Obstructive Sleep Apnea

Obstructive sleep apnea (OSA) shows episodes of partial and/or complete closure of upper airway during sleep leading to breathing cessation, defined as > 10 sec.

Causes of Obstructive Sleep Apnea

  • Anatomic abnormalities, such as a receding or diminutive chin.
  • Narrow airways than average size.
  • Enlarged tonsils, soft palate and tongue.
  • Blocked nasal passages.
  • Obesity, especially obesity in the neck, can increase the risk of developing OSA, because the fat tissue tends to narrow the airway. Obese adults are more likely to develop OSA than obese children.
  • Use of alcohol or tranquilizers causes the neck muscles to relax. These drugs also lower the “respiratory drive” in the nervous system, reducing breathing rate and strength.
  • In children, the most common cause of OSA is enlarged tonsils and adenoids in the upper airway.
  • Although very rare, a tumor or growth in the airway in children can also cause OSA.
  • Defects that occur during birth, like Pierre-Robin or Down syndromes are also potential risk factors that can lead to the development of OSA.

Other predisposing factors associated with OSA include:

  • Family history of OSA, although no genetic inheritance pattern has been proven.
  • Smoking, which can cause inflammation, swelling, and narrowing of the upper airway.
  • Vocal cord paralysis
  • Marfan’s syndrome
  • Hypothyroidism
  • Post-polio syndrome,
  • Neuromuscular disorders

Symptoms of OSA

The signs and symptoms of OSA result from disruption of the normal sleep architecture.

  • Snoring loudly or breathing noisily when asleep
  • Mouth breathing
  • Having a restless sleep despite not being awakened from sleep
  • Excessive daytime sleepiness
  • Falling asleep in a non-stimulating environment, such as while reading in a quiet room
  • Falling asleep in a stimulating environment, during business meetings or while eating
  • Trouble concentrating
  • Irritability
  • Forgetfulness
  • Morning headaches
  • Frequent urination during the night
  • Decreased memory
  • Automobile accident
  • Erectile dysfunction
  • Hypertension is prevalent in patients with OSA, although the exact relationship is unclear. It has been shown, however, that treating OSA can modestly lower blood pressure
  • Decreased sex drive
  • Increased heart rate
  • Anxiety and depression
  • Esophageal reflux and heavy sweating at night
Symptoms in Children

This condition in children may lead to the following symptoms:

  • Behavioral difficulties such as inattention or hyperactivity
  • Bed-wetting
  • Irritability
  • Heaving chests
  • Flaring nostrils
  • Sweating
  • Difficulty in breathing
  • Morning headaches and
  • No weight gain

Symptoms in Adults

Obstructive sleep apnea in adults may cause the following symptoms:

Excessive Daytime Sleeping

A person suffering from this condition may fall asleep during the day. This can happen when he/she is driving, lying down, sitting inactively, watching TV or waiting while reading. These brief sleep episodes may not help them to overcome the overall cause of this condition.

Morning Headaches

This condition can cause irritability, headaches, impaired emotional and mental functions the next morning. These are usually caused when a person has an interrupted sleep during nights.

Snoring

This may cause lots of disturbance to the person sleeping beside you and is the main symptom of obstructive sleep apnea. Snoring can cause choking and gasps producing the loudest sounds. People often suffer from frequent arousals due to this.

Risks or Complications involved with OSA

When OSA continues for a long time, it results in the following serious complications.

  • Weight gain
  • Coronary artery disease
  • Cerebral vascular accidents (strokes)
  • OSA can aggravate congestive heart failure by placing stress on the heart during sleep.
  • Cardiovascular disease is common in patients with obstructive sleep apnea.
  • OSA has been shown to cause dilated cardiomyopathy, which is reversible with successful treatment of the sleep disorder.
  • The most obvious complication arising from OSA is diminished quality of life brought on by chronic sleep deprivation.

Medication

Many types of treatments both surgical and non surgical, medication, diagnosis are available for obstructive sleep apnea.

Treatment

Obstructive sleep apnea can be treated by avoiding the consumption of alcohol. This condition in children can be lowered by making them sleep side ways. Avoid sleeping on your back as this can result in sleep apnea. People with excess weight should eat good food and must exercise regularly to lose weight.

Surgeries for Obstructive Sleep Apnea

Sleep apnea is categorized into two types, viz. obstructive sleep apnea (OSA) and central sleep apnea. Patients suffering from sleep apnea, have certain periods in their sleep where they stop breathing. These periods can vary between seconds to minutes. In OSA, the breathing cessation is a resultant of obstructed airways. While those suffering from central sleep apnea cannot breathe due to lack of signals from the brain that stimulate the breathing muscles. Let us look at the various surgeries that are available to deal with obstructive sleep apnea.

Surgeries for Obstructive Sleep Apnea

Approximately, 20 million Americans are known to suffer from OSA, and may people are known to experience more than 100 incidences in one night’ sleep where they would stop breathing. If the problem is not dealth with, there can be other serious complications apart from a disturbed sleep and snoring.

Palatal Surgery

In most people suffering from OSA, the soft palate is where the airway is found to obstructed. Soft palate is the top soft region within the mouth. In this surgery, a part of the soft palate along with the uvula (the hanging projection in the mouth at the bottom of the tongue). Upon performing this surgery, the breathing cessations and snoring are reduced.

Jaw Surgery

In some people, due to a certain facial deformity, the airways are known to get obstructed leading to OSA. For them, the jaw surgery has to be performed in order to correct the jaw’s position due to which the obstruction to the airways is eliminated. Although very effective in treating the breathing problem, the surgery itself is a very painful one and can take months to heal.

Tracheotomy

This is considered only when the problem becomes a life threatening one. A tibe is inserted through an incision in the neck. The tube eliminates the use of airways and there is a direct exchange of air with the lungs from the tube itself. But the procedure itself is known to lead to problems with speech.

There are various other non-invasive treatment options available for treating obstructive sleep apnea (like CPAP, oral appliance therapy etc). In case these therapies fail, then a surgery would be required to treat the problem. Click here to know more about another surgical option called Uvulopalatopharyngoplasty used for ernlarging narrowed airway.