Obstructive sleep apnea

2021-07-19 05:42 PM

Anyone can develop obstructive sleep apnea, although it usually affects old adults. Treatment for obstructive sleep apnea may involve using a device to keep the respiratory tract open. 

Define

Obstructive sleep apnea meaning:

Obstructive sleep apnea is a serious sleep disorder in which breathing repeatedly stops and then starts again during sleep. Several types of sleep apnea exist, but the most common type is obstructive sleep apnea. Obstructive sleep apnea occurs when the throat muscles repeatedly relax and block the airway during sleep. The most noticeable sign of obstructive sleep apnea is snoring, although not all snorers have obstructive sleep apnea.

Anyone can develop obstructive sleep apnea, although it usually affects old adults. It is also especially common in people who are overweight. Treatment for obstructive sleep apnea may involve using a device to keep the respiratory tract open or undergoing a procedure to remove tissue from the mouth, nose, or throat.

Obstructive sleep apnea

 

Symptoms

Excessive daytime sleepiness (hypersomnia).

Snoring.

Stop breathing during sleep.

Sudden awakening with difficulty breathing.

Waking up with a dry mouth or sore throat.

Morning headache.

Frequent urination at night.

Sleep loss.

Consult a medical professional if experiencing, or if others observe:

Snoring loud enough to disturb other people's sleep or sleep.

Shortness of breath awakens sleep.

Continuous pauses in breathing during sleep.

Excessive daytime sleepiness, possibly falling asleep while working, watching television, or even driving.

Many people don't think of snoring as a sign of something serious, and not everyone who snores has sleep apnea. Be sure to talk to your doctor if you experience snoring. With sleep apnea, snoring is usually loudest when sleeping on your back, and it is quiet when turned on your side.
 
Ask your doctor about any sleep problems, chronic fatigue, drowsiness, and irritability. Excessive daytime sleepiness (hypersomnia) can be caused by another disorder, such as narcolepsy.

Causes

Obstructive sleep apnea occurs when the muscles at the back of the throat relax too much and do not allow normal breathing. Structural support muscles include the palate, windpipe, tonsils, and tongue.

As the muscles relax, the respiratory tract narrows or closes when inhaling, and breathing may not be enough for 10-20 seconds. This can cause blood oxygen levels to be lower. The brain does not have the ability to command breathing and wakefulness so that the airway can be reopened. This usually wakes up briefly and doesn't remember it.
 
Shortness of breath can awaken briefly and correct it quickly, within one or two deep breaths, although this sequence is rare. There may be sniffing, choking, or gasping sounds. This pattern can repeat itself five to 30 times or more every hour all night. Disruptions reduce the ability to achieve restful sleep, and it is possible to feel drowsy during waking hours.

People with sleep apnea may not know their sleep is disrupted. In fact, many people with this type, think they sleep well all night.

Risk factors

Anyone can develop sleep apnea. However, certain risk factors are high:

Excess weight: More than half of people who hold their breath during congestion are overweight. The fat of the upper airway can interfere with breathing. However, not all people who have sleep apnea are overweight and on contrary. Skinny people can be on this developmental disorder.

Neck size: Neck size can indicate whether or not there is a risk of sleep apnea. Because a thick neck can capture breathing and can be a sign of excess weight. Neck circumference greater than 17 inches (43 cm) for men and 15 inches (38 cm) for women is associated with an increased risk of obstructive sleep apnea.

Hypertension: Obstructive sleep apnea is relatively common in people with high blood pressure.

Narrowing of the airways: This can be natural neck, or the tonsils can expand and block the airway.

Chronic stuffy nose: Sleep apnea is frequently present in subjects with nocturnal arrowheads and is twice as common in chronic nasal tips. This can cause airway regurgitation.

Urinary tract: Obstructive sleep apnea is three times more common in people with diabetes.

Male: Overall, men are twice as likely to have sleep apnea.

Black-skinned, Hispanic, or Pacific Islander: Among people under the age of 35, sleep apnea is more common among blacks, Hispanics, and Pacific Islanders.

Elders: Sleep apnea is 2-3 times more frequent in adults over 65 years of age.

Menopause period: Women are at increased risk of sleep apnea after menopause.

Family history: If there is a family member with sleep apnea, there may be an increased risk.

Use alcohol, sedatives: The quality relaxes the muscles in the throat.

Cigarette: Cigarette using is almost three times more likely to have sleep apnea during sleep.

Complications

Sleep apnea is considered a serious medical problem. Complications may include:

Cardiovascular problems: A sudden drop in blood oxygen levels occurs during sleep apnea hypertension and stress on the cardiovascular system. About half of people with sleep apnea have hypertension, which increases the risk of heart failure and stroke. The more severe the obstructive sleep apnea, the greater the risk of high blood pressure. Patients with sleep apnea are very likely to develop abnormal heart rhythms such as atrial fibrillation. If there is underlying heart disease, repeated low blood oxygen levels (hypoxia) can lead to sudden death from a cardiac event.

Daytime fatigue (Central vs obstructive sleep apnea): Repeated awakenings combined with sleep apnea make it impossible to restore normal sleep. People with sleep apnea often experience severe daytime sleepiness, fatigue, and irritability. They may have difficulty concentrating and find themselves falling asleep at work, watching TV, or even while driving.

Pediatric obstructive sleep apnea: Obstructive sleep apnea in children and adolescents with sleep apnea may perform poorly in school, impair mental development, or have behavioral problems. Treating sleep apnea can improve these symptoms, restore alertness, and improve quality of life.

Complications with medications and surgery: Obstructive sleep apnea is also a concern with some medications and general anesthetics. People with sleep apnea may be more likely to have complications after major surgery because they are more prone to shortness of breath, especially during anesthesia and lying on their backs. Before surgery, tell your doctor about sleep apnea. Undiagnosed sleep apnea is especially dangerous in this situation.

Insomnia partner: Snoring can make those around you not rest well and eventually break relationships.

People with obstructive sleep apnea also have memory problems, morning headaches, mood or emotional changes of depression, and the need to urinate frequently at night (nocturia).

Obstructive sleep apnea complications

 

Tests and diagnostics

Your doctor may perform an evaluation based on your signs and symptoms or may refer you to a sleep disorder center. A sleeping specialist can help to decide if further evaluation is needed. The evaluation may include monitoring of overnight breathing and other bodily functions during sleep. Tests to detect sleep apnea include:

Night sleep study: In this test, the device monitors the heart and lungs, and brain activity, breathing patterns, arm and leg movements, and blood oxygen levels during sleep. This can help your doctor point out other problems - such as recurring or narcolepsy - that can also cause excessive daytime sleepiness but need different treatment.

Oxygen measurement method: This involves the use of screening, a small machine that monitors and measures blood oxygen while you sleep. Wearing this is simple, fit, and painlessly on one finger for overnight crawling at home. If you have sleep apnea, the results of this test will usually decrease your blood oxygen level during sleep apnea and continue to increase upon awakening. If the results are abnormal, your doctor may order a night sleep study to confirm the diagnosis. Oximetry doesn't detect all cases of sleep apnea, so your doctor may still recommend a night sleep study even if your oximetry is normal.

Check cardiopulmonary changes: Under certain circumstances, your doctor may offer home tests to diagnose sleep apnea. These tests typically involve oximetry, gas flow measurement, and measurement of breath samples.

Your doctor may also refer you to an otolaryngologist to rule out any anatomical blockage in the nose or throat.

Treatments and drugs

With mild obstructive sleep apnea, your doctor may recommend lifestyle changes, such as losing weight or quitting smoking. If these measures do not improve signs and symptoms or if apnea is moderate to severe, several other treatments are available. Some devices can help open blocked airways. In other cases, surgery may be necessary.

Obstructive sleep apnea treatment

 

Treatments

Positive airway pressure If you have moderate to severe sleep apnea, you may benefit from a machine that delivers air pressure through a mask that is placed over your nose during sleep. The most common types are called continuous positive pressure ventilation, or CPAP (SEE-pap). With this treatment, the pressure of the breathing air is constant and somewhat greater than the surrounding air, just enough to keep the upper airway open. This prevents apnea and snoring.

While CPAP has always been successful and is most commonly used to treat sleep apnea, some people find it cumbersome and uncomfortable. Given that fact, most people learn to adjust the mask for a comfortable and secure fit. It may be necessary to try different types to find the right mask. If you have particular difficulty with pressure, there is a machine with a special adaptive pressure function to improve comfort. Some people also benefit from using a humidifier in conjunction with a CPAP system.

Do not stop using the CPAP machine if there is a problem. Check with your doctor to see what adjustments you can do to improve comfort. Also, contact your doctor if you still snore despite treatment. If the weight changes, the doctor may need to adjust the pressure setting.

Mouth placement device: Another option is to wear a speaker designed to keep the throat open. While airway pressure is almost always an effective treatment, oral appliances are a successful alternative for some patients. Some are designed to open the throat by bringing the jaw out, which can sometimes relieve snoring and obstructive sleep apnea. Others hold the tongue in a different position. If you decide to explore this option, it is important to see a dentist with experience in sleep medical devices and appropriate follow-up treatment.

Some devices are available from dentists: It may be necessary to try different devices before finding one. Because oral devices are not uniformly effective as CPAP, monitoring is necessary to ensure successful treatment of sleep apnea.

Surgery or other procedures

The purpose of surgery for sleep apnea is to remove excess tissue from the nose or throat that may vibrate and cause snoring, or maybe blocking the upper airway and causing sleep apnea. Surgical options may include:

Surgical removal of tissue: Uvulopalatopharyngoplasty (UPPP) is a procedure in which a doctor removes tissue from the back of the mouth and throat. The nasopharyngeal tonsils are usually removed. This surgery can be successful in stopping the throat structures from oscillating and causing snoring. UPPP is usually done in a hospital and requires anesthesia.

Jaw adjustment: In this procedure, the mandible is moved forward relative to the facial bone. This enlarges the space behind the tongue and roof of the mouth, making blockages less likely. This procedure may require an oral and maxillofacial surgeon, which can be combined with other procedures to improve the likelihood of success.

Open surgery in the neck: You may need this surgery if other treatments have failed and you have severe, life-threatening sleep apnea. In this procedure, called tracheostomy, the surgeon makes a hole in the neck and inserts a metal or plastic tube through to breathe, keep closed during the day, but at night allows air in and out of the lungs, bypassing the blocked place in the throat.

Implant: These procedures are a minimally invasive treatment that involves the placement of three small artificial rods in the roof of the mouth. Inserts and supports the tissues of the palate and reduces upper airway collapse and snoring. This treatment is recommended only for people with mild to moderate obstructive sleep apnea.

Removing tissue from the back of the throat with a laser (laser-assisted uvulopalatoplasty) or with radiofrequency energy are procedures that doctors sometimes use to treat snoring. However, these procedures should not be used to treat sleep apnea.

Types of surgery that can help reduce snoring and sleep apnea by removing obstructions or widening the airways:

Surgical removal of the nasal tumor or deviated nasal septum.

Surgery to remove enlarged tonsils or nasopharynx.

Lifestyle and remedies

In many cases, self-care can be the most appropriate way to treat sleep apnea. Try these tips:

Weight loss: Even a slight weight loss can help reduce airway dilation.

Avoid alcohol and sedatives such as sleeping pills: Relaxes the muscles at the back of the throat, interfering with breathing.

Sleeping on the side is better than lying on the back: Sleeping on the back can cause the tongue and roof of the mouth to stretch to the back of the throat and block the airway.

Open the nasal passages at night: If there is a blockage, use a saline spray to help keep the nasal passages open. Talk to your doctor about using a decongestant or antihistamine. Because, unlike saline sprays, these medications are generally recommended for only a short shelf life.