough air, which can lower the oxygen level in your blood. Your brain senses your inability to breathe and briefly rouses you from sleep so that you can reopen your airway. This awakening is usually so brief that you don't remember it. This pattern can repeat itself 5 to 30 times or more each hour, all night, impairing your ability to reach the deep, restful phases of sleep.

Central Sleep Apnea

This less common form of sleep apnea occurs when your brain fails to transmit signals to your breathing muscles. It means that you make no effort to breathe for a short period. You might awaken with shortness of breath or have difficulty getting to sleep or staying asleep.

Sleep Apnea- Risk factors

Excess Weight. Obesity greatly increases the risk of sleep apnea. Fat deposits around your upper airway can obstruct your breathing.
Neck Circumference. People with thicker necks might have narrower airways. A narrowed airway. You might have inherited a narrow throat. Tonsils or adenoids also can enlarge and block the airway, particularly in children.
Male Sex. Men are two to three times more likely to have sleep apnea than women. However, women increase their risk if they're overweight, and their risk also appears to rise after menopause.
Increasing Age. Sleep apnea occurs significantly more often in older adults.
Family History. Having family members with sleep apnea might increase your risk.
Use of Alcohol, Sedatives or Tranquilizers. These substances relax the muscles in your throat, which can worsen obstructive sleep apnea.
Smoking. Smokers are three times more likely to have obstructive sleep apnea than people who've never smoked. Smoking can increase the amount of inflammation and fluid retention in the upper airway.
Nasal Congestion. If you have difficulty breathing through your nose — whether from an anatomical problem or allergies — you're more likely to develop obstructive sleep apnea.
Medical Conditions. Congestive heart failure, high blood pressure, type 2 diabetes and Parkinson's disease are some of the conditions that may increase the risk of obstructive sleep apnea. Polycystic ovary syndrome, hormonal disorders, prior stroke and chronic lung diseases such as asthma also can increase risk.

Sleep Apnea- Complications

Sleep apnea is a serious medical condition. Complications can include

Daytime Fatigue. The repeated awakenings associated with sleep apnea make normal, restorative sleep impossible, making severe daytime drowsiness, fatigue and irritability likely. You might have difficulty concentrating and find yourself falling asleep at work, while watching TV or even when driving. People with sleep apnea have an increased risk of motor vehicle and workplace accidents.
Mood disturbances: You might also feel quick-tempered, moody or depressed.
Poor school performance: Children and adolescents with sleep apnea might perform poorly in school or have behaviour problems.
High Blood Pressure or Heart Problems. Sudden drops in blood oxygen levels during sleep apnea increase blood pressure and strain the cardiovascular system. Having obstructive sleep apnea increases your risk of high blood pressure (hypertension). Increased risk of recurrent heart attack, stroke and abnormal heartbeats, such as atrial fibrillation. If you have heart disease, multiple episodes of low blood oxygen (hypoxia or hypoxemia) can lead to sudden death from an irregular heartbeat.
Diabetes. Having sleep apnea increases your risk of developing insulin resistance and type 2 diabetes.
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.
Liver Problems. People with sleep apnea are more likely to have abnormal results on liver function tests, and their livers are more likely to show signs of scarring (nonalcoholic fatty liver disease).
Sleep-deprived Partners. Loud snoring can keep anyone who sleeps near you from getting good rest. It's not uncommon for a partner to go to another room, or even to another floor of the house, to be able to sleep.

Sleep Apnea- Treatment

It is essential to be aware of this medical condition and seek treatment, which includes lifestyle changes, such as weight loss, regular physical activity (but not just before bedtime), avoiding caffeine before bed, minimising mobile phone use before bedtime, developing a pre-bedtime routine such as taking a warm bath, dimming the lights or having some herbal tea and refraining from smoking and alcohol intake. Side sleeping instead of sleeping on the back, raising the head of the bed at an angle of about 60 degrees while sleeping, and using a breathing-assisted device at night, such as continuous positive airway pressure (CPAP) machines, may help in some cases. Surgery may be required in some cases.

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