Sleep apnea syndrome is a sleep disorder in which breathing stops for at least 10 seconds repeatedly. If the patient has snoring and feels tired in the morning, even after a night’s sleep considered uninterrupted, they may have sleep apnea.
Obstructive Sleep Apnea Syndrome (OSA)
Causes of apnea and risk factors
Risks and complications of untreated sleep apnea
When is respiratory polygraphy recommended and what does it consist of?
How does continuous positive airway pressure therapy work | CPAP?
Obstructive Sleep Apnea Syndrome (OSA)
Obstructive Sleep Apnea Syndrome (OSA) is characterized by repeated episodes of partial or total airway blockage during sleep, preventing airflow into the lungs. These blockages are caused by the relaxation of the muscles that normally keep the airways open.
Snoring is a symptom of sleep apnea and is the most ‘noisy’ symptom that sends patients to the doctor, but not all patients who snore also have sleep apnea.
Other symptoms may include:
- difficulty concentrating
- morning headaches
- frequent need to urinate during the night (called nocturia)
- libido problems
- high blood pressure
- weight gain
Untreated obstructive sleep apnea could have serious consequences for the patient’s health. Poor sleep quality and daytime sleepiness are highly prevalent among patients suffering from obstructive sleep apnea syndrome.
In a study on sleepiness and traffic accidents in patients with OSA, the US National Highway Traffic Safety Administration (NHTSA) estimates that drowsiness while driving is among the leading causes of traffic accidents. In another study conducted in the UK, according to police-reported data, between 16% and 20% of car accidents are caused by drowsiness and fatigue.
SASO symptom
The following symptoms may occur in patients with obstructive sleep apnea:
- Severe wheezing
- Episodes of breathlessness during sleep, are generally observed by family members
- Brief awakenings due to shortness of breath
- The sensation of dry mouth, sore throat, and headache in the morning when waking up
- Difficulty falling asleep or sleeping through the night (insomnia)
- Excessive daytime sleepiness
- Difficulty paying attention and impaired ability to concentrate
- The appearance of irritability, memory disorders
- Depressive syndromes
- Frequent urination during the night
Causes of apnea and risk factors
The airway closes either partially or completely due to the relaxation of the muscles inside the throat. When the patient breathes in (draws air into the chest), air cannot reach the lungs, hence the awakening caused by breathlessness. There is a mix of genetic and non-genetic (biological, behavioral) factors that can contribute to apnea, including:
- Genetic factors – a person is more likely to suffer from apnea if they have first-degree relatives who snore or have sleep apnea syndrome
- Gender – sleep apnea syndrome is more common in males, with a ratio of 2:1 – male to female
- Hormonal factors – menopause for example, although the mechanisms by which the onset of menopause influences the onset of apnea are not yet known
- Endocrinological conditions – such as hypothyroidism and acromegaly, which favor sleep apnea
- Age – almost 1 in 10 men between 40 and 59 suffer from sleep apnea syndrome
- Being overweight – belongs to the category of major risk factors, in recent years there have been numerous studies indicating a strong correlation between SASO and obesity in adults and children alike
- Neck circumference over 44 cm for men and over 37 cm for women
- Changes in the face (small, hidden chin) or neck (large tongue, prominent tonsils)
- Alcohol consumption, smoking and the use of sedative or hypnotic drugs are risk factors for the development of sleep apnea
Risks and complications of untreated sleep apnea
The patient with apnea experiences chronic fatigue during the day. Repeated awakenings and microwaking interfere with the restful sleep the body needs to recover.
The human need for sleep is fundamental, when a person does not get enough sleep or has a fragmented sleep, behavioral changes and the appearance of nervousness, and irritability are noticed.
Intermittent hypoxemia (low level of oxygen in the blood) is the consequence of the fact that in obstructive sleep apnea syndrome, episodes of airway obstruction systematically occur, the airflow is interrupted and the respiratory effort increases.
The heart rate varies greatly and over time these changes lead to cardiovascular complications, hypertension, cardiac arrhythmias, myocardial infarction, and stroke.
Metabolic complications, development of type 2 diabetes – sleep apnea predisposes to insulin resistance and diabetes.
Post-surgical complications, patients with sleep apnea are at increased risk of complications after major surgery, as they are more at risk due to respiratory problems during surgery or post-surgery.
Sleep apnea diagnosis
The diagnosis of sleep apnea is made by the specialist. For a full assessment, the necessary steps and investigations, a pneumological consultation is necessary. Sleep apnea diagnosis step by step:
Clinical examination includes: measuring blood pressure, checking body weight, height, pulse oximetry (blood oxygen level) and neck circumference.
History includes identification of specific symptoms, history of the condition, patient’s sleep schedule, living and working conditions, and existence of other diseases associated or not with sleep apnea.
Two specific questionnaires will be applied to each patient:
- Epworth questionnaire (also known as Epworth daytime sleepiness test, Epworth scale) is a subjective test to determine the degree of daytime sleepiness.
- The STOP-BANG questionnaire is an assessment questionnaire used to ascertain the presence of obstructive sleep apnea; it has a subjective and objective component to determine the risk of suffering from sleep apnea. The STOP-BANG questionnaire is used in the preoperative protocol of bariatric surgery.
Respiratory polygraphy is a medical investigation used to confirm the diagnosis of sleep apnea, it is non-invasive and painless for the patient.
When is respiratory polygraphy recommended and what does it consist of?
Respiratory polygraphy is recommended for patients with a high suspicion of sleep apnea syndrome.
For this investigation, a special device, called a polygraph, will be used to monitor nasal flow, thoraco-abdominal movements, oxygen saturation and sleep position. The minimum monitoring time with the polygraph device is 5 hours in a single night. Based on these parameters, a trace is obtained, which is then validated and interpreted by the specialist.
Apnea treatment
Sleep apnea symptoms can be controlled. How is obstructive sleep apnea syndrome treated?
Depending on the result of the respiratory polygraph, the doctor may recommend starting therapy to treat sleep apnea and/or recommend further investigations: ENT assessment, cardiology, and neurology.
For mild sleep apnea treatment (AHI 5), the doctor may recommend lifestyle changes, and elimination of risk factors associated with apnea: weight loss, and avoidance of alcohol and tobacco.
The AHI is an index calculated based on the number of apnea episodes divided by the number of hours of sleep in which the apnea episodes were recorded.
Sleep apnea treatment – moderate or severe (AHI over 10) – Continuous Positive Airway Pressure (CPAP) therapy aims to reduce the number of pauses in breathing that occur during sleep and is considered the most effective treatment for moderate and severe obstructive sleep apnea.
How does continuous positive airway pressure therapy work | CPAP?
The device used in Continuous Positive Airway Pressure Therapy is used at night to deliver air through a nasal or nasal mask at a certain pressure. The pressure of the device is regulated by the doctor.
CPAP therapy prevents airway blockage, thereby improving sleep quality and helping to reduce the negative effects of obstructive sleep apnea syndrome (OSA) on the patient’s long-term health.
In conclusion, if you snore or have sleep disorders associated with daytime or nighttime symptoms that may be compatible with a diagnosis of sleep apnea or if you are diagnosed with diabetes, hypertension, cardiovascular disease, or obesity, we recommend that you assess your risk level for sleep apnea and get tested.
If you are experiencing the unpleasant symptoms of sleep apnea, chronic fatigue, snoring, or insomnia, it is important to know that there are solutions to your problem.
References:
- Poor Sleep Challenging the Health of a Nation, M.E. Wells & B.V. Vaughn https://www.tandfonline.com/doi/abs/10.1080/21646821.2012.11079859
- Management of Insomnia, D.J. Kupfer, M.D., and C. F. Reynolds https://www.nejm.org/doi/full/10.1056/nejm199701303360506
