Obstructive sleep apnoeais the disruption of breathing that occurs during sleep. It’s most notably characterised by snoring, and it can be potentially dangerous due to the lack of oxygen flow to the brain. In this article, Dr Swapna Mandal, aconsultant in respiratory medicine with an interest in sleep and ventilation, explains the effects of obstructive sleep apnoea, and how it can be managed.
What is sleep apnoea?
Apnoea comes from the Greek word for ‘breathless’. There are three main types of sleep apnoea: obstructive sleep apnoea (OSA), which is the most common and occurs due the muscles in the back of the throat relaxing; central sleep apnoea (CSA), which is when the brain fails to transmit the correct signals to the muscles that facilitate breathing; and complex apnoea, which is a mix of both OSA and CSA.
With OSA, the throat muscles that support the soft palate, the uvula, and tonsils, and the walls of the throat close in on the windpipe, narrowing the airways and disrupting respiration. This leads to lower oxygen levels in the blood, which may trigger a brief awakening by the brain to reopen the airway, so patients with OSA may suddenly jerk awake after a period of not breathing – these are called apnoeic episodes, and are usually not remembered by the patient.
In addition to disrupting breathing, sleep apnoea disrupts the sleep cycle as well. Patients may experience between five (mild) and 30 (severe) apnoea-related interruptions in an hour. The lack of consistent, deep sleep can have further detrimental effects on health, as a lack of quality sleep and oxygen to the brain can lead to high blood pressure,strokes, and depression.
OSA is overall more common in men and older individuals, but may be often under-recognisedin women. People who are overweight or obese are likely to have OSA, as well as those who naturally have thicker necks, nasal congestion or a narrow airway. The use of relaxants, sedatives, tranquillisers, and alcohol can also possibly cause affliction.
What are the symptoms of obstructive sleep apnoea?
The signs of obstructive sleep apnoea include:
- Snoring, which is the most common symptom but is not necessarily present in all cases
- Daytime fatigue and feeling tired upon waking up due to interrupted sleep
- Mood changes and irritability
- Brain fog, like memory issues and inability to focus
- Waking up repeatedly in the night, though patients may not be able to remember these events
- Pauses in breathing while sleeping, which may be noted by friends, families, or partners, or recorded with sleep trackers
To lower the risk factors of obstructive sleep apnoea, it is recommended to maintain a healthy weight and exercise regularly, to avoid smoking tobacco and alcohol overconsumption, and to cease using sleep medicines unless advised by a doctor.
How is obstructive sleep apnoeadiagnosed?
OSA apnoea is typically diagnosed beginning with a review of the symptoms and medical history. If doctors suspect apnoea, they may want to conduct asleep study, which will monitor breathing patterns, heart rate, chest and abdominal movement, and blood oxygen levels while the patient sleeps, usually in their own home.
How is obstructive sleep apnoea treated?
OSA can be treated in a variety of different ways.There is no definitive cure, but there are methods to manage and reduce apnoea events in frequency or severity.
Conservative, at-home management techniques for mild obstructive sleep apnoea includeweight lossfor those who are overweight,sleeping in different positions (positional therapy)and having sleep aidslike supportive pillows that patients sleep on their side to encourage nasal breathing. Ceasing smoking is known to have a positive impact on OSA.
The gold standard treatment for OSA is thecontinuous positive airway pressure machine (CPAP), which consists of a special mask that is worn during sleep that increases the air pressure of the air in the airways and lungs during inhales, so that the tissues surrounding those areas don’t collapse. An alternative that is only suitable for some patients is amandibular advancement device (MAD), a dental device that is worn during sleep and works by moving the lower jaw forward to prevent the tongue and throat walls from collapsing and obstructing airflow.
In a small subset of cases, surgery may be considered, such as tonsillectomy, making it easier for air to pass through; nasal surgeryto straighten the nasal passages; upper airwaystimulationwhich involves an implanted device in the chest that triggers the nerves in the tongue during sleep so does not collapse; andmaxillomandibular advancement (MMA),which involves moving the upper and lower jaw forward surgically to increase the space behind the tongue and soft palate to reduce obstruction.
If you believe you are suffering from obstructive sleep apnoea, you can consult with a specialist on Top Doctors today.
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