Obstructive sleep apnea refers to a temporary blockage or obstruction of airflow into the lungs during sleep. Unlike central sleep apnea, where breathing muscles don’t receive signals from the brain, in obstructive sleep apnea, the airflow is blocked due to collapsible airways.
Duration: The blockage typically lasts for at least 10 seconds and can extend up to 30 to 35 seconds.
Movement: During OSA episodes, minimal chest and belly movement may be observed despite the lack of airflow.
The vulnerability of the airways behind the tongue is a key factor in OSA. Several elements contribute to the collapse and obstruction of the upper airways:
Muscular Factors: Certain muscles in the tongue and upper airways work to keep the airways open.
Forces Leading to Collapse: Factors such as the weight of neck tissues while sleeping can counteract the muscles’ efforts. If the forces pushing on the airways are greater than the forces keeping them open, collapse occurs, requiring substantial pressure to reopen the airways. This often leads to gasping for air during apnea episodes.
Obesity: The most consistent factor associated with OSA is obesity. Accumulation of fat around the neck and upper airways increases pressure on these tissues, making collapse more likely.
Medications and Substances: Certain medications, like testosterone supplements, allergy medications (e.g., Benadryl), specific sleeping pills, alcohol, and opiates, can relax upper airway muscles, leading to obstruction.
Anatomical and Neuromuscular Factors: Anatomical abnormalities and neuromuscular disorders can lead to smaller upper airways or relaxed airway muscles, causing obstruction.
In Children: Enlarged tonsils and adenoids are common causes of upper airway obstruction in children.
Sleep Study (Polysomnography): A definitive diagnosis is typically made through a sleep study conducted in a sleep clinic or at home. Polysomnography monitors various body functions during sleep, including brain activity, eye movement, muscle activity, heart rate, respiratory effort, air flow, and blood oxygen levels. The number of apnea and hypopnea events per hour determines the severity of sleep apnea:
Mild: 5-14 events per hour
Moderate: 15-30 events per hour
Severe: More than 30 events per hour
Non-Surgical Options
Continuous Positive Airway Pressure (CPAP): The most common and effective treatment. CPAP delivers a constant stream of air through a mask to keep the airways open.
Bi-level Positive Airway Pressure (BiPAP): Provides two different pressure levels, higher during inhalation and lower during exhalation, allowing for more comfortable breathing.
Adaptive Servo-Ventilation (ASV): Adjusts air pressure based on the patient’s breathing patterns, ensuring optimal support.
Oral Appliances: Custom-made devices, like mandibular advancement devices, reposition the lower jaw and tongue to keep the airways open.
Positional Therapy: Encourages sleeping in certain positions to prevent airway obstruction.
Lifestyle Changes: Weight loss, avoiding alcohol and sedatives, and treating allergies can help reduce symptoms.
Surgical Options
Uvulopalatopharyngoplasty (UPPP): Removes excess tissue from the throat, widening the airways.
Genioglossus Advancement (GA): Repositions the tongue muscle attachment to prevent airway collapse.
Maxillomandibular Advancement (MMA): Repositions the upper and lower jaw to enlarge the airways.
Inspire Therapy: Implants a device that stimulates the hypoglossal nerve, preventing airway collapse during sleep.
Daytime Sleepiness: Chronic fatigue and reduced alertness, leading to an increased risk of accidents.
Cardiovascular Issues: High blood pressure, heart disease, stroke, and arrhythmias.
Metabolic Disorders: Increased risk of obesity, insulin resistance, and type 2 diabetes.
Mental Health Disorders: Depression, anxiety, and decreased cognitive function.
Decreased Quality of Life: Impaired work and social functioning, reduced overall well-being.
Complications During Surgery: Higher risk of complications if undergoing surgical procedures.
It’s essential to diagnose and treat sleep apnea promptly to prevent these health consequences and improve overall quality of life. Consultation with a healthcare professional is crucial for proper evaluation and personalized treatment planning.