Obstructive Sleep Apnoea

Obstructive sleep apnoea is a condition wherein there are pauses in breathing and reduction of ventilation during sleep. This can be caused by narrowing, blockage or a floppy airway. Each apneic episode leads to a pause in breathing. A decrease in airflow during breathing is called a hypopnea episode. Almost everyone has brief apnoea episodes while they sleep.

A recent article from http://www.nytimes.com has described features of sleep apnoea among adults.

• Apnoea occurs when the muscles in their upper throat relax during sleep, their breathing can stop for a period of time (often more than 10 seconds).

• The snoring in people with obstructive sleep apnoea is caused by the air trying to squeeze through the narrowed or blocked airway. However, everyone who snores does not have sleep apnoea.

• Factors that may increase your risk include a lower jaw that is short compared to the upper jaw (retrognathia), certain shapes of the palate or airway that cause the airway to be narrower or collapse more easily, large neck or collar size (17 inches or more in men and 16 inches or more in women), large tongue, which may fall back and block the airway, obesity and large tonsils and adenoids in children that can block the airway.

• Sleeping on the back also increases sleep apnoea episodes.

• A person who has obstructive sleep apnoea often is not aware of the apnoea episodes during the night. Often, family members witness the periods of apnoea.

• A person with obstructive sleep apnoea usually begins snoring heavily soon after falling asleep. Often the snoring gets louder. The snoring is then interrupted by a long silent period during which there is no breathing. This is followed by a loud snort and gasp, as the person attempts to breathe. This pattern repeats.

• Excessive daytime sleepiness can make you wake up unrefreshed in the morning and feel sleepy or drowsy throughout the day.

• People with sleep apnoea may act grumpy, impatient, or irritable, be forgetful, fall asleep while working, reading, or watching tv, feel sleepy while driving, or even fall asleep while driving and have hard-to-treat headaches.

• Problems that may occur with this condition include depression that becomes worse, hyperactive behavior, especially in children and leg swelling (if severe).

• A sleep study (polysomnogram) is used to confirm obstructive sleep apnoea.

• Other tests that may be performed include arterial blood gases, electrocardiogram (ECG), echocardiogram and thyroid function studies.

• Avoiding alcohol or sedatives at bedtime, avoiding sleeping on the back may help with mild sleep apnoea and losing weight may decrease the number of apnoea spells during the night.

• Continuous positive airway pressure (CPAP) is now the first treatment for obstructive sleep apnoea in most people. CPAP is delivered by a machine with a tight-fitting face mask.

• Some patients may need dental devices inserted into the mouth at night to keep the jaw forward.

• Uvulopalatopharyngoplasty (UPPP) removes excess tissue at the back of the throat. This surgery has not been proven to completely clear up sleep apnoea. Long-term side effects are also possible.

• More invasive surgeries can correct problems with the face structures in rare cases when patients have severe sleep apnoea and treatment has not helped.

• Tracheostomy creates an opening in the windpipe to bypass the blocked airway if there are physical problems (rarely done).

• Surgery to remove the tonsils and adenoids often cures the condition in children. It does not seem to help most adults.

• With treatment, the symptoms and problems of sleep apnoea should be totally corrected.

• Untreated obstructive sleep apnoea may lead to or worsen heart disease, including heart arrhythmias, heart failure, high blood pressure and stroke.

Read more here:

http://www.nytimes.com/health/guides/disease/sleep-apnoea/overview.html?inline1=nyt-classifier

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