• Sleep Apnea

    (Obstructive Apnea; Central Apnea; Mixed Apnea)


    Sleep apnea is a disorder resulting in brief periods when breathing stops during sleep. These periods can last for 10-30 seconds at a time, up to 20-30 times per hour. Over the course of the night, interrupted breathing can occur up to 400 times.
    There are 3 types of sleep apnea:
    • Obstructive—temporary, partial, or complete blockage of the airway (most common)
    • Central—temporary failure to make an effort to breathe
    • Mixed—a combination of the first 2 types


    Sleep apnea is the result of a combination of factors. Major causes depend on the type of sleep apnea:
    • Obstructive—During sleep, muscles in the body to relax. Relaxation of the muscles around the throat and neck allow some soft tissue to sink toward the throat. For some people, there is enough soft tissue to block the airway and interrupt 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—A combination of both types.
    With all types of sleep apnea, the brain senses the breathing interruption and signals the body to wake up. Waking up restores normal breathing but breaks the sleep cycle. Poor sleep can cause daytime fatigue and over time lead to other serious medical conditions like high blood pressure or depression.
    Obstructive Sleep Apnea
    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
    • Structural abnormalities of the nose, throat, or other part of the respiratory tract. Examples include:
    • Hypothyroidism
    • Asthma
    • Certain medications, such as sedatives and sleeping aids
    • Excess alcohol intake
    • Smoking


    Sleep apnea may cause:
    • Fatigue and sleepiness during waking hours
    • Loud snoring
    • Breathing that stops during the night—as noticed by a bed partner
    • Repeated waking at night
    • Unrefreshing sleep
    • Morning headaches
    • Poor concentration or problems with memory
    • Irritability or short temper
    Untreated sleep apnea can lead to other health complications, such as:
    • High blood pressure
    • Cardiovascular disease
    • Depression
    • Stroke
    • Kidney disease
    The effects of sleep apnea associated with motor vehicle accidents.


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


    Polysomnography is a sleep test. It helps detect the presence and severity of sleep apnea. During sleep, it measures your:
    • Eye and muscle movements
    • Brain activity using an electroencephalogram (EEG)
    • Heart rate
    • Breathing pattern and depth
    • The percent of your red blood cells that are saturated with oxygen

    Other Studies

    In addition to sleep studies, your doctor may order:


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

    Behavior Therapy

    • Lose excess weight with the help of your doctor or a registered dietitian.
    • Avoid using sedatives, sleeping pills, alcohol, and tobacco, which can make the condition worse.
    • Try sleeping on your side instead of on your back.
    • Use pillows to increase your level of comfort when sleeping.
    • For daytime sleepiness, practice safety measures, such as avoiding driving or operating potentially hazardous equipment.

    Mechanical Therapy

    Continuous positive airway pressure (CPAP) is a machine that forces a constant and continuous flow of air through a hose connected to a mask. It is used while you sleep. The air flow prevents the soft tissues in the throat and neck from collapsing and blocking the airway.

    Oral Appliances

    Oral appliances that help keep the tongue or jaw in a more forward position may help those with mild to moderate sleep apnea. They can also be used for those with severe obstructive sleep apnea who cannot use CPAP therapy or have tried it without success.


    In some cases, surgery may be advised. It is most often helpful in children.
    Types of surgery that may be done to treat severe cases of sleep apnea include:
    • Adenotonsillectomy—The adenoids and tonsils are removed.
    • Uvulopalatopharyngoplasty—Excess soft tissue is removed 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.
    • Phrenic nerve stimulation (central sleep apnea)—An implanted device stimulates the phrenic nerve to contract the diaphragm, a sheet of muscle under the lungs. When the diaphragm contracts, air is drawn into the lungs.
    Bariatric surgery may help with weight loss in those who do not have success with other methods . This surgery may reduce many of the complications that are related to obesity, including sleep apnea.


    Only used in central apnea, acetazolamide may help improve the ability to regulate breathing.
    Supplemental oxygen may be given if blood levels of oxygen fall too low during sleep, even after opening the airway.


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


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

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


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

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


    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.

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