• Sleep Apnea

    (Obstructive Apnea; Central Apnea; Mixed Apnea)

    Definition

    Sleep apnea is a sleep disorder with pauses in breathing while you are asleep. The stoppage can last for 10-30 seconds at a time, up to 20-30 times per hour. During one night, breathing may stop up to 400 times.
    There are 3 types of sleep apnea:
    • Obstructive
    • Central
    • Mixed
    With all types of sleep apnea, the brain will sense the pause in breathing and wake you up. Waking up restores normal breathing but breaks the sleep cycle. Poor sleep can make you tired during the day and over time lead to other serious medical conditions like high blood pressure or depression.

    Causes

    Major causes depend on the type of sleep apnea:
    • Obstructive—Muscles in the body to relax during sleep. This can let soft tissue in the back of the throat and mouth to sink toward the throat. If the tissue blocks the airway it will temporarily stop normal breathing.
    • Central—Breathing is controlled by signals from the brain. If the signals are not working properly, breathing can be slowed or interrupted.
    • Mixed—Both soft tissue and nerve signals are causing problems.
    Obstructive Sleep Apnea
    IMAGE
    Copyright © Nucleus Medical Media, Inc.

    Risk Factors

    Sleep apnea is more common in men, and in adults over 40 years old.
    Factors that may increase your chance of sleep apnea include:
    • Excess weight or obesity
    • Large neck circumference
    • Family history of apnea
    • Structure problems of the nose or throat such as:
    • Hypothyroidism
    • Asthma
    • Certain medications, such as sedatives and sleeping aids
    • Excess alcohol intake
    • Smoking
    • Sleeping without dentures, in those that have dentures
    • Heart failure (central sleep apnea)

    Symptoms

    Your partner may notice loud snoring or that you breathing stops at night. You may notice repeated waking at night.
    Regular sleep apnea can lead to:
    • Fatigue and sleepiness throughout the day
    • Unrefreshing sleep
    • Morning headaches
    • Poor concentration or problems with memory
    • Irritability or short temper
    Untreated sleep apnea has been linked to other health problems, such as:
    • High blood pressure
    • Cardiovascular disease
    • Depression
    • Stroke
    • Kidney disease
    Sleep apnea also increases the risk of motor vehicle accidents, most likely due to lack of sleep. If you have daytime sleepiness avoiding driving or operating potentially hazardous equipment.

    Diagnosis

    The doctor will ask about your symptoms and medical history. If the doctor thinks it may be sleep apnea you will be sent for an overnight sleep study in a clinic.
    Polysomnography is test that will help find sleep disorders. It can help show the severity of the apnea as well. During sleep, the test will measure your:
    • Eye and muscle movements
    • Brain activity using an electroencephalogram (EEG)
    • Heart rate
    • Breathing pattern and depth
    • Amount of oxygen that reaches your blood
    To look for any changes caused by sleep apnea, your doctor may also do the following tests:

    Treatment

    Treating sleep apnea will decrease symptoms and reduce risk factors for other health conditions. More mild forms may be managed with some lifestyle changes. More severe forms may need long term treatment. The exact treatment will depend on the type of sleep apnea and its severity.

    Managing Mild Apnea

    Mild obstructive apnea may be relieved with some of the following:
    • If you are overweight, lose excess weight. Work with your doctor or a registered dietitian ti help create a plan.
    • Avoid using sedatives, sleeping pills, alcohol, and tobacco. They can make the condition worse by further relaxing tissue.
    • Try sleeping on your side instead of on your back. Laying on your back will let soft tissue fall directly into your airway.
    • Use pillows to help you prop yourself into a better position when sleeping.

    Oral Appliances

    Oral appliances are small devices that keep the lower jaw in a forward position. This helps pull the tongue away from the airway. It may be helpful for those with mild sleep apnea. The devices can also be used for those with severe obstructive sleep apnea who cannot use CPAP therapy.

    Mechanical Therapy

    Continuous positive airway pressure (CPAP) is a machine that gently blows air into your airway to help keep it open. The air is delivered through a mask that you wear while sleeping. CPAP will help you manage sleep apnea but it does not cure it. If you stop using CPAP, sleep apnea will return immediately.
    Oxygen may also be added at night with CPAP. It may be recommended if the level of oxygen in the blood falls too low during sleep, even with CPAP alone.

    Surgery

    Surgery may be helpful for some.
    Surgery to shrink tissue or remove extra tissue may help relieve obstructive sleep apnea. Options include:
    • Adenotonsillectomy—adenoids and tonsils are removed.
    • Uvulopalatopharyngoplasty—Extra soft tissue is removed from the nose and/or throat.
    • Maxillomandibular advancement—The jawbone is repositioned forward.

    Medications

    Certain medications may be used to reduce daytime symptoms of sleep apnea. Other medications may need to be adjusted or stopped if they are making sleep apnea worse.

    Prevention

    You may be able to prevent sleep apnea by maintaining a healthy weight.

    RESOURCES

    American Sleep Apnea Association http://www.sleepapnea.org

    National Sleep Foundation http://www.sleepfoundation.org

    CANADIAN RESOURCES

    Canadian Sleep Society http://css-scs.ca

    The Lung Association http://www.lung.ca

    References

    Kushida CA, Littner MR, Hirshkowitz M, et al. Practice parameters for the use of continuous and bilevel positive airway pressure devices to treat adults with sleep-related breathing disorders. Sleep. 2006;29(3):375-380.

    Littner MR, Kushida C, Wise M, et al. Practice parameters for clinical use of the multiple sleep latency test and the maintenance of wakefulness test. Sleep. 2005;28(1):113-121.

    Morgenthaler TI, Kapen S, Lee-Chiong T, et al. Practice parameters for the medical therapy of obstructive sleep apnea. Sleep. 2006;29(8):1031-1035.

    Obstructive sleep apnea (OSA). EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T115600/Obstructive-sleep-apnea-OSA. Updated June 10, 2016. Accessed September 13, 2016.

    Pack AI, Maislin G. Who should get treated for sleep apnea? Ann Intern Med. 2001;134(11):1065-1067.

    Sleep apnea. American Sleep Apnea Association website. Available at: http://www.sleepapnea.org/learn/sleep-apnea.html. Accessed January 15, 2015.

    Smith I, Lasserson TJ, Wright J. Drug therapy for obstructive sleep apnea. Cochrane Database Syst Rev. 2006;19:CD003002.

    11/24/2014 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: AIM Specialty Health guideline on management of obstructive sleep apnea using oral appliances. National Guideline Clearinghouse website. Available at: http://www.guideline.gov/content.aspx?id=48271. Updated May 20, 2014. Accessed January 15, 2015.

    1/28/2015 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Teodorescu M, Barnet JH, Hagen EW, et al. Association between asthma and risk of developing obstructive sleep apnea. JAMA. 2015;313(2):156-164.

    8/11/2015 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Molnar MZ, Mucsi I, Novak M, et al. Association of incident obstructive sleep apnoea with outcomes in a large cohort of US veterans. Thorax. 2015;70(9):888-895.

    10/5/2016 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T115123/Central-sleep-apnea: Costanzo MR, Ponikowski P, Javaheri S. Transvenous neurostimulation for central sleep apnoea: a randomised controlled trial. Lancet. 2016;388(10048):974-982.

    Revision Information

    • Reviewer: EBSCO Medical Review Board Marcin Chwistek, MD
    • Review Date: 03/2017
    • Update Date: 10/05/2016
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