Obstructive Sleep Apnea is common among 1-2% of the population and is the most common sleep-related breathing disorder. Apnea occurs when the airway at the back of your throat gets closed while breathing during deep sleep which leads to awakening you from sleep. This awakening can be a very brief episode that can be even not remembered in the morning. But you can be woken up for like a hundred times during sleep which leads to sleep deprivation and daytime sleepiness.
Causes for Sleep Apnea
Several factors that narrow the upper airway can be reasons for OSA to occur. Those factors are,
- Protruding structures to the pharynx as enlarged tonsils and obesity which causes narrowing in the pharynx by deposition of fat.
- Nasal obstructions such as nasal polyps, structural deformities, rhinitis, and lymphatic enlargements in the nose called adenoids.
- Drugs that depress respiration as alcohol, sedatives, and some strong painkillers.
- Neuromuscular conditions such as strokes.
- Fluid buildup due to diseases such as heart failure or renal failure.
- Pregnancy
Risk Factors
- Obesity and other diseases associated with obesity, such as hypothyroidism and polycystic ovary syndrome, increase the risk of obstructive.
- Sleep apnea.
- Increasing age can increase the risk.
- Having a large tongue, a lower jaw smaller than the upper jaw, and a narrow palate.
- High blood pressure.
- Diabetes
- Men are more prone to develop OSA approximately twice or three times a day.
- Long-term congestion of the nasal airway at night.
- Having a blood relative with OSA can increase your risk as well.
- Smoking and respiratory diseases such as Asthma can also make you more prone to get OSA.
Clinical Manifestations
- Increased daytime sleepiness.
- Impaired intellectual functioning including the inability to concentrate.
- Complains of loud snoring from partners or family members.
- Abrupt awakenings followed by gasping or choking.
- A dry mouth or sore throat is present every morning and a headache.
- Mood changes as irritability.
- High blood pressure.
- Loss of interest in sexual activities.
- Eye problems such as glaucoma.
Diagnosis
Initially, the doctor will assess you by asking a few questions about your sleeping patterns and daytime sleepiness followed up by an interview with a family member of yours about your sleeping patterns and snoring. Later the doctor will examine you for any causes suggestive of OSA. Specialized investigations such as overnight pulse oximetry performed at home, inpatient pulse oximetry, and video recording are used to check whether there are at least 10-15 episodes of apnea during one hour of sleep to confirm the diagnosis.
Management of Sleep Apnea
- The initial step of management is educating the patient on how this disease is caused and the importance of lifestyle modification.
- Regular exercise, a healthy diet, and reducing junk food can cause loss of weight as a solution for obesity. It is important to maintain a good BMI.
- The sleeping position can be changed to sleeping on your side. Sleeping on your back can worsen symptoms hence it must be avoided.
- Continues positive airway pressure or else called CPAP is the first-line treatment option available and is proven to be highly effective for OSA. Using a mask air is delivered with a positive airway pressure to keep your airway open throughout the night.
References
- Kumar and Clerk’s Clinical Medicine -8th Edition- Parveen Kumar, Michael Clark
- Oxford Handbook of Clinical Medicine – 10th Edition
