Obstructive sleep apnea (apnea)

General or Other | General Practice | Obstructive sleep apnea (apnea) (Disease)


Description

Obstructive sleep apnea is a significant medical problem affecting up to 4 percent of middle-aged adults. The most common complaints are loud snoring, disrupted sleep and excessive daytime sleepiness.

Patients with apnea suffer from fragmented sleep and may develop cardiovascular abnormalities because of the repetitive cycles of snoring, airway collapse and arousal.

Causes and Risk factors

It is caused by obstruction of the upper airway and characterized by repetitive pauses in breathing during sleep, despite the effort to breathe, and is usually associated with a reduction in blood oxygen saturation.

These pauses in breathing, called apneas (literally, without breath), typically last 20 to 40 seconds. Initially, partial obstruction may occur and lead to snoring. As tissues collapse further or the patient rolls over on his or her back, the airway may become completely obstructed. Whether the obstruction is incomplete (hypopnea) or total (apnea), the patient struggles to breathe and is aroused from sleep. Often, arousals are only partial and are unrecognized by the patient, even if they occur hundreds of times a night.

Many patients with obstructive sleep apnea have lower-face abnormalities, which may include a small chin, maxilla and mandible, as well as a large tongue. Occasionally, obstructive sleep apnea can be caused by less common medical problems, including hypothyroidism, acromegaly and renal failure.

Neuromuscular disorders such as postpolio syndrome can result in inadequate neuromuscular control of the upper airway and lead to obstructive sleep apnea. Restrictive lung disease from scoliosis has also been associated with the disorder.

Diagnosis and Treatment

A sleep study, also called a polysomnogram, is usually performed. Additional tests may be done to rule out other causes of the symptoms.

The goal of therapy is to keep the airway open during the night. Losing weight, and surgery to remove excess tissue at the back of the throat may be recommended. Continuous positive airway pressure (CPAP) involves the use of a specially-designed mask worn over the nose or nose and mouth at night may be prescribed. ...