Obstructive Sleep Apnea (OSA)
Obstructive sleep apnea is a condition in which the flow of air pauses or decreases during breathing while you are asleep because the airway has
become narrowed, blocked, or floppy.
Untreated obstructive sleep apnea may lead to or worsen heart disease!
Causes, incidence, and risk factors: All of the muscles in your body become more relaxed during sleep. This includes the muscles that help keep the
airway open and allow air to flow into the lungs. Normally, the upper throat still remains open enough during sleep to let air pass by. However, some people have a narrower throat area. When the muscles in their upper throat relax during sleep, their breathing can stop for a period of time (often more than 10 seconds). This is called apnea.
The snoring in people with obstructive sleep apnea is caused by the air trying to squeeze through the narrowed or blocked airway. However, everyone who snores does not have sleep apnea. Other factors may also increase your risk for OSA. If you have heart disease, valvular heart disease or a cardiac arrhythmia, your physician will assess for these other factors at your next office visit.
Symptoms: A person who has obstructive sleep apnea often is not aware of the apnea episodes during the night. Often, family members witness the
periods of apnea. Many people wake up unrefreshed in the morning and feel sleepy or drowsy throughout the day. This is called excessive daytime
sleepiness (EDS). People with sleep apnea may act grumpy, impatient, or irritable. They may be forgetful or fall asleep while working, reading, or
watching TV. Some patients feel sleepy while driving, or even fall asleep while driving. Other patients may also have hard to treat headaches.
Signs and tests: The health care provider will perform a complete history and physical exam. This will involve carefully checking your mouth, neck, and throat. You may be given a survey that asks a series of questions about daytime sleepiness, sleep quality, and bedtime habits.
A sleep study (polysomnogram) is used to confirm obstructive sleep apnea.
Treatment: The goal is to keep the airway open so that breathing does not stop during sleep. The following lifestyle changes may relieve symptoms of
sleep apnea in some people:
• Avoiding alcohol or sedatives at bedtime, which can make symptoms worse
• Avoiding sleeping on the back may help with mild sleep apnea
• Losing weight may decrease the number of apnea spells during the night
Continuous positive airway pressure (CPAP) is now the first treatment for obstructive sleep apnea in most people. CPAP is delivered by a machine with a tight-fitting face mask. Many patients have a hard time sleeping with CPAP therapy. Good follow-up and support from a sleep center can often help overcome any problems in using CPAP. Surgery may be an option in some cases for those individuals where CPAP treatment is not effective. Surgery to remove the tonsils and adenoids often cures the condition in children. It does not seem to help most adults.
Expectations (prognosis): People with poorly treated sleep apnea often have an increase in anxiety and depression, a loss of interest in sex and poor performance at work or school. Because of daytime sleepiness, people with sleep apnea have an increased risk of motor vehicle accidents from driving while sleepy and industrial accidents from falling asleep on the job.
With treatment, the symptoms and problems of sleep apnea should be totally corrected. The benefits of correcting obstructive sleep apnea will
usually prevent progression of known cardiac disease processes known to be affected by sleep apnea.