Sleep Apnea

Apnea means cessation of breathing, or not breathing. Sleep apnea refers to repeated episodes of apnea that result from either transient obstruction of the upper respiratory passages (obstructive sleep apnea) or lack of effort to breathe (central apnea).

Obstructive Sleep Apnea Syndrome (OSAS) is the most frequent condition seen in sleep centers. It is estimated that at least four percent of men and two percent of women in America have symptomatic obstructive apnea and feel poorly as a result of the sleep disruption it causes. Not only are affected persons tired, sleepy and fatigued, but a strong statistical association exists between sleep apnea and cardiovascular problems like high blood pressure, heart failure and strokes. While most persons with OSAS are overweight, a significant minority is not. A particularly disturbing association is the propensity for automobile accidents in persons with OSAS.

The Warning Signs of Sleep Apnea

• Habitual loud snoring
• Propensity to fall asleep at inappropriate times, regardless of the duration of the preceding sleep (at times tiredness and fatigue are more prominent than sleepiness)
• Observed pauses in breathing (snoring interrupted by quiet episodes during which the person seems to be trying to suck in air unsuccessfully)
• Frequent nocturnal urination
• Problems with memory and concentration
• For children: restless sleep, loud snoring and possible hyperactivity

The Causes of Sleep Apnea

• In children, enlargement of the tonsils and adenoids is the most common cause of OSAS.
• Obesity is at least a contributory factor in some children and most adults.
• A narrow upper airway associated with certain facial features like a small mandible (jaw) can cause OSAS.

Comfirming Sleep Apnea
Polysomnography is the test that objectively confirms the presence of sleep apnea. Polysomnography has been conventionally performed in the Sleep Laboratory; however, ambulatory monitoring has shown promise and in the future may expedite the evaluation and treatment of sleep apnea.

The Treatment of Sleep Apnea
Most, but not all children with OSAS are cured or improve with the removal of enlarged tonsils and adenoids.

Weight loss and avoidance of alcohol before bedtime may be effective in selected patients. Unfortunately, weight loss is not frequently attained by sufferers of OSAS, although it is the most logical and healthiest choice.

Continuous Positive Airway Pressure (CPAP) is the treatment of choice in most persons with symptomatic sleep apnea. CPAP forces air through the nose under gentle pressure, thereby introducing a splint of air that holds the throat open during sleep. CPAP permits the patient to sleep without interruption by preventing the repeated obstructions in the breathing passages which are the hallmark of obstructive sleep apnea.

CPAP is a remedy rather than a cure, but the improvement in symptoms is prompt and persists as long as the patient uses the machine throughout the night every night. The prescribed CPAP pressure is traditionally determined in the Sleep Laboratory. Outpatient “titrations” utilizing an automatic CPAP machine are sometimes performed.

Oral appliances in OSAS are usually utilized in patients who are not very symptomatic or overtly overweight. The appliances are fitted by an expert, usually a dentist with an interest in sleep disorders, and they gently position the jaw forward and slightly downward during sleep. The exact way in which these appliances work is not entirely clear. They are also effective in the treatment of simple snoring.

Surgery in the treatment of OSAS is controversial as the results are highly variable and generally unpredictable. A variety of surgical procedures have been tried over the years.

Contact
For more information on sleep apnea please contact the Scott & White Sleep Disorders Center at 254-724-3227.