What is Obstructive Sleep Apnea?

 

The most common type of Sleep Apnea is Obstructive Sleep Apnea (OSA). Patients suffering from OSA literally stop breathing during sleep, as their breathing airway is obstructed or blocked.  In fact, the word, “apnea” means “without breath.”  When the body is deprived of oxygen, it responds by gagging or gasping for air.  These gasping episodes, or "apneic events," can last anywhere from 10 - 60 seconds, interrupting the patient’s sleep, even though the patient may not fully “wake up.”

These constant arousals explain why OSA patients chronically feel so tired, even after a full night of sleep.  The exact prevalence of OSA is unknown, but most experts agree the prevalence of OSA is significantly under-diagnosed and untreated.  A recent study showed that:

  •  9% of women and 24% of men aged 30-60 years had apnea episodes of 5 or higher

  • OSA can occur at any age, but it is most commonly diagnosed in patients aged 45-65 year

  • In adults, the male-to-female ratio is approximately 2:1(1)

Based on current population data, over 24 million men and over  9 million women, age 30-60, have undiagnosed or untreated OSA.(2)  For older populations, 65 and older, the number of undiagnosed and untreated people with OSA can be as much as 3-4 times higher.(3)

To understand how one's breathing can be obstructed, compare a normal breathing airway and an obstructed airway during sleep.  
                      

NORMAL AIRWAY


With normal airway openings, notice that even though the patient is lying down:

 

There is still an open airway from the mouth and nose; and

 

All the way down the “trachea” or airway to the lungs.
 


OBSTRUCTED AIRWAY

 
In patients with Sleep Apnea, these portions of the airway is blocked by:
 
The palate or roof of the mouth sagging toward the back of the throat; and

The back of the tongue sagging or pressing against the back of the throat



Common Symptoms of Obstructive Sleep Apnea

  1. Snoring (the most common)

  2. Labored breathing while sleeping

  3. Episodes of gasping for air during the night

  4. Restless sleep and sleeping in unusual positions

  5. Chronic morning headaches

  6. Chronic fatigue, even after a full night's sleep

Diagnosing Obstructive Sleep Apnea

A diagnosis of OSA can only be confirmed by a Sleep Study, conducting by a qualified sleep specialist.  (For more information, see the section marked, "Sleep Study" in the navigation bar.) 


Treatments for Obstructive Sleep Apnea:   How to Keep the Airway Open During Sleep
 

Mild Obstructive Sleep Apnea

In mild cases, usually < 5 episodes of apnea per hour, the patient and his/her doctor may want to try
a simple dental device, which holds the tongue forward during sleep, creating an open airway.  Some dentists specialize in fitting these devices.

Moderate to Severe Obstructive Sleep Apnea

For moderate and severe cases,  > 5 episodes of apnea per hour, the most common treatment is Continuous Positive Airway Pressure, or CPAP.  A CPAP machine, as shown to the right, blows air through a tube and into a mask worn by the patient at night.   The amount of air pressure required to keep the airway open is determined by the sleep specialist during the Sleep Study.   

Effective CPAP treatment provides a comfortable mask with just enough pressure to keep the airway open, but not too much to make the patient uncomfortable.  Today's CPAP machines offer automatic adjustments for air pressure and over 35 different styles of masks.






Surgical Treatment for Obstructive Sleep Apnea

For some patients, the amount of obstructive tissue may be so significant, that surgical removal of the tissue is necessary.  There are a number of surgical options, including:

  1. Uvulopalatopharyngoplasty, or UPPP procedure, which enlarges the airway by removing or shortening the uvula and removing the tonsils and adenoids, as well as part of the soft palate or roof of the mouth

  2. Laser-assisted uvulopalatoplasty or LAUP, is a modification of the UPPP, where the surgeon cuts the uvula with a laser.

  3. Midline glossectomy and lingualplasty is a surgical procedure where part of the tongue is removed

  4. The most involved surgical procedure to enlarge the airway by moving the jaw forward are maxillomandibular osteotomy or advancement (MMO or MMA)

When making any decisions about surgery, patients should always get a second opinion and discuss consequences, both positive and negative, of each type of surgery. 

References
1. Young T; Palta M; Dempsey J; Skatrud J; Weber S; Badr S Department of Preventive Medicine, University of    Wisconsin School of Medicine, Madison. "The occurrence of sleep-disordered breathing among middle-aged adults,"
N Engl J Med, April 1993.

2. The World Fact Book. "Population Data of the United States." https://www.cia.gov/library/publications/the-world-factbook/print/us.html (2007).

3. Young T, Shahar E, Nieto FJ, et al. "Predictors of sleep-disordered breathing in community-dwelling adults: the Sleep Heart Health Study." Arch Intern Med. 2002;162:893-900.
 



Click to email any questions about sleep disorders or clinical trials
 



Click Here for the Latest
 Sleep in the Newzzz...Sleep in the Newzzz...Sleep in the Newzzz...