Sleep Apnea - July 27, 2010 Newsletter

Sleep Apnea

EHE Newsletter, Volume 10, Number 30
July 27, 2010

It is estimated that over 18 million Americans have sleep apnea — a disorder that affects an individual’s breathing during sleep. It is usually a chronic condition that disrupts sleep three or more nights each week, resulting in insufficient sleep and excessive daytime sleepiness. Such poor quality of sleep is associated with the onset of a number of chronic diseases and conditions including diabetes, cardiovascular disease, obesity and depression.

What is Sleep Apnea?

An apnea is clinically defined among adults as a cessation of breath that lasts for at least ten seconds; among children, it is defined as a cessation of breath that lasts for the equivalent of two–and–a–half missed breaths. There are several types of sleep apnea, but the most common is obstructive sleep apnea (OSA). OSA occurs when the throat muscles intermittently relax and block the airway during sleep. This obstruction causes pauses in breathing or shallow breaths that lead to loud snoring and a drop in blood oxygen levels. The brain responds to the lack of oxygen by alerting the body, causing a brief arousal from sleep — in which the individual often makes a loud ‘snort’ or choking sound — that restores normal breathing. Breathing pauses last from a few seconds to minutes, and can occur between 5 and 30 times or more per hour.

The result of this interrupted breathing pattern is severely disrupted sleep. Surprisingly, despite these frequent interruptions, most individuals with OSA have no recollection of being awakened. In many cases, the only evidence of this serious condition is excessive daytime fatigue and reports of loud snoring from bed partners or family members.

Risk Factors

Anyone can develop obstructive sleep apnea, although it most commonly affects older adults. Risk factors for sleep apnea include:

  • Being overweight. More than half of those with sleep apnea are overweight. This may be because excessive weight increases the amount of tissue in the throat and, thus, makes airway obstruction more likely.
  • Being male. In general, men are more likely to have sleep apnea. An estimated 24 percent of adult men and 9 percent of adult women suffer from sleep apnea.
  • Being aged 65 and older. Sleep apnea occurs two to three times more often among adults older than 65.
  • Being a post–menopausal woman. After menopause, a woman’s risk appears to increase.
  • Being of Hispanic, African–American or Pacific Island descent. Among individuals under age 35, OSA is more common in these ethnic groups.
  • Having a family history of sleep apnea. Individuals with a family history of sleep apnea may be at increased risk.
  • Having Diabetes. OSA is three times more common in people who have diabetes.
  • Having a large neck circumference. A neck circumference greater than 17 inches for men and 15 inches for women is associated with an increased risk of obstructive sleep apnea.
  • Being a smoker. Smokers are nearly three times more likely to have OSA.
  • Having high blood pressure. Sleep apnea is relatively common among individuals with high blood pressure.
  • Alcohol Use. Alcohol relaxes the muscles in the throat and may be associated with sleep apnea.
  • Having small airways.
  • Having enlarged tonsils.

The consequences of sleep apnea range from irritating to life–threatening. The combination of fitful sleep and reduced oxygen caused by OSA may lead to hypertension, heart disease, mood and memory problems and an increased risk of motor vehicle accidents. In a new study reported in Circulation: Journal of the American Heart Association, researchers found that, after adjusting for known heart disease risk factors, men between the ages of 40 and 70 who have severe sleep apnea are 68 percent more likely to develop heart disease and 58 percent more likely to develop heart failure than those without the condition.

Symptoms

The main symptoms of OSA are loud snoring and excessive daytime sleepiness. Other symptoms may include one or more of the following:

  • Restlessness during sleep
  • Sudden awakening with choking or gasping
  • Morning headaches
  • Dry mouth or sore throat upon awakening
  • Trouble concentrating, forgetfulness or irritability
  • Night sweats
  • Sexual dysfunction
  • Waking frequently to urinate
  • Anxiety or depression

Some individuals, however, may not have symptoms. Additionally, since fatigue has many causes and is often attributed to overwork and/or increasing age, a person may be slow to recognize that he or she has a problem. It is often the bed partner of an individual who snores loudly that prompts him or her to seek medical care. Diagnosis is based on a combination of an individual’s medical and family history, a physical exam and results from sleep studies.

Treatment

OSA can be very serious. An individual’s quality of life can greatly be improved, however, if he or she follows an effective treatment plan. Treatment for OSA depends on the cause of the obstruction, the severity of the apnea, individual preference and consideration of other medical problems that the person may have.

For mild to moderate sleep apnea, one of the following behavioral changes or treatments may be recommended:

  • Lose weight: Individuals who are overweight or obese should lose weight. Even a little weight loss can improve symptoms.
  • Change sleep position: Individuals should not sleep on their backs. Individuals should sleep on their sides instead of their backs in order to help keep the airways and throat open.
  • Avoid alcohol and other sedatives: Alcohol and sedatives may worsen sleep apnea by further relaxing the airway muscles.
  • Stop smoking: Smoking can increase the swelling in the upper airway which may worsen both snoring and apnea.
  • Use a dental or oral device: Also called "oral appliances" or "mandibular repositioning devices," these devices adjust the lower jaw and tongue to make the airway larger and improve airflow. They also decrease the chance that tissue will collapse and narrow the airway when the individual breathes in.

For moderate to severe cases of OSA, the Continuous Positive Airway Pressure (CPAP) device is almost always the first line of treatment recommended by healthcare professionals. During sleep, the CPAP keeps the airway open by sending a constant, low–pressure stream of air through the nose and into the airway.

Bi–level Positive Airway Pressure therapy delivers different air pressures during inhalation and exhalation which improve comfort and tolerance for some individuals over the CPAP device. Other treatment options include surgical procedures that widen the airway so that it is less likely to close during sleep. Surgery can be risky, however, and doctors do not generally recommend it unless a blockage can be fixed easily.

Individuals who suspect that they may have OSA should consult a healthcare professional. Sufficient sleep is not a luxury; it is a necessary and vital component of a healthy life.

MEDICAL DISCLAIMER: The information is not intended to constitute medical advice and is not a substitute for consultation with a physician or other healthcare provider. Individuals with specific complaints should seek immediate consultation from their personal physicians.