• Sleep Apnea

    (Obstructive Apnea; Central Apnea; Mixed Apnea)

    Definition

    Sleep apnea is a condition in which breathing is repeatedly interrupted during sleep. The time period for which the breathing stops or decreases is usually between 10 and 30 seconds. When these episodes occur repeatedly, sleep apnea can seriously disrupt the quality of sleep.
    Blocked Airway
    IMAGE
    Copyright © Nucleus Medical Media, Inc.

    Causes

    There are three types of respiratory events:
    • Obstructive apnea—caused by a temporary, partial, or complete blockage of the airway
    • Central apnea—caused by a temporary failure to make an effort to breathe
    • Mixed apnea—combination of the first two types

    Risk Factors

    These factors increase your chance of developing sleep apnea. Tell your doctor if you have any of these risk factors:
    • Sex: male
    • Overweight
    • Large neck circumference
    • Age: middle to older age
    • Family history of apnea
    • Structural abnormalities of the nose, throat, or other part of the respiratory tract. Examples include:
    • Hypothyroidism
    • Medicines: sedatives and sleeping aids
    • Alcohol consumption
    • Smoking

    Symptoms

    Symptoms include:
    • Fatigue and sleepiness during waking hours
    • Loud snoring
    • Breathing that stops during the night (noticed by the partner)
    • Repeated waking at night
    • Unrefreshing sleep
    • Morning headaches
    • Poor concentration or problems with memory
    • Irritability or short temper
    People with chronic untreated sleep apnea may be at risk for:

    Diagnosis

    An overnight sleep study is used to help diagnose sleep apnea.

    Overnight Sleep Study (Polysomnography)

    This test helps detect the presence and severity of sleep apnea. During sleep, it measures your:
    • Eye and muscle movements
    • Brain activity ( electroencephalogram )
    • Heart rate
    • Breathing (pattern and depth)
    • Percent saturation of your red blood cells with oxygen

    Other Studies

    In addition to sleep studies, your doctor may order:

    Treatment

    There are a number of treatment options for sleep apnea, including:

    Behavioral Therapy

    • Lose weight if you are overweight.
    • Avoid using sedatives, sleeping pills, alcohol, and nicotine, which tend to make the condition worse.
    • Try sleeping on your side instead of your back.
    • Place pillows strategically so you are as comfortable as possible.
    • For daytime sleepiness, practice safety measures, such as avoiding driving or operating potentially hazardous equipment.

    Mechanical Therapy

    Continuous positive airway pressure (CPAP) entails wearing a mask over your nose and/or mouth during sleep. An air blower forces enough constant and continuous air through your air passages to prevent the tissues from collapsing and blocking the airway. In some cases, dental appliances that help keep the tongue or jaw in a more forward position may help.

    Surgery

    In some cases, surgery may be recommended. It is most often beneficial in pediatric patients.
    Types of surgery that may be done to treat severe cases of sleep apnea include:
    • Uvulopalatopharyngoplasty—The doctor removes excess soft tissue from the nose and/or throat.
    • Maxillomandibular advancement—The jawbone is repositioned forward.
    • Tracheotomy —For life-threatening cases of sleep apnea, an opening is made in the windpipe to allow for normal breathing.
    Bariatric surgery may help with weight loss in some people who are obese . This surgery may reduce many of the complications that are related to obesity, including sleep apnea.

    Medications

    Only used in central apnea, acetazolamide (Diamox) may help improve the ability to regulate breathing. Overall, there is not a lot of evidence to support the use of medicines to treat sleep apnea.
    Supplemental oxygen may be given if blood levels of oxygen fall too low during sleep, even after opening the airway.

    Prevention

    You may be able to prevent the onset of sleep apnea by maintaining a healthy weight . Avoid alcohol, nicotine, and sedatives, which may contribute to airway obstruction.

    RESOURCES

    American Academy of Sleep Medicine http://www.sleepeducation.com/

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

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

    CANADIAN RESOURCES

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

    Canadian Sleep Society http://www.canadiansleepsociety.ca/

    References

    American Academy of Sleep Medicine. The International Classification of Sleep Disorders. 2nd ed. Westchester, IL; American Academy of Sleep Medicine; 2005.

    American Sleep Apnea Association website. Available at: http://www.sleepapnea.org . Accessed July 9, 2009.

    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;29:375-380.

    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;28:113-121.

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

    Obstructive sleep apnea. DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Accessed October 22, 2007.

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

    Sleep apnea: treatment and drugs. Mayo Clinic website. Available at: http://www.mayoclinic.com/health/sleep-apnea/DS00148/DSECTION=treatments-and-drugs . Updated June 29, 2010. Accessed April 4, 2011.

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

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