Sleep Disorders > Obstructive Apnea

The majority of the most commonly seen sleep disorders fall into the Dyssomnia category. The Dyssomnia most often seen in sleep laboratories is Sleep Apnea, usually Obstructive Sleep Apnea (OSA). APNEA is from the Greek word, meaning "want of breath." OSA is a repeated stoppage of breathing or a marked reduction in breathing during sleep, due to a collapse in the upper airway (throat area). The two most commonly seen signs of OSA are:

Loud snoring
Excessive daytime sleepiness (EDS; evaluated with instruments such as the Epworth Sleepiness Scale

OSA Process

What happens with OSA?

Fall asleep.
Muscles in body relax, including those around upper airway.
In persons with OSA, relaxation of muscles is enough for upper airway to collapse (multiple possible reasons – large tonsils; short, thick neck; narrow or restricted upper airway); collapses may be partial (known as a hypopnea – usually accompanied by snoring) or full (known as an apnea – stoppage or pauses in breathing, breath holding).
Oxygen level drops due to apneas/hypopneas, brain senses drop in oxygen level.
Brain arouses person from sleep enough to take a breath (snorting/gasping/choking), raise oxygen level.
Cycle repeats.
10 or more events per hour generally warrants an OSA diagnosis and calls for some form of treatment.
Often worse in supine sleeping position (sleeping on back), and in REM sleep.

OSA Facts

As a result of the OSA process, a person with OSA has a fragmented sleep pattern due to frequent arousals from sleep, hence the symptom of daytime sleepiness. The following are potentially associated with OSA: high blood pressure, short-term memory loss, morning headaches and dry mouth, depression/anxiety, acid reflux, sexual dysfunction, decreased productivity at work/school, family history. OSA is seen more often in overweight persons and persons with restricted upper airways. If left untreated, OSA generally increases one's risk for having a stroke or heart attack. Research has also shown an increased number of motor vehicle accidents - six times as many in people with OSA. It is estimated that approximately 18 million Americans have OSA (5% of men, 3% of women). It is thought that many others go undiagnosed.

OSA Diagnosis

How is OSA diagnosed? Diagnosing OSA generally requires spending the night in a sleep laboratory to undergo a sleep study – also known as POLYSOMNOGRAPHY (PSG).
Measure multiple things as part of PSG
- Brain activity (EEG)
- Eye movements
- Muscle tension
- Heart activity (EKG)
- Limb movements
- Nasal and oral airflow
- Efforts at breathing

Identifying OSA

Have you ever witnessed an apnea? OSA is often accompanied by loud snoring, and the bed partner will frequently note pauses in breathing/breath holding, choking, gasping, or snorting.
Often the two factors that bring people to treatment for OSA are:
- EDS
- Disturbance to bed partner's sleep
Three main types of issues: health (as previously mentioned, many health problems an be associated with OSA), quality of life (decreased participation in activities, sleeping frequently), socio-marital (snoring often causes spouse to sleep in a separate room).

OSA Treatments

The most commonly used and effective treatment for OSA is nasal Continuous Positive Airway Pressure (CPAP). Nasal CPAP consists of a pressurized mask (multiple different types, usually fits over the nose), which blows air pressure through the nasal passageway, down to the upper airway, and holds the upper airway open.
Surgery may also be used to treat OSA:
- Procedures done by otolaryngologists (ear/nose/throat doctors), such as uvulopalatopharyngoplasty (UPPP; laser surgery of the upper airway) and radio frequency volume reduction of the tongue base (RFVRT; using certain types of radio frequency waves to shrink the tongue base), and
- Oral surgery - usually to advance the jaw bone and open the upper airway.
An oral appliance can also be made by an orthodontist, which holds the jaw in such a position that snoring is sharply reduced, and mild apnea may be effectively treated.
The "tennis ball technique" is one of the oldest tricks in the field of sleep disorders. It involves sewing a tennis ball into a pocket on the back of a pajama top, thus prohibiting a person from sleeping supine. This technique is usually reserved for people who have apnea only when sleeping on their back).
All treatments for OSA are aimed at keeping the upper airway open. Weight loss is usually recommended as part of treatment, since weight loss almost invariably helps to reduce OSA.

For Our Patients:

For Our Referring Physicians: