Sleep Apnea

Obstructive Sleep Apnea Syndrome (OSA), the most prevalent of the hypersomnolence disorders, affects approximately 4% of adult males and 2% of adult females. It is characterized by heavy snoring and the recurrent collapse of the throat airway during sleep which generally requires arousal to re-establish an open airway and resume breathing. Patients suffer from both sleep fragmentation (frequent arousal) and the recurrent lack of oxygen with possible cardiovascular complications. It is therefore important to recognize this condition and treat it.

If you snore loudly, have frequent pauses in breathing while asleep, wake up gasping for air, suffer from sleepiness during the day, fall asleep easily during the day, there is a high probability that you suffer from sleep apnea.

One of the best predictors of whether there are upper airway problems during sleep is neck circumference. More than 16″ – could be a snorer, more than 17″ – could have sleep apnea. One can still have sleep apnoea with smaller necks but it is less common.

Supportive treatment of obstructive sleep apnea includes maximizing nasal breathing, and more intensive approaches such as dental appliances and upper airway surgery. Treatment of OSA has been shown to improve both quality of life and may reduce medical complications.

Strychnine has been tried to cure sleep apnea – it works to a certain extent, but there are worries that spouses might be tempted to give an overdose when the snoring is particularly bad!

Brain damage, not a blocked airway, may be the cause of a sleeping disorder that causes explosively loud snoring and fitful nights, US researchers recently discovered. Scientists at the University of California at Los Angeles say patients who suffer from the disorder, known as sleep apnea, also show a dramatic early loss of grey matter.

“Our findings show that sleep apnea patients also suffer disordered wiring in brain regions that control muscles of the airway,” said UCLA neurobiology professor Ronald Harper, who led research into the problem. These glitches may lead to the syndrome, which is exacerbated by a small airway,” he added of the research, details of which appear in the latest edition of the American Journal of Respiratory and Critical Care Medicine. Doctors had previously blamed the condition on a narrowed airway caused by enlarged tonsils, a small jaw or excess fat, Harper said.

“Our findings suggest this sleep apnea is a pre-existing condition, that abnormal brain wiring from childhood contributes to the onset of the disorder in adulthood,” Harper said. Harper added that obstructive sleep apnea patients often display other traits that suggest subtle brain damage, including problems with memory, thought and motor skills. The repeated oxygen loss from sleep apnea may damage other brain structures that regulate memory and thinking.

A sleep study may be required, especially in severe cases.

 


Signs, symptoms & indicators of Sleep Apnea

Symptoms - Sleep  

Difficulty getting out of bed

Excessive daytime sleepiness is a specific indicator of an underlying sleep disorder, the most common of which is obstructive sleep apnea syndrome.



 

Unsound sleep

Insomnia and sleepiness are two of the clinical criteria required for making a diagnosis of obstructive sleep apnea.



Counter Indicators
Symptoms - Sleep  

No/history of sleep apnea




Conditions that suggest Sleep Apnea

Circulation  

Increased Risk of Stroke

There is evidence suggesting that individuals with obstructive sleep apnea may be at increased risk of stroke. Researchers looking at “heavy snorers” say that their increased risk of stroke may be linked to reduced blood flow in the brain during certain stages of sleep.



 

Arrhythmias/Dysrhythmias

Sleep apnea can also result in cardiac arrhythmias. Most often, the heart slows while the person stops breathing, and increases when the apneic episode ends. In 90% of those patients studied with nocturnal bradyarrythmia (slowed heart rate), there was no sign of heart rhythm abnormalities while awake. Bradyarrhythmias occurred only during sleep and varied considerably in frequency and severity. [American Heart Journal 2000; 139: pp.142-8]



Respiratory  

Problems Associated With Snoring

Sleep apnea manifests itself in most people as loud snoring interrupted by periods of obstructed breathing or breath holding.



Risks  

Increased Risk of Coronary Disease / Heart Attack

Obstructive sleep apnea is a significant risk factor for myocardial infarction.



 

Increased Risk of Hypertension

A study from the University of Wisconsin School of Medicine suggests that sleep apnea is a risk factor for chronic hypertension and heart disease. [New England Journal of Medicine, May 2000]



Symptoms - Sleep  

Regular/occasional CPAP use



Counter Indicators
Symptoms - Sleep  

Normal sleep study



Uro-Genital  



Risk factors for Sleep Apnea

Hormones  

Hypothyroidism

Hypothyroidism can present itself as obstructive sleep apnea and snoring.



Metabolic  

Problem Caused By Being Overweight

Most patients with obstructive sleep apnea are overweight and typically have a short, thick neck



Symptoms - Sleep  

History of CPAP use




Sleep Apnea suggests the following may be present

Metabolic  

Problem Caused By Being Overweight

Most patients with obstructive sleep apnea are overweight and typically have a short, thick neck




Sleep Apnea can lead to

Circulation  

Arrhythmias/Dysrhythmias

Sleep apnea can also result in cardiac arrhythmias. Most often, the heart slows while the person stops breathing, and increases when the apneic episode ends. In 90% of those patients studied with nocturnal bradyarrythmia (slowed heart rate), there was no sign of heart rhythm abnormalities while awake. Bradyarrhythmias occurred only during sleep and varied considerably in frequency and severity. [American Heart Journal 2000; 139: pp.142-8]




Recommendations for Sleep Apnea

Diet  

Alcohol Avoidance

Alcohol is useful for relaxation but unfortunately it also relaxes the throat muscles and provokes snoring and obstructive apneas. Alcohol or sedative use near bedtime may thus further depress breathing mechanisms.



 


Lab Tests/Rule-Outs  


Physical Medicine  

Physical Supports

There are several different styles of devices available over the counter to enhance nasal breathing. Some remain on the outside of the nose, sticking to the skin and supplying a lifting action. Others insert into the nostrils, forcing them to remain open.

Several oral devices have been tested to treat people with obstructive sleep apnea (OSA), including a tongue-retaining device that is worn while sleeping. It pushes the tongue and jaw forward, improving airflow. Changing the position of the lower jaw enlarges the airway and decreases the chance that it will collapse when you inhale. Some oral breathing devices supply electrical stimulation to the throat muscles to prevent the airway from collapsing when you sleep.

The most common treatment for sleep apnea is CPAP, or Continuous Positive Airway Pressure, therapy. A CPAP machine is usually about the size of a shoebox but may be smaller. A flexible tube connects the machine with a mask or other interface device that is worn over the nose and/or mouth. CPAP works by pushing air through the airway passage at a pressure high enough to prevent apneas and can be prescribed for both obstructive and central sleep apnea. The pressure is set according to the patient’s sleep apnea.

Because CPAP is a medical device, all CPAP units must have FDA approval (in the US) before they can be sold. For the same reason, you must have a physician’s prescription in order to obtain a CPAP.



Surgery/Invasive  

Surgery

Surgery to remove soft tissue from the palate and throat is an option in the treatment of OSA, but success rates tend to be disappointing. Still, surgery is an option that can successfully treat some apnea cases.



Key

Weak or unproven link
Strong or generally accepted link
Proven definite or direct link
Very strongly or absolutely counter-indicative
Likely to help
Highly recommended

Glossary

Apnea

Cessation of breathing.

Cardiovascular

Pertaining to the heart and blood vessels.

Stroke

A sudden loss of brain function caused by a blockage or rupture of a blood vessel that supplies the brain, characterized by loss of muscular control, complete or partial loss of sensation or consciousness, dizziness, slurred speech, or other symptoms that vary with the extent and severity of the damage to the brain. The most common manifestation is some degree of paralysis, but small strokes may occur without symptoms. Usually caused by arteriosclerosis, it often results in brain damage.

Cardiac

Pertaining to the heart, also, pertaining to the stomach area adjacent to the esophagus.

Arrhythmia

A condition caused by variation in the regular rhythm of the heartbeat. Arrhythmias may cause serious conditions such as shock and congestive heart failure, or even death.

Chronic

Usually Chronic illness: Illness extending over a long period of time.

Hypertension

High blood pressure. Hypertension increases the risk of heart attack, stroke, and kidney failure because it adds to the workload of the heart, causing it to enlarge and, over time, to weaken; in addition, it may damage the walls of the arteries.

Hypothyroidism

Diminished production of thyroid hormone, leading to low metabolic rate, tendency to gain weight, and sleepiness.

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