Managing obstructive sleep apnea

Sleep apnea is a serious sleep disorder where breathing repeatedly stops and starts during sleep. There are two main types of sleep apnea: 

1. Obstructive sleep apnea (OSA): This is the most common form, occurring when the throat muscles relax excessively, causing a blockage in the airway. This blockage reduces airflow, leading to a decrease in oxygen reaching the heart, brain and lungs. 
2. Central sleep apnea: Unlike OSA, central sleep apnea occurs when the brain fails to send proper signals to the muscles that control breathing. This can be due to conditions such as high-dose narcotic use, brain injury, strokes, or heart failure. 

This article focuses on OSA, the more common form. 

Prevalence and risk factors 

Approximately 39 million adults in the U.S. are affected by OSA. It occurs in about one-third of men and nearly 17% of women. The risk for women increases after menopause, aligning their risk with that of men as they age.

Several factors increase the likelihood of developing OSA:

• Older age
• Male gender (due to a higher neck circumference)
• Obesity
• Structural deformities of the head and neck
• Smoking (smokers have a three-times-higher incidence of OSA due to inflammation or associated co-morbidities)
• Family history of snoring or OSA
• Allergies (which contribute to nasal congestion and worsen symptoms)

Symptoms of obstructive sleep apnea

OSA disrupts sleep and leads to various symptoms, including:

• Daytime fatigue: Frequent night awakenings prevent restorative sleep, leading to daytime drowsiness
• Snoring: Loud snoring with intermittent pauses, often noticed by bed partners
• Gasping or choking: Waking up with the sensation of choking or gasping
• Insomnia: Particularly in women, OSA may present as insomnia with frequent awakenings.
• Cognitive issues: Long-term OSA can lead to memory problems, irritability and mood changes.
• Morning headaches: Frequent headaches in the morning

Why sleep apnea matters

Ignoring OSA can lead to significant health and quality of life issues:

• Increased risk of accidents: OSA-related daytime sleepiness raises the risk of motor vehicle accidents. Individuals with OSA are 2 to 3 times more likely to have motor vehicle accidents.
• Cardiovascular problems: Untreated OSA is linked to high blood pressure, atrial fibrillation, heart failure and stroke. People with atrial fibrillation are often referred for a sleep study before treating their arrhythmia.
• Metabolic issues: Conditions like diabetes, metabolic syndrome, fatty liver disease and gout can worsen with untreated OSA.
• Mental health: Anxiety, depression and other mood disorders are exacerbated by sleep disturbances.

Screening and diagnosis

The STOP-BANG Questionnaire is a common screening tool used for OSA. It includes questions about:

• Snoring
• Daytime tiredness
• Observed apneas
• High blood pressure
• Body mass index (BMI)
• Age
• Neck size
• Gender

A positive score of two or more indicates intermediate risk, while five or more suggest a high likelihood of OSA.

Once we suspect OSA, a home sleep study is sufficient for most people. This involves wearing a device that monitors breathing patterns, oxygen levels and heart rate. More complex cases may require an in-lab sleep study, which provides detailed data through additional monitoring, including brain activity (EEG).

Although most people with sleep apnea do snore, just because you snore doesn't mean you have sleep apnea.

If it's simple snoring, it's more of a nuisance than quality of life and medical problems. But if it's OSA, it is a medical issue and we have to so treat it. Screen for sleep apnea and treat sleep apnea.

Treatment of OSA

The most common treatment options for OSA include:

• Continuous positive airway pressure (CPAP): This is the primary treatment for moderate-to-severe OSA. It involves wearing a mask connected to a machine that delivers air to keep the airway open. Although adjusting to CPAP can be challenging initially, most users find significant relief once accustomed to the device.
• Positional therapy: For those with OSA primarily when sleeping on their back, a positional belt can help encourage side-sleeping.
• Mandibular advancement devices: These oral appliances move the lower jaw forward to keep the airway open and are often used for mild OSA.
• Inspire® therapy: This is a surgical option for severe cases that do not respond to other treatments. It involves implanting a device that stimulates the muscles of the throat to prevent airway collapse.

OSA and weight

Weight loss can be a highly effective treatment for OSA. Studies suggest that 50% of individuals with sleep apnea may see significant improvement or resolution of their symptoms with weight loss alone. Regular follow-up with a sleep specialist is crucial, especially during the initial treatment phase and at least annually thereafter.

Conclusion

Managing sleep apnea is essential for overall health and quality of life. If you suspect you have sleep apnea or are experiencing symptoms, consult with a specialist to discuss screening and treatment options.