Sleep apnea is a serious sleep disorder that occurs when the upper airway becomes blocked repeatedly during sleep, reducing or completely stopping airflow. This causes disrupted sleep and drops in your oxygen level. This is known as obstructive sleep apnea (OSA). If the brain does not send the signals needed to breathe, the condition may be called central sleep apnea
What Causes Sleep Apnea?
Some people develop sleep apnea because of their physical structure and others get it due to a medical condition, such as obesity, large tonsils, endocrine disorders (e.g., hypothyroidism), neuromuscular disorders, heart or kidney failure, certain genetic syndromes (e.g., cleft lip or cleft palate), and premature birth.
Are There Any Risk Factors Associated with Sleep Apnea?
There are many risk factors for sleep apnea, including aging (fatty tissue buildup in the neck and tongue), unhealthy lifestyle habits (alcohol, smoking, unhealthy eating and lack of physical activity), being male, family history (inherited, structural development of the face and skull), having nasal obstruction due to a deviated septum, allergies or sinus problems, and race or ethnicity (more common among African-Americans, Hispanics, and Native Americans).
What Are the Signs and Symptoms of Sleep Apnea?
The most common signs that someone may have sleep apnea include reduced or absent breathing (apnea events), frequent loud snoring, and gasping for air during sleep.
The symptoms associated with sleep apnea include excessive daytime sleepiness and fatigue; a decrease in attention, vigilance, concentration, motor skills, and verbal and visuospatial memory; dry mouth or headaches when waking; sexual dysfunction or decreased libido; and waking up often during the night to urinate.
Women tend to have more issues with headaches, fatigue, depression, anxiety, insomnia, and sleep disruption
Are Sleep Apnea Symptoms Different for Children?
Symptoms of sleep apnea are different for children. Children may experience a problem with bedwetting, asthma exacerbations, hyperactivity, and learning and academic performance issues. Children are also more at risk for sleep apnea if they have enlarged tonsils and adenoids.
Are There Any Complications Associated with Sleep Apnea?
If left untreated, complications can develop with sleep apnea. Untreated sleep apnea can increase your risk for the following disorders:
Cancers (pancreatic, renal, and skin)
Chronic kidney disease
Cognitive and behavioral disorders
Diseases of the heart and blood vessels
Eye disorders (glaucoma, dry eye)
Metabolic disorders (glucose intolerance, type 2 diabetes)
Pregnancy complications (gestational diabetes, gestational high blood pressure)
Sleep apnea can also cause your body to be in a chronic state of inflammation. This happens because your blood oxygen levels drop due to OSA, so your body and brain trigger the fight or flight response. As a result, your blood pressure and heart rate increase, waking you from sleep so that your upper airway can open. During sleep, these cycles of decreased and increased blood oxygen levels can cause inflammation that may contribute to the buildup of plaque in blood vessels (atherosclerosis), which can increase your risk of heart attack or stroke. Chronic inflammation can also damage the pancreas and lead to type 2 diabetes.
How is Sleep Apnea Diagnosed?
Diagnosis of sleep apnea involves a review of your family and medical history, a physical exam, and sleep study results.
Specifically, your doctor will ask you questions about your family and medical history with sleep apnea, such as:
Whether or not you have a family history for sleep apnea or another sleep disorder;
Whether or not you have risk factors for sleep apnea; and
Whether or not you have experienced any complications from untreated or undiagnosed sleep apnea.
For your physical exam, your doctor will look for signs of other conditions that may increase your risk for sleep apnea, including obesity, large tonsils, narrowing of the upper airway, or a large neck circumference (>17” for men or >16” for women is considered large). Your doctor will also examine your jaw size and structure, the size of your tongue, and your tongue’s position in your mouth, as well as your lungs, heart and neurological systems to see whether you have developed any complications of sleep apnea.
As for a sleep study, your doctor will order this for you, and it can be done at home or at a sleep center. The study records the number of episodes of “slowed or stopped breathing,” and the number of central sleep apnea events detected in an hour. The study also monitors blood oxygen levels and brain and heart activity during sleep.
Results of your sleep study can tell your doctor if you have mild, moderate, or severe sleep apnea based on the number of sleep apnea events you have within an hour.
They can also help determine the type of sleep apnea you have, obstructive versus central sleep apnea.
What is the Difference Between Obstructive and Central Sleep Apnea?
OSA is more common than central sleep apnea. With OSA, your sleep test results will show an increase in breathing muscle activity when muscles try to open an obstructed upper airway. With central sleep apnea, sleep study results show decreased activity in chest muscles, which can lead to periods of slowed or no breathing.
Does Everyone Who Snores Have Sleep Apnea As Well?
Just because you snore doesn’t mean you have sleep apnea as well. But anyone who snores loudly, nightly and has other symptoms, like pauses in breathing at night or daytime sleepiness, should talk to a doctor to rule out sleep apnea.
Are Any Other Diagnostic Tests Required?
Based on the information gathered during your consultation, your doctor may order the following additional tests to rule out other medical conditions that can cause sleep apnea:
Blood tests to check levels of certain hormones (e.g., thyroid, growth, DHEAS), and to rule out hypothyroidism, acromegaly, and polycystic ovary syndrome (PCOS).
What Treatment Options Are Available for Sleep Apnea?
Sleep apnea can either be medically managed or surgically corrected. Your doctor will recommend the best treatment option that helps you to maintain an open airway during sleep. Usually, these recommendations depend on the type and severity of your sleep apnea.
Medical Management Mild cases of sleep apnea can be medically managed. Your doctor may recommend one or more of the following:
Healthy Lifestyle Changes. Patients should follow a healthy lifestyle that includes eating a heart-healthy diet, limiting alcohol intake, aiming for a healthy weight, getting regular physical exercise, developing healthy sleeping habits, and quitting smoking.
Sleep Positioning Pillows. These are special anti-snoring pillows that support side sleep and support the position of the head for optimal airflow.
Mouthpieces/Oral Appliances. Patients wear these mouthpieces while they sleep. They are custom-fit devices (molded to your individual anatomy) that help keep your lower jaw (mandible) and tongue in place. Specifically, they are designed to keep the lower jaw in the forward position and they help to mitigate the backward compression of the tongue base on the oral airway.
Continuous Positive Airway Pressure Device (CPAP). CPAP devices resist the collapse associated with OSA. Patients sleep with a mask that opens the airway with forced air, and they can also use facial pillows to wear with the masks for added comfort.
Surgical Management If you have severe OSA that does not respond to medical management or your OSA is due to a visible obstruction to the upper airway, you may need surgery. Fortunately, there are a couple of surgical procedures that could be done to help you with your OSA, some of which include:
Hypoglossal Nerve Stimulation. This procedure employs a stimulus applied to the nerve that controls the forward movement of the tongue, so the tongue does not block the airway when you breathe.
Nasal Airway Surgery. There are a number of nasal airway surgeries that can be done in the office or in the operating room depending on several factors, including the severity and location of the blockage. When the nasal airway contributes to snoring, treatment options include straightening the deviated septum, shrinking the enlarged inferior turbinates, repairing the nasal valve collapse, or removing the enlarged adenoids.
Tonsillectomy. Tonsils are organs located at the back of the throat. When they get enlarged, they lead to obstruction of the oral airway. This condition is more common in children than in adults. The procedure (tonsillectomy) involves surgical resection of enlarged tonsils.
Uvulopalatopharyngoplasty (UPPP). The uvula is the “punching bag” in the back of the throat. When it gets enlarged or elongated, it may contribute to OSA. A UPPP surgery involves removing the tonsils (if present), as well as expanding the dimensions of the throat by removing excess tissue of the soft palate or uvula, and using stitches to hold the muscles of the throat in a more open position.
Ultimately, effective treatment of OSA depends on proper diagnosis and location of the anatomic source of the problem
If you think you have the signs and symptoms of sleep apnea, please contact North Dallas ENT at (214) 382-5100 for evaluation, diagnosis, and treatment recommendation.
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