Sleep Apnea & Airway Obstruction
What you should know about Sleep Disordered Breathing and Sleep Apnea
Obstructive Sleep Apnea (OSA) is a sleep breathing disorder caused by airway obstruction, when a person stops breathing while they sleep. The tissues in the throat collapse, narrowing the airway, despite one's efforts to breathe. Apnea is defined as "a cessation of airflow for 10 seconds or more." This can occur multiple times per hour, and up to hundreds of times an hour.
Commonly, a person with sleep apnea snores laboriously, and stops breathing while still sleeping. A sleeping partner would find that the person is straining to breathe but there is no snoring sound. These periods of interrupted and restricted breathing are followed by a gasping or choking. The person with sleep apnea will partially awaken in order to breathe, leading to fragmented, unrefreshed sleep which can be the cause of excessive daytime sleepiness.
The greater concern is that when the airway collapses and oxygen is suspended, the body goes into a fight-or-flight response, putting immense strain on the heart and increasing blood pressure. Over time, this can wear out the heart and lungs, and can lead to heart disease, diabetes, stroke, obesity, and several other co-morbidities.
Sleep Apnea Statistics
Public health and safety are threatened by the increasing prevalence of obstructive sleep apnea, which now afflicts at least 25 million adults in the US, according to the National Healthy Sleep Awareness Project. (AASM News Archive)
"Obstructive sleep apnea is destroying the health of millions of Americans, and the problem has only gotten worse over the past two decades", American Academy of Sleep Medicine President Dr. Timothy Morgenthaler.
Findings from new studies emphasize the negative effects of sleep apnea on the brain and heart health: however, these health risks can be reduced through the effective treatment of sleep apnea. (AASM News Archive).
A person afflicted with untreated obstructive sleep apnea is up to 4 times more likely to have a stroke, as well as 3 times more likely to have heart disease.
Approximately 50% of all patients who have hypertension, or high blood pressure, are also afflicted with obstructive sleep apnea.
People suffering from OSA are as much as 6 times more likely to be involved in a car crash than those without sleep disorders. This is due to the fact that they are drowsy from lack of sleep.
Who Is At Risk For Sleep Apnea?
Even though sleep apnea can affect anyone regardless of age, weight, and gender, these factors indicate a higher likelihood of having sleep apnea:
Mouth breathing: Sleeping with the mouth open is a sign that the nasal airway is obstructed. Nasal obstruction causes the jaw to drop, reducing the diameter of the pharyngeal airway and increasing the likelihood of obstructive sleep apnea. If you know a sleeping mouth breather, they may be suffering from obstructive sleep apnea.
Excess weight: Fat deposits around the neck and chin may obstruct your breathing. Keep in mind though, not everyone who has sleep apnea is overweight. Thin people suffer from OSA as well.
Neck size (circumference): People with large neck circumferences tend to have narrowed airways as a result. Men with a 17 inch neck size and women with a 16 inch neck size are at higher risk. Another risk factor is excess skin from the chin to the neck, often referred to as a turkey neck.
Family history: If you have family members who suffer from OSA or snoring, you may be at increased risk. There is a hereditary link associated with sleep apnea.
Use of alcohol or other sedatives: These substances cause the muscles in your throat to relax, exacerbating sleep breathing issues such as OSA.
Smoking: Smokers are three times more likely to suffer from OSA than their non-smoking counterparts. Smoking tends to cause inflammation and fluid retention in the airway, resulting in less space for air to pass through the airway.
Being a male: Men are projected to be twice as likely to have sleep apnea. This gap narrows as age increases. Once women reach menopause, the ratio is almost equal.
Age: OSA occurs significantly more often in adults that are older than 40.
A narrowed airway: You may have a naturally narrowed airway. This is more common in women than in men, and could be a strong indicator of sleep apnea in women.
Enlarged tonsils and/or adenoids: Your tonsils and/or adenoids may become enlarged, which lessens the amount of room for air to pass through your airway. In children, this is the most common cause of sleep apnea, in which removal is the most effective solution.
Jaw structure: A lower jaw that is undersized compared to the upper jaw.
What Are The Symptoms Of Sleep Apnea?
Often the person with sleep apnea is totally unaware of the problem and will often deny the fact that he / she snores, but the bed partner will observe:
Loud snoring followed by cessation of breathing
Gasping and choking during sleep
Excessive daytime sleepiness
More sleep apnea symptoms
Sleep Disorders Associated With Breathing
Determining if you have a sleep breathing disorder, or just snoring is as easy as consulting a health care provider who is trained in sleep disorders. Normally, the evaluation will begin with a screening questionnaire and from there an assessment will be made to conclude if a sleep study is necessary to determine what type of sleep disorder a person might be suffering from.
The three most common sleep breathing disorders are:
Obstructive Sleep Apnea (OSA) means the muscles and tissues in the airway collapse and block off the airway, preventing airflow. When the oxygen in the brain becomes low enough, the sleeper partially awakens, the obstruction in the throat clears and the flow of air starts again, usually with a loud gasp. Often treated with oral appliance therapy (OAT), PAP therapy, weight loss, or surgery.
Central Sleep Apnea (CSA) is when the brain temporarily stops sending signals to the muscles that control breathing. Typically this sleep breathing disorder affects people with certain neurological medical conditions. Symptoms of this disorder are similar to those of OSA, but treatment options are different. CPAP or BiPAP therapy are common therapy choices, in addition to treating the underlying medical condition. In some cases oxygen treatment at night is suggested to ensure the lungs get enough oxygen during sleep.
Upper Airway Resistance Syndrome (UARS) is usually thought of as severe snoring. There are times when the airway narrows so much that the muscles in the chest and diaphragm have to work really hard to pull air into the lungs. UARS is in the middle of snoring and sleep apnea. Normally when snoring gets worse, it becomes UARS, then untreated UARS can turn into OSA. It is thought that UARS is more common in young, thin people, and is most commonly treated with OAT.
Measuring Sleep Apnea
Sleep apnea is measured by the number of times you stopped or reduced breathing per hour. Together, these events are counted and known as the Apnea-Hypopnea Index (AHI).
A sleep study will measure your AHI as well as the drop in your blood-oxygen levels to help determine the severity of the disease. If you have obstructive sleep apnea, your sleep study results will indicate mild, moderate or severe sleep apnea.
Untreated Sleep Apnea Health Consequences
Obstructive sleep apnea causes hypertension, diabetes, high blood pressure and if left untreated, could reduce life expectancy by 10 years or more. With 95% of those suffering from obstructive sleep apnea undiagnosed, sleep apnea may be the number one cause of death.
If you or a loved one has several risk factors above, it is important to consult a health care provider trained in sleep disorders to be evaluated for obstructive sleep apnea.