An Overview of Obstructive Sleep Apnea

Obstructive sleep apnea is a serious health condition that often leads to a host of other health issues. However, while a significant part of the population is suffering from obstructive sleep apnea, only a small part of that group have been diagnosed.

There are reports from the University of Utah Health division that upwards of 80% of sleep apnea cases are undiagnosed at any given time. The vast majority of people who suffer from sleep apnea are unaware their symptoms add up to a real condition. Before we provide a general overview of obstructive sleep apnea, let us get into definitions.

What is Obstructive Sleep Apnea?

The introduction of one recent study succinctly described what obstructive sleep apnea is:

"Obstructive sleep apnea (OSA) is a common disorder characterized by repetitive episodes of nocturnal breathing cessation due to upper airway collapse."

Upper airway collapse in the nose, mouth, and throat is what causes the cessation of breathing during sleep. It is a mechanical problem of something moving in front of something else, thus stopping all possibility of free passage from one area to another. In this case, the soft tissue in the back of the throat blocks the airway and prevents the free passage of air from the environment into the lungs.

Snoring and Obstructive Sleep Apnea

The Incidence of Obstructive Sleep Apnea

The particularly nefarious thing about obstructive sleep apnea is that it occurs in all age groups and genders (children included). There are estimates that at least 18 million American adults have sleep apnea. Also, while accurate estimates are difficult to obtain in children, some say that anywhere from 2%–20% of children are likely to have obstructive sleep apnea. In other words——this is a condition that can affect just about anyone. As we will see later, many of the risk factors are lifestyle-based, so anyone could adopt a lifestyle that creates the environment for obstructive sleep apnea.

The Incidence of Obstructive Sleep Apnea

Symptoms of Obstructive Sleep Apnea

Many people with sleep apnea are likely to experience at least some of the symptoms of the condition, but might not be aware that it is a sign of a significant problem. If you have any of the following symptoms, you should consider bringing up your symptoms with your doctor:

  • Snoring during sleep
  • Missing or skipping breaths during sleep
  • Waking up abruptly due to choking
  • Dry throat in the morning
  • Morning headaches
  • Having trouble concentrating during the day
  • Changes in mood
  • Loss of interest in sex
  • High blood pressure

Risk Factors for Obstructive Sleep Apnea

Obstructive sleep apnea is the result of several risk factors that eventually cause the airway to collapse during sleep. Some of those risk factors include:

  • Narrowed airways in the nose and throat
  • Chronic nasal congestion
  • Smoking
  • Obesity
  • Excessive alcohol or sedative use
  • Asthma

If you or someone you know has any of the above risk factors, it might be worth getting a medical evaluation.

Dr. Donald Sesso of the Berger Henry ENT Specialty Group referenced a general profile that characterizes the most likely group of people to be at risk for obstructive sleep apnea. According to Dr. Sesso, you are at a higher risk if you fall into this general profile:

  • Male
  • Obese (BMI >30)
  • Diagnosed with hypertension
  • Excessive use of alcohol or sedatives
  • Upper airway or facial abnormalities
  • Smoker
  • Family history of obstructive sleep apnea
  • Large neck circumference (>17” men; >16” women)
  • Presence of endocrine or metabolic disorders

You do not need to have all of these risk factors to have obstructive sleep apnea. However, one thing to note from this list is that several of them are lifestyle factors. For example, smoking and alcohol use are risk factors within the realm of control to influence and change. Family history is not. That said, the good news is that obstructive sleep apnea can be managed through lifestyle changes.

Complications of Obstructive Sleep Apnea

The challenge with obstructive sleep apnea is that we do not experience the problem as it is happening. Sleep apnea only occurs while you are asleep. Therefore, when the condition is doing its most damage, we are utterly oblivious to it. In the end, we do not experience the consequences of the disease early enough and lack urgency to address the problem until it causes significant damage. Often, the issues that emerge look like this:

  • Heart failure
  • Stroke
  • High blood pressure
  • Liver damage
  • Glaucoma
  • Attention problems
  • Depression
  • Decreased sex drive
  • Fatigue and sleepiness during the day

This constellation of complications is broad. It includes everything from mental health problems to heart attacks. For that reason, it can be difficult to pin down a pattern of health issues that point to sleep apnea in the beginning.

Therefore, it is prudent to investigate the potential for obstructive sleep apnea if you experience any of the complications on this list. While the presence of one complication——in isolation——does not mean you have obstructive sleep apnea, the presence of 2 or more puts you in a higher risk category.

Diagnosis

There are two main pathways for diagnosing obstructive sleep apnea:

  1. Home Testing
  2. If obstructive sleep apnea is suspected as opposed to central sleep apnea, then your doctor might order the home test first. While the devices vary, generally you take a machine home with you and sleep with it. It provides basic vitals like heart rate, respiratory rate, and blood oxygen levels.

  3. Polysomnography (Sleep Study)
  4. If a more thorough evaluation is necessary, your doctor might order a sleep study. These exams are usually done in a lab setting and gather information about movement and brain activity in addition to basic vital signs.

Treatment

Treatment options generally fall into three main categories:

  • Lifestyle Changes
  • Therapy
  • Surgery

Many of the causes of obstructive sleep apnea can be reversed with lifestyle changes such as losing weight, quitting cigarette use, sleeping on your side instead of your back, avoiding alcohol use at least 3 hours before bed, and taking steps to prevent and manage allergies and nasal congestion.

Therapy options include the use of continuous positive airway pressure (CPAP) machines or oral devices that keep the tongue from falling back to create an obstruction.
While surgery generally is reserved for extreme cases, some patients require jaw surgery or a tracheostomy to manage their cases of obstructive sleep apnea.

Final Thoughts

In conclusion, obstructive sleep apnea is a serious health condition that affects many systems of health. Since the disease is difficult to pin down in the beginning, it is important to take the presence of any of the signs or symptoms of sleep apnea seriously. Fortunately, this disease has many treatment options, including many of which you can do on your own.
References

The information on this page is not intended to be a substitute for professional medical advice, diagnosis, or treatment. For more information about asthma, talk to your doctor or primary care provider.

Sources:

About Ryan Anthony: Ryan A., BS, RRT is a registered respiratory therapist and content writer and medical blogger currently located in Los Angeles, California. As a Respiratory Therapist, he performs a wide range of hospital duties including adult and neonatal intensive care, nitric oxide therapy, high-frequency oscillatory ventilation, conventional mechanical ventilation, noninvasive ventilation, BiPAP, CPAP, intubation assistance, bronchoscopy assistance, cardiopulmonary resuscitation, chest physiotherapy, and nebulizer therapy.

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