A Family Doctor's Tale - OBSTRUCTIVE SLEEP APNEA

DOC I HAVE OBSTRUCTIVE SLEEP APNEA

Snoring may be a joke among relatives and family members.

Many patients with snoring may have Obstructive Sleep Apnea (OSA) which may lead to inadequate sleep and insufficient oxygen to the brain leading to poor brain function and confusion.

Ideally all cases of OSA must be investigated and treated.


Obstructive Sleep Apnea (OSA) is the absence of respiratory airflow (for 10 seconds or more) during sleep despite respiratory effort due to upper airway obstruction.

Patients with OSA do not have adequate sleep and may have problem staying awake during the day posing problems in their employment during the day  and keeping their family awake at night.

Obstruction causes:

1.Inadequate muscle tone of the palate, tongue and pharynx leads to airway collapse during inspiration during the deep stage sleep.

2.bulky tissue in the upper respiratory airway(adenoids and tonsillar hypertrophy, cysts and tumors)

3.excessive soft palatial tissue or long uvula

4.receding chin resulting in a backward prolapsing tongue

5.anatomical abnormalities in the nose(deviated nasal septum, hypertrophied inferior turbinate) or congested nasal passages (allergies, sinusitis, nasal polyps)

Systemic disorders:

1.Hypothyroidism

2.Acromegaly

3.Alcohol

4.Sedatives

5.Obesity

Symptoms:

1.snoring present in 20% of men and 5% of women at age 30-35 years.
At age 60 years or more, 60% of men and 40% of women snore habitually

2.unrefreshed sleep

3.daytime sleepiness

4.poor concentration

5.forgetfulness

6.morning headaches

7.dryness of mouth in the morning

8.irritability

9.depression

10.sexual dysfunction

Signs:

1.Enlarged nasal turbinate, polyps , and nasal blockage

2.Enlarged tonsils and adenoids

3.Long uvula

4.large protruding tongue

Diagnosis of Obstructive Sleep Apnea  is made through:


1.Symptoms of snoring, nasal congestion and inadequate sleep

2.observation of airway obstruction during sleep

3.Sleep study using monitoring devices such as

a. electroencephalogram(EEG)

b electro-oculogram(EOG)

4.Electrocardiogram(ECG)

5.Blood oxygen studies

6.Nasal and oral airflow

7.Thoracic and abdominal movement

8.Snoring sounds

Complications and dangers of Obstructive Sleep Apnea:


1.higher risk of hypertension

2.cardiovascular disease

3.Congestive heart failure

4. cardiac arrhythmias

5.cerebrovascular accidents

Treatment of OSA is by:


A.Non Surgical treatment:


1.Continuous Positive Airway Pressure(CPAP)
CPAP administered by mask through the nose is the single most effective  least invasive treatment for OSA.
It can improve all the bad effects of OSA.

2.Oral appliances which pushes the mandible forward and prevent it from falling open during sleep

3.Nasal Congestion treatment:
Patients with nasal congestion and blockage should be treated with antihistamine and decongestant

4. Weight reduction:
Any obese patients should have at least 10% of his weight reduced over a 6 months period

B.Surgical Treatments:


1.Surgery on the upper pharyngeal airway(uvula and palate)

a.Radiofrequency reduction is indicated in simple snorer or mild OSA.

b.Uvulopalatopharyngeal (UPPP) surgery includes uvulectomy, palatal releasing and shortening incisions.

2.Surgery of the Tongue base:
Radiofrequency reduction is done for mild cases.
Advancement of the tongue, hyloid suspension is done under general anesthesia. All these enlarge the posterior airway space.

3.Maxillomandibular Advancement:
This is the most effective surgical procedure for treatment of OSA. It causes enlargement of the pharyngeal and hypopharyngeal airway by physically expanding the skeletal framework.

Prognosis depends on the severity of the condition but is generally good.

Prevention is by:


1.Lose weight in obese individual with OSA

2.Healthy lifestyle with balanced diet and exercise.

3.Neck elevation

4.Avoid alcohol