• Sleep Apnea

    (Obstructive Apnea; Central Apnea; Mixed Apnea)


    Sleep apnea occurs when breathing stops for brief periods of time while a person is sleeping. It can last for 10-30 seconds, and may occur up to 20-30 times per hour. During 1 night of sleep, this can cause up to 400 episodes of interrupted breathing.
    Blocked Airway
    Copyright © Nucleus Medical Media, Inc.


    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—a combination of the first 2 types

    Risk Factors

    Sleep apnea is more common in men and in adults over 40 years of age.
    Factors that increase your chances of developing sleep apnea include:


    Symptoms may include:
    • 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
    People with chronic, untreated sleep apnea may be at risk for:


    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 using an electroencephalogram
    • 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:

    Behavioral Therapy

    • Lose weight if you are overweight.
    • Avoid using sedatives, sleeping pills, alcohol, and nicotine, 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 done by 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.

    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.
    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.


    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 Lung Association http://www.lung.ca

    Canadian Sleep Society http://www.canadiansleepsociety.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;29:375-380.

    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 (OSA). EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated January 12, 2015. Accessed January 15, 2015.

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

    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, et al. Association between asthma and risk of developing obstructive sleep apnea. JAMA. 2015 Jan 13;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 Jun 2 [Epub ahead of print].

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