By Dr. Inell Rosario, M.D.
Obstructive sleep apnea is a common condition in which, while asleep, a person stops breathing or their breathing becomes extremely shallow for 10 seconds or more. There is ongoing respiratory effort to breathe, but no or minimal airflow is getting into the body as tissues in the throat have collapsed and are limiting air or oxygen from getting to the lungs. It is most often noticed by persons who live with the patient as the breathing pauses can be quite dramatic and alarming to hear.
Why should I care about OSA
Obstructive sleep apnea, once poorly understood and at times the source of comedy, is now understood to be a very serious medical condition affecting essentially all aspects of a person’s health. Untreated OSA makes management of common diseases such as hypertension, diabetes, atrial fibrillation, and obesity much less effective.
Also, patients with OSA are more likely to complain of daytime tiredness, be less productive at work, be involved in motor vehicle and work accidents, and have more issues with depression. As one ages, the incidence of OSA increases in part because of the increased collapse or sag of airway tissue. Therefore, either you will eventually suffer from OSA or it will affect someone you know, so learning more about it is very important.
What causes OSA?
Obstructive sleep apnea is caused by the collapse of tissues in the upper airway, especially at the level of the back of the tongue. This collapse of tissue is worsened by the presence of increased fatty tissue in a person’s body, so while persons of all sizes can have OSA, the risk increases greatly with obesity.
Abnormal or large anatomical structures in the upper airway such as a big tongue, large tonsils or adenoids, tumors in the head and neck, or a deviated septum worsen the severity of and can alone cause obstructive sleep apnea.
How is OSA diagnosed?
OSA is often suspected in a child or adult when they are noticed by their significant others to have periods where they snore loudly or stop breathing. The patient with OSA may complain of poor quality sleep with frequent nighttime awakenings, needing to sleep more upright or in a recliner, being tired most mornings, daytime napping, poor school or work performance, sexual dysfunction, and worsening of their underlying medical conditions such as hypertension and diabetes.
Diagnosing OSA is best done with an overnight polysomnogram (PSG), also called a sleep study. The study is done in a center or hospital where a specialized sleep technician places many monitors or electrodes on the skin and scalp to record brain activity (EEG), heart rate and rhythm (EKG), muscle activity (EMG), eye muscle movement (EOG), oxygen saturation, nasal and oral airflow and chest wall movement. The electrode placement is painless.
The patient then goes to sleep at the facility and their sleep is recorded. The information is reviewed by a certified sleep physician and a treatment plan discussed with the patient. The PSG is the gold standard for diagnosing OSA. For some patients, an at-home test measuring EKG, oxygen saturation, nasal and oral airflow may be acceptable, and the results also need to be reviewed by a certified sleep medicine physician.
Can OSA be prevented?
The risk of OSA is significantly increased in persons who are obese, so exercise and dietary management to reduce or prevent obesity will reduce the likelihood of OSA in many people. For other people, it is their anatomy and aging causing the condition, so they are not able to prevent OSA.
How is OSA treated?
There are many different methods for treating OSA including weight loss, positional sleeping, oral appliances, Continuous Positive Airway Pressure (CPAP), Expiratory Positive Airway Pressure (EPAP), surgery, or some combination of these methods.
CPAP machines nowadays are small (about the size of a bedside alarm clock), fairly quiet, and much better tolerated than in the past. They deliver pressurized air to decrease the collapse of the upper airway tissues during both inspiration and expiration.
EPAP is a band-aid or breath-rite strip-like device with a valve that is placed over a nostril, and it increases the pressure during expiration using the patient’s own airflow.
Actions steps for anyone wanting to learn about OSA
Start with a discussion with your primary care doctor. They will begin the evaluation process and/or refer you to an ENT or family physician who is also board certified in sleep medicine, a pulmonologist, neurologist, or another board-certified sleep physician. In the meantime, it is always good to start an exercise and diet regimen to lose weight if you are overweight, get 7-8 hours of sleep per night, and please do not drive or operate machinery when tired.
Dr. Rosario is a board certified Otolaryngologist (ENT physician) and Sleep Medicine specialist who has been in private practice since July of 1997. She treats a wide range of ENT problems including sinusitis and tonsil issues in both adults and pediatric patients, manages patients with difficult nasal breathing, ear lobe deformities, facial scars, thyroid tumors, insomnia, seasonal affective disorder, snoring and sleep apnea, and hearing loss. Feel free to contact or visit her at her new office: 5565 Blaine Ave., Suite 225, Inver Grove Heights, MN Phone: 651-888-7800; fax: 651-888-7899; website: www.androsent.sleep.com.