Obstructive sleep apnea (OSA) is the most common sleep-related breathing disorder. In the following article, I’ll explain everything about it.
There are around 7 to 18 million people affected by this condition in the US. Of all of these people, approximately 4 million people suffer from severe chronic sleep apnea. This results in several complications and adverse effects on many organs of your body. Typically, OSA affects men 2 to 3 times more than women. Also, this condition is more common for older adults who are 65 years or more. It can also affect small children.
You’ve probably heard about obstructive sleep apnea before. I invite you to read this article if you want to know more about this common condition. In this article, I’ll review the essentials of this disease. Everything from what is it, what causes it, and the symptoms and treatment for the OSA. This will be briefly explained by a doctor, in simple words. So, continue reading and find out more about this interesting disease.
What is sleep, and why is it important?
It can be a little challenging to define what sleep actually is. Doctors describe it as a recurring, normal state of mind and the body. The main characteristics are altered consciousness, reduction of muscles activity, inhibition of all voluntary muscles, and reduced interaction with surroundings.
Sleep occurs in repeating periods like REM (rapid eye movement) sleep and non-REM sleep. Different hormones in your body regulate sleep. These hormones will tell you to go to sleep at night and wake up in the morning. This is what doctors know as circadian rhythm. One of the functions of sleep is to regulate circadian rhythm and other bodily functions. Since so many body functions depend on sleep, we can’t say just one reason why we need sleep. Some of the many roles that rely on sleep include:
- Energy conservation: We save around 35% of energy after a good night’s sleep.
- Cellular restoration: During sleep, the cells of your body repair and regrow. Some of the processes during sleep are muscle repair, protein synthesis, tissue growth, and hormone release.
- Brain function: Your brain needs sleep in order to reorganize its neurons. Sleep also lets the brain clean itself from toxic substances that build up during the day. While you sleep, your memories become long-term memories. Sleep also is a significant factor for learning, problem-solving, creativity, and concentration.
- Emotional well-being: During sleep, the areas of your brain in charge of emotion have higher activity. This supports healthy brain function and emotional stability.
- Proper hormone function: This is especially important for insulin. Sleep keeps your cells healthy so they can produce and take up insulin.
- Immunity: Sleep is also essential for a robust immune system. This happens because while you sleep, your body produces substances that fight infection and inflammation.
What is apnea?
Apnea is simply the stopping of breathing. During this period, there is no movement of respiratory muscles, and the volume of the lungs remains unchanged at first. There can or can’t be an airflow between the lungs and the environment. This depends on the presence of an obstruction.
During this period, the gas exchange to the cells is not affected. This can be done voluntarily, what we know as “holding your breath.” However, there are other causes of apnea.
Involuntary apnea can be due to drug abuse, strangulation or choking, neurological disease, or trauma. Apnea can also be present during periods of high emotion, like while crying or laughing. People also can experience apnea episodes during their sleep. In these patients, apnea episodes can appear multiple times in just one night.
What is obstructive sleep apnea?
Obstructive sleep apnea (OSA) is the most common sleep-related breathing disorder. It’s a condition characterized by episodes of involuntary breathing cessation during your sleep. There are several types of sleep apnea, but the most common is obstructive sleep apnea.
In the latter case, OSA occurs because your throat muscles relax and block the airway during sleep. It becomes the way to narrow for any air to pass to your respiratory airways. This makes the airflow repeatedly stopped during the night.
Obstructive sleep apnea can happen in children and adults. In OSA, apnea episodes can occur hundreds of times a night; they can occur 1 to 2 times in a minute in patients with severe OSA.
In the United States, obstructive sleep apnea is a common sleep disorder. Overall affects around 7 to 18 million people. This includes about 1.5 to 4 million people who are diagnosed with severe obstructive sleep apnea. Both age and sex are important factors in the distribution of sleep apnea cases. The cases of obstructive sleep apnea increase 2 to 3 times in older adults (older than 65). Also, men are 2 to 3 times more likely to develop OSA than women. We’ll review the reason for this later on.
What causes obstructive sleep apnea?
The leading cause of obstructive sleep apnea is the obstruction of the airway during sleep. Most of the time, it’s the soft tissue of your palate and your throat that collapses and blocks the airway. This way, the structures supported by this tissue (uvula, tonsils, and tongue) also become an obstruction.
When your muscles relax, your diaphragm and chest muscles have to make extra effort to open the airway to keep airflow. When the obstruction happens, the level of oxygen in your blood decreases, and carbon dioxide increases. Most of the time, your brain will sense this impaired breathing and will cause you to wake up. This is a mechanism to open the airway again. Still, patients may not even notice that they woke up. Also, this can happen multiple times in one night, depending on OSA severity.
Additionally, there are both structural and non-structural factors that cause obstructive sleep apnea. These are the most common ones:
- Structural: It depends on the anatomy of your cranial and facial bones. Changes in distribution can predispose to the collapse of pharyngeal soft tissue during sleep. This includes inherent anatomic variations like facial elongation, a small chin or mandibula, and genetic syndromes like Down syndrome. Other important structural factors include nasal obstruction due to polyps, septal deviation, tumors, or trauma. Of course, these factors can’t be modified and have a genetic predisposition too.
- Non-structural: Usually respond to modifiable factors like smoking, alcoholism, obesity or central fat distribution, and sedative use. Other factors like age, being male and postmenopausal state are also related to developing obstructive sleep apnea.
Who is at risk of obstructive sleep apnea?
Like we mentioned before, both adults and children can be at risk of developing OSA. Nevertheless, like any other condition, some factors make you more likely to develop it. This includes both structural and non-structural factors that we mentioned before. Here I’ll explain the most common ones:
- Obesity: An excess weight dramatically increases the chance of developing OSA. This happens because fat can deposit around the upper airway and obstructs your breathing while lying down.
- Neck circumference: Paradoxically, people with wider necks usually have a narrower airway. This makes it easier for the airway to become obstructed.
- Being male: Men are 2-3 times more likely to develop OSA than women. Also, this risk increases for overweight men. However, women who’ve already gone through menopause have a higher risk too.
- Age: Obstructive sleep apnea is more common in older adults (65 years) due to the tissue softening that comes with age.
- Family history: Like many other conditions, you are more likely to develop it if you have a family member with OSA.
- Use of substances like alcohol and sedatives: These substances can relax the muscles in your throat, causing the obstruction.
- Smoking: People who smoke have 3 times more chances of developing OSA. This is due to the inflammation and increased mucus caused by smoking.
- Medical conditions: Other conditions like congestive heart failure, high blood pressure, type 2 diabetes, and Down syndrome can result in a higher chance of getting OSA.
Why do individuals with down syndrome have a higher incidence of obstructive sleep apnea?
Obstructive sleep apnea is really common in people with Down syndrome. This increased prevalence is primarily because of anatomic abnormalities of this condition.
People with Down syndrome often have a bigger tongue and a smaller chin. They also have a wider neck than usual, with sometimes narrower airways. Besides, they can suffer from neurologic conditions that affect the nerves that control the tongue and the soft palate.
Furthermore, down syndrome is also closely related to other diseases like heart disease and obesity. These conditions also put higher pressure on the airway when the patient lays down. This results in many factors for people with Down syndrome to be at higher risk of OSA. Sadly, the OSA severity is higher in people with this condition. This is why people with Down syndrome need to receive early diagnosis and treatment.
What are the symptoms of obstructive sleep apnea?
Obstructive sleep apnea symptoms are noticed mainly by the patient’s partner. This is because the obstructive apnea episodes are short enough for you not to notice them during your sleep. When you stop breathing, the oxygen saturation of your blood decreases quickly. Doctors call this oxyhemoglobin desaturation. This results in signals to your brain to wake you up to restore your normal breathing pattern. The most common apnea symptoms include:
- Daytime sleepiness: With apnea episodes, your quality of sleep decreases a lot. Although you may not notice it, your brain wakes you up when it senses low oxygen. This makes you wake up tired and experience extreme daytime sleepiness.
- Dry mouth or sore throat: People with OSA usually will have to breathe through their mouth while they sleep. This is what causes the dry mouth and sore throat feeling.
- Snoring: It’s an early sign of airway obstruction. People who snore usually have upper airway obstruction caused by different reasons. The problem is usually in the nose, where swollen adenoids can be the problem.
- Waking up suddenly: Sometimes, the apnea can wake you up. Patients refer to these episodes as waking up gasping or choking.
- Headaches in the morning: This is caused by a poor night’s sleep.
- Restlessness during the night: You don’t get enough rest with a sleep full of interruptions. This may also cause you trouble waking up in the mornings.
- Trouble concentrating, bad mood, and depression: This is all caused by not getting enough sleep for an extended period.
What are the effects of obstructive sleep apnea?
In the long run, obstructive sleep apnea can cause several effects on your whole body. The most commonly affected systems of your body are:
- Respiratory system: OSA is a respiratory condition. It can worsen symptoms of other respiratory conditions like asthma and COPD (chronic obstructive pulmonary disease).
- Endocrine system: The system in charge of regulating your hormones depends a lot on your sleep cycle. When sleep is disrupted, there can be many effects. The most common include insulin resistance or type 2 diabetes. Also, sleep apnea has a link to metabolic syndrome, including obesity, high cholesterol, and high blood sugar.
- Digestive system: People who suffer from OSA are likely to develop gastrointestinal problems. It’s linked to fatty liver, liver scarring, and gastroesophageal reflux disease that causes heartburn that can interrupt sleep too.
- Circulatory system: Untreated sleep apnea can be related to obesity and high blood pressure, increasing the work for your heart. Besides, sleep apnea is related to abnormal heart rhythm like atrial fibrillation, increasing your risk of stroke.
- Nervous system: Obstructive sleep apnea disrupts your central nervous system. This results in numbness, tingling, and cognitive effects like lack of concentration and depression.
What is the outlook of obstructive sleep apnea?
Normally, the outlook of obstructive sleep apnea is excellent if treated. However, it’s still a chronic condition. This means that it won’t get cured after receiving treatment. But it can be managed to avoid the complications and the effects on your life quality.
Untreated obstructive sleep apnea is a major risk factor for the development of cardiovascular disease, including heart attacks and stroke. Depending on the case, OSA patients can benefit themselves from different treatments, which will give them a good night’s rest. This prevents the untreated OSA complications that we mentioned before.
How is obstructive sleep apnea diagnosed?
The diagnosis of obstructive sleep apnea can be a little difficult, especially because patients don’t always notice the symptoms at first. If the apnea episodes are short, they may not wake you up for you to notice them. But you can have symptoms like daytime sleepiness, a bad mood, and headaches when you wake up. If you sleep with someone else, they can notice you snore, or you stop breathing during your sleep. If you notice some of these symptoms and suspect you have OSA, you should go to the doctor.
Your doctor will ask questions about your symptoms and your medical history. Also, they will ask about your habits (like smoking) and will perform a physical examination. During this examination, they will take a look at your throat and your nose. Also, they can examine your neck and your head, looking for possible structural abnormalities. If your doctor thinks you have OSA, they may refer you to a sleep specialist. They are the ones that can perform special tests to confirm the diagnosis.
The test to diagnose obstructive sleep apnea is a polysomnogram. In order to do it, you need to spend the night in a hospital or a sleeping center. This test will measure several systems during your sleep. A polysomnogram can measure brain waves, eye movement, muscle tone, heart rate and rhythm, and oxygen levels in your blood. This helps identify the sleep phases, the moment when apnea or hypopnea occurs, and how much it affects blood oxygen.
How to treat obstructive sleep apnea?
Obstructive sleep apnea treatment can be different from patient to patient. For mild cases of sleep-disordered breathing, doctors may recommend lifestyle changes. Quit smoking, losing weight, and avoiding substances like alcohol and sedatives can help a lot with OSA. If this is not enough to treat your sleep apnea syndrome, you may need a different treatment. Furthermore, if you experience moderate or severe OSA, the approach can be different. Many different breathing devices can help open a blocked airway.
The most common treatment for OSA is CPAP therapy. CPAP stands for continuous positive airway pressure. The CPAP device provides enough air pressure to keep the airway open during your sleep. This prevents airway blockage, preventing apnea and snoring. Still, many patients don’t get used to using a CPAP machine. The mask can be uncomfortable and hard to sleep on with.
Another option is oral appliances. Oral appliance therapy may not be as effective as CPAP therapy. However, it’s another way to keep your airway open during your sleep. Also, it’s well tolerated by patients because it’s easy and comfortable to use. Finally, surgery can be a way to treat OSA. This is only possible for a patient with structural problems that cause apnea. This includes removing the tonsil, the adenoids of correcting problems of the maxillary.
What types of doctors treat obstructive sleep apnea?
Several types of doctors can treat obstructive sleep apnea. On one side, an ENT (ear, nose, and throat) doctor can rule out blockage of the upper airway. They can also perform surgery to clear this blockage and definitely cure the OSA.
Another specialist that really treats obstructive sleep apnea is the neurologist. They can look if the cause of the apnea is in the central nervous system. Also, neurologists can perform and interpret the results of a polysomnogram. This is important to get the correct diagnosis. Cardiologists and pulmonologists can also be involved when heart or lung disease can cause apnea.
Can obstructive sleep apnea be prevented?
There is no confirmed or direct way to treat obstructive sleep apnea. However, you can benefit from some lifestyle changes to prevent it. This is mainly for the non-structural risk factors for the condition. The most effective way to prevent OSA include:
- Exercise regularly
- A healthy diet that combined with exercise can prevent obesity which is a major risk factor for OSA
- Not smoking
- Not drinking or drinking in moderation
- Avoid taking sleeping or sedative pills
Do you think you have this disease?
This tool is an Obstructive Sleep Apnea Symptoms Checker. It gathers the most important signs, symptoms, and risk factors for the disease. Therefore, the tool will tell anybody who uses their likelihood of their symptoms being because of Obstructive Sleep Apnea. Using the tool is free and would only take a few minutes.