What is Sleep Apnea?
Obstructive sleep apnea syndrome (OSA) is characterized by repeated cessation or reduction of airflow while sleeping. This is caused by collapse of the upper airway structures, most commonly the tongue base, soft palate or upper throat. Symptoms of obstructive sleep apnea include daytime fatigue and sleepiness, poor concentration, morning headaches and many others. Sleep apnea can cause many health problems and may increase your risk of chronic cardiovascular and respiratory disease such as hypertension (high blood pressure), heart disease and stroke.
The following will help you understand how sleep apnea is diagnosed and treated. CPAP therapy and sugical treatmetn options are discussed.
How common is obstructive sleep apnea?
Sleep disorders are on a spectrum, with snoring on one end and sleep apnea on the other. Partial airway obstruction causes snoring, which has no adverse health consequences. Snoring occurs in 40% of men and 20% of women in the US. Sleep apnea is complete airway obstruction and occurs in 2% of women 4% of men. Obesity (especially around abdomen) increases your risk of having sleep apnea.
How is obstructive sleep apnea diagnosed?
Sleep apnea is suspected based on abnormal sleep patterns like heroic and loud snoring, restless and disturbed sleep, observed gasping or apnea during sleep, and nighttime sweating.
Daytime signs and symptoms of sleep apnea include excessive daytime sleepiness, cognitive impairment and morning headaches. The Epworth Sleepiness Scale is useful tool to assess a patients at risk for sleep apnea.
Your doctor will perform a complete physical exam, including inspected of your head and neck. Those with a large neck size (men over 17 inches and women over 16 inches), narrow throat, large tongue or enlarged tonsils can be at risk.
A sleep study, also known as polysomography, is the gold standard for diagnosing obstructive sleep apnea. It can be performed overnight in a sleep lab or can be performed at home. Sleep studies provide detailed information regarding many aspects of sleep quality and architecture. It allows stratification of sleep apnea into mild, moderate or severe OSA.
Overnight oximetry can be used as a screening test. However, it is limited in usefulness and if OSA is suspected on this test, a formal overnight sleep study is required to confirm diagnosis and to assess severity.
What are treatment options for OSA?
Treatment must be individualized based on symptoms and OSA severity. Someone with mild OSA and no symptoms may not require treatment. However, those with moderate and severe obstructive sleep apnea are at increased risk of mortality or death. All patients with moderate or severe sleep apnea should be treated regardless of symptoms.
Weight loss is critical to sleep apnea treatment. It is thought that most patients have a “set weight” above which will trigger sleep apnea. Even modest weight loss of 15 to 20 pounds can have a profound effect.
Other behavioral changes that can beneficial: avoid alcohol and sedating medication; eliminate tobacco and caffeine.
Nonsurgical treatment of obstructive sleep apnea
- CPAP therapy is the most common and effective non-surgical therapy. It is considered first-line therapy and relieves symptoms and improves morbidity associated with obstructive sleep apnea. Continuous positive airway pressure is delivered by nasal or facial mask and prevents airway collapse that causes sleep apnea. This is appropriate treatment for all forms and severity of obstructive sleep apnea. The CPAP is titrated in a sleep lab once the diagnosis of OSA has been made. This can sometimes be performed the same night as the sleep study. The technicians at Southwest Sleep Center are highly skilled in fitting CPAP and ensuring proper fitting. Patient education and follow-up are critical to patient compliance for CPAP. Tolerance to wearing the mask is the most significant limitation to CPAP therapy.
- Oral appliances devices are inserted into the mouth at night for advancing the tongue and/or lower jaw to help relieve obstruction. This requires fitting by a specialized dentist. It can be most useful in those with mild or moderate sleep apnea who are intolerant of CPAP therapy.
Surgical treatment for obstructive sleep apnea syndrome is sometimes appropriate for patients with sleep apnea, especially if a patient has failed CPAP therapy and cannot tolerate the mask. Surgery has limitations with varying success rates and often will not cure the patient’s sleep apnea. It is considered successful if it reduces the sleep apnea severity to mild or by 50%. Multiple staged surgeries addressing different levels of the airway may be required.
- Nasal surgery. It is believed that nasal obstruction in of itself does not cause obstructive sleep apnea. Nasal obstruction, however, can increase the severity of the obstruction or can impair one’s ability to tolerate CPAP. Nasal septoplasty is a common procedure to improve nasal CPAP tolerance.
- Palate and/or tonsil surgery. UPPP (uvulopalatoplasty) is the most common palate surgery for OSA. Ideal candidates are those with palate airway collapse and less severe apnea. Success rates vary from 44-65%.
- Other sleep apnea surgery options include tongue-base reduction procedures, maxillomandibular procedures, mandibular osteotomy with genioglossus advancement, hyoid myotomy and suspension, maxillomandibular osteotomy and advancement, and tracheotomy
I’m concerned about sleep apnea, what do I do next?
If you are concerned that you or a loved one is suffering from obstructive sleep apnea, please consult with our board-certified physician of sleep medicine at Southwestern Sleep Center. You may also consult with one of our otolaryngologist at Southwestern Ear, Nose &Throat Associates.