Medical Health Issues

Health Issue: Sleep Apnea

FAQs

What is Obstructive Sleep Apnea?

Obstructive sleep apnea is a condition that exists, when the airway partially or completely closes during sleep.  This closing of the airway causes reductions in blood oxygen levels, severe sleep fragmentation, and excessive daytime sleepiness. 

The potential consequences of untreated obstructive sleep apnea include hypertension, coronary heart disease, myocardial infarction, pulmonary hypertension, congestive heart failure, stroke, neuropsychiatric problems, cognitive impairment, sexual dysfunction and injuries due to accidents.

What is the connection between Obstructive Sleep Apnea and Cardiac Disease?

Obstructive Sleep Apnea, a potentially deadly phantom, is the frequent stoppage of breathing caused by relaxed tissues in the throat during sleep.  Snoring is caused by vibrations of the relaxed throat tissues and is often the precursor or companion of sleep apnea.

People with Coronary Artery Disease whose blood oxygen level is lowered by sleep-disordered breathing may be at risk of ventricular arrhythmias and nocturnal sudden death.  CPAP treatment may reduce this risk.  Sleep disordered breathing, including apnea, may cause coronary artery disease and hypertension.

Some of the research suggests that sleep apnea may indeed be a cause of heart disease.

• Congestive Heart Failure affects 5 million Americans, about 10% of the adult population.
• 10% of men and 5% of women are estimated to have sleep apnea.
• In obstructive sleep apnea, often marked by snoring, the right side of the heart may suffer damage because it has to pump harder to support the extra effort of the lungs trying to overcome the obstruction to the airway. 
• Several obese patients with both obstructive sleep apnea and heart failure were treated with CPAP, the usual treatment for sleep apnea.  Marked improvement was seen with increased energy and lessened fatigue, lower blood pressure, and a more positive outlook as a result of treatment.
• Central apneas may cause high blood pressure, surges of adrenaline, and irregular heartbeats.  Central apnea occurs without snoring and is not caused by airway obstruction; rather it is caused by the failure of the brain to signal for a breath.

How can I find out if I have Obstructive Sleep Apnea?

Diagnosis is made on the basis of the clinical picture, patient, bed partner and/or family member reports snoring and an overnight polysomnogram.

What is a polysomnogram?

A polysomnogram is an overnight recording in a sleep lab of all of your sleep activities.  These activities include brain waves, muscle movements, eye movements, breathing through your mouth and nose, snoring, heart rate and pattern and leg movements.

Information is gathered using small disc called electrodes, belts that are placed around your chest and abdomen, a sensor that is placed on your finger and electrodes placed on your chest and a few on your face.

None of these devices hurt they all are designed to be as comfortable as possible.   The rooms at the sleep center are all private and decorated somewhat like a standard home or hotel bedroom.  Each room has a television and a bathroom.

If I have Obstructive Sleep Apnea what are my treatment options?

• CPAP Continuous Positive Airway Pressure
  The “Gold standard” treatment accepted by physicians who specialize in sleep medicine, is positive airway pressure.  This is so because it is the most effective when tolerated.  The CPAP consists of an air compressor, a tube, and a mask that covers the nose.  The compressor blow air into the airway this prevents the airway from collapsing when you are sleeping. This form of treatment can often provide immediate resolution of the OSA.
• Intra-oral Fixation Device – Also known as an oral appliance
  The Intra-oral Fixation devise is designed to gently move the lower mandible forward.  Studies have shown positive results in at least a subset of patients. This device is custom made by a dentist who specializes in the treatment of sleep apnea.  Once fitted the device must be adjusted to eliminate as many apnea events as possible.
• Surgery
  • Tonsillectomy - In children the problem is most often large tonsils that meet in the mid-line and block the airway.  If this is the cause a tonsillectomy will most likely resolve the OSA.
  • Repositioning the jaw – when the problem is caused by a jaw that is set back too far. (the long term effect of this procedure is not known)
  • LAUP Surgery – removal or shortening of the uvula, removal of tonsils, and sometimes shortening of the soft palate.  This procedure may eliminate snoring without preventing OSA.
  • Tracheostomy – the creation of an opening in the lower part of the throat, below where the airway collapses.  This opening is plugged during the day so that normal speech is possible, and open during the night so that normal breathing is possible.
  • Straightening of the septum, Turbinectomy and/or UPPP - These procedures may diminish the number of OSA events but may not resolve the condition completely.   These procedures have been shown to be effective in the resolution of primary snoring. 

My doctor told me to avoid exacerbating factors.  What are these?

Exacerbating factors are events or activities that contribute to the severity of your sleep disordered breathing. Some of these events or activities are listed below.

• Weight:
  Excessive weight brought about by sedentary life style, too many rich foods, or by medically related situations such as retention of weight after delivering a child or thyroid problems are probably the leading factors contributing to Obstructive Sleep Apnea.  In a large percentage of patients weight loss, aided by exercise if medical conditions don’t contraindicate doing exercise, down to ideal weight has reversed the process.
• Smoking:
  Cigarette smoking causes swelling of the mucous membranes in the nose, swelling of tissue in the back of the throat, and blockage of small vessels in the lungs.
• Alcohol:
  Alcohol causes too great of a relaxation of the airway during sleep.
• Organization of sleep and wakefulness across the week:
  There is two periods of sleep which, given the right circumstances, are especially vulnerable to the development of sleep-disordered breathing.  These are Stage 1 sleep, which should only occur when a person is first falling asleep but which can occur many times during the night is sleep poor; and REM sleep, which is the time when dreams most frequently occur.
• If a person, for instance, goes to bed at 10pm and awakens at 5am each workday, but then waits until several hours later to go to sleep and wake up on non-work days, both stage 1 and REM behave oddly.  This problem with REM and stage 1 is also true if on some days of the week a person just does not get enough sleep, and then on other days of the week they try to make up for it by sleeping longer.
  
  To prevent this try to go to bed and get up at the same time every day of the week.

Other factor affecting quality of nighttime sleep that can lead to apnea:

1. a disruptive bed partner
2. a baby or child waking you up
3. daytime stress or aggravation
4. sleeping during the day
5. excessive use of caffeinated products
6. room too hot or cold
7. ambient light
8. use of medications that effect sleep
9. Medical Problems:

Anything that leads to the blockage of the nose, the throat, or the lung potentially play a role in the development of sleep disordered breathing such as:

1. allergies to airborne particles such as pet dander
2. dryness in the nose because of a wood burning stove or other heat in your home
3. deviated septum
4. large tonsils
5. large adenoids
6. excessive amounts of fatty tissue
7. enlargement of some of the complex tissues at the back of the throat
8. lung problems related to childhood asthma through emphysema
9. can be a symptom that results from hypothyroidism
10. can be a symptom that results from diabetes

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