1st Revision: Nabil Jawlakh Sleep apnea is a problem that affects a person breathing during sleep. A person with sleep apnea often experiences breathing difficulties, which means airflow cannot pass through to the lungs due to an obstruction caused by a collapse of tissue in the back of the throat.
Overview
Sleep Apnea is a serious condition and can be life-threatening. Apnea is a Greek word that means (Want of breath). It is described and characterized as a short interruption of breathing during sleep.
there are two types of apnea; central sleep apnea and obstructive sleep apnea.
Central sleep apnea is less common and affects the brain and the brain fails to send the right signal to the respiratory muscles to initiate breathing. Obstructive sleep apnea is more common and happens when the air cannot enter the airflow or out of the mouth or nose of the person.
During sleep, a number of breathing pauses or what is medically called (apneic events) occur in one night on an average of 20 to 30 per hour. Mostly, those events are associated with disruptive snoring and choking sensations. Disruptive sleep and frequent interruption can lead to morning headaches and excessive sleepiness. It is highly important to treat sleep apnea at an early stage as It is going to be associated with irregular heartbeat, blood pressure and heart attack.
Types of sleep apnea
Apnea is categorised as obstructive and central sleep apnea and both result in a reduction in airflow to upper airway muscles regardless of the differences in their mechanism.
Obstructive sleep apnea OSA happens when the upper airway is obstructed completely due to absence of airflow or the tongue falling backwards which prevenst the respiratory muscles from pumping the air.
Central sleep apnea occurs when there is a reduction in the generation of breathing rhythm when the brain fails to send proper signals to the targeted respiratory muscles, it is more common in adults with heart failure conditions.
Stages of sleep apnea
- Sleep apnea is characterised by the stop of breathing for 10 seconds or longer and can be mild, moderate and severe
Mild Sleep Apnea: it is described as 5 to 14 events of apnea per hour, meaning that the airflow to the lungs is reduced. Symptoms may include drowsiness or falling asleep during normal activities and may affect the quality of life and may cause problems at work - Moderated Sleep Apnea: when patients have moderate sleep apnea they experience 15 to 29 episodes of apnea per hour. Symptoms include drowsiness, and falling asleep while doing activities that require a degree of attention which potentially causes problems at work or social communication
- Severe Sleep Apnea: Severe apnea causes 30 or more episodes of apnea or reduced breathing per hour. Patient with severe apnea shows symptoms of drowsiness or falling asleep during regular activities such as eating or talking
Causes of sleep apnea
Anything that causes airway obstruction can lead to sleep apnea. The potential etiological risk factors include:
- Respiratory control instability
- Obesity
- Upper airway dysfunction
The downstream consequences of sleep apnea include:
- Increased sympathetic nerve activity
- Metabolic dysregulation
- Inflammation
- Oxidative stress
- Vascular endothelial dysfunction
- Intermittent hypoxia
These mechanistic pathways are crucial in developing coronary heart disease, hypertension and atrial fibrillation and potentially end-stage cardiovascular disease.
Signs and symptoms of sleep apnea
Symptoms can include:
- Daytime sleepiness
- Cognitive impairment
- Fatigue
- Insomnia
- Loud snoring
- Mood disorder
- Sleep events or episodes during normal activities
- Gasping for air while sleeping and wake up or chocking
Management and treatment for sleep apnea
Sleep apnea can be managed either surgically or non-surgically. The risk factors identified by the history and physical examination and the severity of patients’ situation; all must be taken into consideration when planning for treatment of sleep apnea. Since obesity is a risk factor, a weight loss plan might reduce the symptoms of sleep apnea.
Non-surgical treatment:
1- Continuous positive airway pressure: this is a standard treatment for patients with moderate to severe apnea where steady pressurized air is introduced to the patient through a mask.
2- Oral appliances
Oral or dental appliances may be a good treatment for patients with mild to severe apnea which keeps the airflow open and prevent pauses in breathing.
Surgical treatment:
The surgical solution is used to increase the size of the airway, although they are not totally successful. Some of the procedures include the removal of adenoids and tonsils, nasal polyps or any other growth or tissue that block the airway.
Diagnosis of sleep apnea
In addition to signs and symptoms, a diagnostic approach must be considered.
- Clinical history: It includes clinical observation of sleeping gasping for breath, morning headache, loud snoring, excessive daytime sleepiness and neck circumference of greater than 16 inches
- Physical examination: In addition to large neck circumference, posterior chin position (retrognathia), reduced distance and increased angles from the chin to the thyroid cartilage are examined as well
- Polysomnography: Sleep studies can be done in sleep clinics can quantify the apnea-hypopnea index which helps in the diagnosis.
FAQs
How common is sleep apnea
Sleep apnea can occur in all age groups and sex especially men, and can be underdiagnosed in women.
What are the risks factors of sleep apnea
People with high blood pressure, or have physical abnormalities in the nose, throat or other part of the upper airway. In addition to obese people.
How can sleep apnea be prevented
For mild conditions changes in lifestyle can be recommended like losing weight if overweight, exercising regularly, limiting alcohol consumption and quitting smoking.
When should I see a doctor
When you experience symptoms like gasping for breath during sleep, snorting and making choking noises while asleep and feeling very tired during the day.
Summary
Sleep apnea is a condition characterized by repetitive episodes of airflow cessation that result in brief choking or gasping for air and hypoxia. Sleep apnea is a serious condition that can cause high morbidity. Patients and physicians must be aware of the symptoms so that diagnosis and treatment can be addressed at an appropriate time. Sleep apnea can be obstructive apnea or central sleep apnea and downstream consequences might occur if not treated on time, like high blood pressure or heart problem, metabolic syndrome, fatigue, stroke, depression and anxiety.
References
- Javaheri S, Barbe F, Campos-Rodriguez F, Dempsey JA, Khayat R, Javaheri S, et al. Sleep apnea. Journal of the American College of Cardiology [Internet]. 2017 Feb [cited 2023 Mar 31];69(7):841–58. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0735109717300098
- [cited 2023 Apr 2]. Available from: https://www.lancastergeneralhealth.org/healthwise-library/healthwise-article?documentId=td1135
- Arnold J, Sunilkumar M, Krishna V, Yoganand SP, Kumar MS, Shanmugapriyan D. Obstructive sleep apnea. J Pharm Bioallied Sci [Internet]. 2017 Nov [cited 2023 Apr 3];9(Suppl 1):S26–8. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5731026
- Semelka M, Wilson J, Floyd R. Diagnosis and treatment of obstructive sleep apnea in adults. afp [Internet]. 2016 Sep 1 [cited 2023 Apr 3];94(5):355–60. Available from: https://www.aafp.org/pubs/afp/issues/2016/0901/p355.html
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