Obstructive Sleep Apnea

Last updated: May 20, 2019

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The information on this website is not intended to replace a one-on-one relationship with a qualified health care professional and is not intended as medical advice. Read our full medical disclaimer.

Obstructive Sleep Apnea (OSA) is also referred to as Obstructive Sleep Apnea-hypopnea. It is a sleep disorder characterized by the cessation or significant decrease in airflow while a person sleeps. This is a common type of sleep-disordered breathing. Those who suffer from OSA often experience recurrent episodes of upper airway collapse during sleep. These episodes are commonly associated with persistent oxyhemoglobin desaturation and arousals from sleep.

What is Obstructive Sleep Apnea?

OSA is a potentially serious sleep disorder. Among the different types of sleep apnea, Obstructive Sleep Apnea is the most common. OSA occurs when a person’s throat muscles relax and block the airway during sleep. A person with OSA repeatedly stops breathing for 10 seconds or more during sleep. As a result, the oxygen level in the blood decreases and awakens the sleeper. A common sign of OSA is snoring. This is why snoring should not be taken for granted.

What causes OSA?

Obstructive Sleep Apnea in Adults

The most common cause of obstructive sleep apnea among adults is an excess in weight or obesity. These conditions are associated with the soft tissues of the mouth and throat. While a person sleeps, his throat and tongue muscles are more relaxed. A relaxed soft tissue can block a person’s airway. However, there are other factors that can cause this sleep disorder in adults.

Aside from obesity, there are hereditary anatomical features associated with obstructive sleep apnea. These include a narrow throat, a thick neck, and a rounded head.

Hypothyroidism is another medical condition that can lead to OSA. Obstructive Sleep Apnea and Hypothyroidism have the same symptoms. This makes telling these two disorders apart difficult.  Hypothyroidism can cause a decrease in the ability to respond to chemical changes within the blood. It can also result in damage to the nerves or muscles used in breathing. Another way that hypothyroidism can contribute to OSA is through macroglossia. Macroglossia is the enlargement of the tongue. An enlarged tongue can make it more difficult to breathe. Hypothyroidism can result in the disruption of the muscles responsible for controlling the upper airway. Obesity is also common for patients with hypothyroidism. Obstructive sleep apnea is common for people who are obese or overweight.

Obstructive Sleep Apnea in Children

Although adults are more at risk with obstructive sleep apnea, children can also have this disorder. The most common causes of OSA in children are enlarged tonsils or adenoids. They can block the airway and cause OSA. Dental conditions such as a large overbite can also cause OSA.

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There are also other less common causes of OSA in children. A growth or a tumor in the airway can cause OSA. Some birth defects can lead to obstructive sleep apnea. These include Down syndrome and Pierre-Robin syndrome. When a child has Down Syndrome there is an enlargement of the tongue, adenoids, and tonsils. There is also a decrease in the muscle tone in the upper airway. Pierre-Robin Syndrome results in a smaller jaw. As a result, the tongue tends to ball up and fall back towards the back of the throat. Obesity can also lead to OSA in children. However, obesity in children is less commonly associated with OSA than adult obesity.

What are the symptoms of Obstructive Sleep Apnea?

Signs and symptoms of obstructive sleep apnea in adults include:

  • Excessive Daytime Sleepiness. This is a result of the abnormal sleep quantity or sleep quality that a person with OSA got from the night before. Those who suffer from OSA often involuntarily wake up during the night when their breathing stops. As a result, that person doesn’t feel refreshed or well-rested.
  • Dry mouth or sore throat. People suffering from obstructive sleep apnea often complain of a dry mouth or sore throat upon awakening. This is a result of an increased time spent with an open mouth while sleeping. Although chronic snorers also complain of a dry mouth upon awakening, the prevalence of dry mouth upon awakening is higher in patients with OSA than that of chronic snorers.
  • Morning headaches. When a person suffers from obstructive sleep apnea, his airway is partially or completely blocked while he sleeps. Due to this blockage, the amount of oxygen transported to the brain is reduced. This results in morning headaches.
  • Night sweats. The prevalence of nocturnal sweating or night sweats is threefold higher in people with OSA. This is due to the narrowing of the airway which restricts breathing.
  • Restlessness during sleep. A person with OSA often experiences restlessness during the night. This is a result of the body reorienting itself in order to get more air.
  • Choking or gasping for air. People with OSA may wake up abruptly choking or gasping for air. This is a response to the body’s tendency to stop breathing because of OSA.
  • Problems with sex

In most cases it is the person’s sleeping partner who discovers or first observes these symptoms.

In children, symptoms of obstructive sleep apnea may not be as obvious. Signs and symptoms include:

  • Bedwetting
  • Choking or drooling
  • Night sweats
  • Learning or behavioral disorders
  • Inward movement of the rib cage while breathing
  • Daytime sleepiness or sluggishness
  • Snoring
  • Teeth grinding
  • Restlessness in bed
  • Pauses in breathing

What is the difference between snoring and OSA-snoring?

Snoring is an annoying sleep disorder and is often harmless. In some cases, though, snoring may be a result of obstructive sleep apnea. How can someone tell the difference? There are signs that can help determine if a person’s snoring is just a result of noisy breathing and if it is a symptom of OSA.

  • Volume. Low and light sighs are nothing to worry about. If a person’s snoring is deeper and louder, it may be indicative of OSA. Snoring because of OSA is also accompanied by audible snorts. The louder the snoring is, the greater the chance that it is associated with OSA.
  • Consistency. Snoring occasionally is normal for most people. It is common for a person to snore if that person has a cold or nasal congestion. If a person snores because of OSA, that person will snore almost every night.

How is Obstructive Sleep Apnea Diagnosed?

Obstructive Sleep Apnea is diagnosed through a series of tests and physical examinations. A doctor will examine the back of the throat, mouth, and nose. This is a way for the doctor to check for extra tissues or abnormalities. A doctor might also measure the neck and waist circumference. The doctor might also check the patient’s blood pressure.

Aside from a physical examination, there are tests that a sleep specialist can conduct to detect obstructive sleep apnea. These include:

Polysomnography

This is a sleep study where the patient is hooked up to a piece of equipment that monitors the activities of the heart, lungs, and brain. It also measures breathing patterns, arm and leg movements, and blood oxygen levels while the patient sleeps. This is often done overnight so that the sleep specialist can observe the patient for a full night.

A sleep specialist can also opt to conduct a split-night study. During a split-night sleep study, the patient is monitored during the first half of the night. If the patient gets diagnosed with OSA during the first half of the night, the sleep specialist will wake the patient. The patient is then given continuous positive air pressure for the remainder of the night.

This kind of test accomplishes two things. First is, it helps the doctor determine if the patient has obstructive sleep apnea. The second thing it does is help the doctor determine if any adjustment needs to be done in the positive airway pressure therapy. A sleep study like this can also help the doctor rule out other sleep disorders with similar symptoms.

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Home sleep apnea testing. A doctor may provide a patient with an in-home version of polysomnography. This is done only under special circumstances. This allows the patient to measure his own airflow, breathing patterns, and blood oxygen levels. It is also possible to use this test to measure limb movements and snoring intensity.

How is obstructive sleep apnea treated?

Non-medical treatment can be prescribed to those who have mild cases of obstructive sleep apnea. It can include lifestyle changes like:

  • Regular exercises
  • Losing weight
  • Quitting smoking
  • Change in sleeping position
  • Reduction in alcohol consumption.

Taking nasal decongestants or antihistamines might also be recommended if OSA is caused by allergic reactions.

Positive Airway Pressure

This is a treatment where a machine delivers air pressure.  A piece gets fitted into the nose or placed over the mouth and nose of the patient while the patient sleeps. This piece delivers air pressure to the patient. The use of positive pressure leads to a reduction of respiratory events that occur while the patient sleeps. This reduces daytime sleepiness and improves the quality of sleep.

The most common type of machine used in this kind of therapy is a Continuous Positive Pressure Airway Pressure or CPAP. In this therapy, the pressure of the air that the patient breathes is continuous and constant. The air pressure is also greater than that of the surrounding air. This makes it enough to keep the upper airway passages of the patient open while he sleeps. This therapy is used not just in obstructive sleep apnea but also with chronic snoring.

Oral Devices

Mouthpieces or oral devices are alternative treatments for those who suffer from mild to moderate obstructive sleep apnea. These are devices that can help a patient keep his throat open while he sleeps. There are also devices that can keep the airway open by bringing the jaw forward. The patient needs to see a dentist who has experience in dental sleep medicine appliances so he can be fitted. It is also the dentist who will recommend a follow-up therapy if needed.

Surgical Procedures

Some patients need to undergo surgery to relieve obstructive sleep apnea. This is recommended only if other therapies are ineffective. Surgical options include:

  • Tissue removal. Uvulopalatopharyngoplasty (UPPP) is a surgical procedure wherein the doctor removes tissue from the back of the mouth or from the top of the throat. If needed, the tonsils and adenoids might get removed through surgical means.
  • Upper airway stimulation. This is a new device for those who suffer from moderate to severe obstructive sleep apnea. This is only for patients who can’t tolerate CPAP. In this procedure a small, thin impulse generator gets implanted under the skin in the upper chest. The said device detects the patient’s breathing patterns. It can also stimulate the nerve that controls the movement of the tongue if needed.
  • Jaw surgery. This is a procedure called maxillomandibular advancement. In this procedure, the upper and lower parts of the jaw get moved forward from the rest of the facial bones. This results in the enlargement of the space between the tongue and soft palate. As a result, obstructions in the upper airway become less likely.
  • A surgical opening in the neck. This is a procedure recommended only if all other treatments have failed. This procedure, called a tracheostomy, is only an option if the patient has life-threatening obstructive sleep apnea. In this procedure an opening is made in the neck. A metal or plastic tube is then inserted. It is through this tube that a patient breathes. Through this tube, air passes in and out of the lungs without having to go through the blocked air passage in the throat.
  • Implants. This is a procedure for patients who suffer from mild obstructive sleep apnea. In this procedure three tiny polyester rods get placed in the soft palate. These polyester rods stiffen and provide support to the tissue of the soft palate. As a result, it reduces the collapse of the upper airway. It can also help prevent snoring.
  • Air passages clearing. These are minor surgeries. The aim of these surgeries is to reduce snoring and sleep apnea. Nasal surgery is conducted to remove polyps. It can also be sued to straighten a deviated septum or the partition between the nostrils.
  • There are also minor surgeries that can remove enlarged tonsils or adenoids.

Obstructive sleep apnea is not just snoring. Snoring is just a symptom. Unlike snoring, OSA can be life-threatening. This is why it is important to seek medical opinion if snoring becomes chronic and other signs of OSA are present.

Additional Resources:

The information on this website is not intended to replace a one-on-one relationship with a qualified health care professional and is not intended as medical advice. Read our full medical disclaimer.

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