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Health Tip: Snoring, nuisance or medical concern?
Part 2: Obstructive Sleep Apnea
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Last week we looked at benign snoring, a problem that affects approximately 30%
to 50% of the US population at one time or another. This week we'll look at a situation
in which snoring represents a much more serious concern. Unlike simple snoring,
obstructive sleep apnea is a potentially life-threatening condition that requires medical attention.
The American Sleep Apnea Association has published a questionnaire known as the Snore Score. Answering yes to any one of the following questions places you at higher risk for having obstructive sleep apnea:
- Are you a loud and/or regular snorer?
- Have you ever been observed to gasp or stop breathing during sleep?
- Do you feel tired or groggy upon awakening, or do you awaken with a headache?
- Are you often tired or fatigued during the wake time hours?
- Do you fall asleep sitting, reading, watching TV or driving?
- Do you often have problems with memory or concentration?
The Greek word "apnea" means "without breath". In Sleep Apnea, a disorder that is thought to affect up to 12 million Americans, breathing repeatedly stops during sleep. These pauses in breathing can last anywhere from 10 seconds to as much as a minute. In addition to snoring, sleep apnea can be associated with serious health problems including high blood pressure, heart failure, memory problems, weight gain, impotency, and headaches.
What causes sleep apnea? Obstructive Sleep Apnea (OSA) occurs when soft tissue in the back of the throat collapses during sleep, blocking off the airway. This can occur in those of normal weight, but is much more likely to occur in obese individuals. Other risk factors for the development of OSA include: a large neck, a recessed chin, smoking and alcohol use. The characteristic picture of obstructive sleep apnea involves loud snoring that begins soon after falling asleep. The snoring is then interrupted by silent periods during which no breathing takes place (apnea). These apneic episodes are then followed by sudden efforts to breathe. The result is disturbed sleep, leading to excessive daytime drowsiness.
How is OSA diagnosed? It is important to realize that the person with OSA will be unaware
of their snoring or episodes of apnea. The predominant symptom will be excessive daytime
drowsiness. The snoring and apnea episodes are usually reported by a family member. Other
symptoms that can be associated with OSA include morning headaches, weight gain, attention deficits and memory loss. The Snore Score is a good way to screen yourself or family member for the possibility of OSA. The diagnosis is usually confirmed by monitoring for apneic episodes in a sleep laboratory.
How is OSA treated? Fortunately, there are a number of treatment options available
for OSA, depending on the severity and underlying cause. Treatment options include:
- Avoidance of alcohol and medications that relax the airway and/or reduce
respiratory drive.
- Weight loss to reduce excess fat around the neck where it may be constricting the airway
- Positional therapy, i.e., avoiding sleeping on the back (for adults).
- Oral appliances designed to keep the airway open.
- Surgery (a tonsillectomy and adenoidectomy is the most common
surgical procedure for younger patients) for pediatric patients
- Continuous positive airway pressure (CPAP)
Of these treatments CPAP is the most common and effective method for treating OSA. It works by blowing pressurized air into the person's airway at a high enough pressure to keep the airway from collapsing. A relatively new surgical procedure known as the Pillar Procedure has been found to be helpful in mild-to-moderate OSA. This procedure involves the placement of flexible implants into the soft palate to keep it from relaxing and blocking the airway. Other surgical options include procedures to partially remove the uvula (uvulopalatopharyngoplast), tighten the front tongue tendon in order to reduce tongue displacement into the throat (genioglossus advancement), and to move the upper and lower parts of the jaw forward from the rest of the face (maxillomandibular advancement).
For more on Obstructive Sleep Apnea, visit the
American Sleep Apnea Association.
If you or your family have any questions about Obstructive Sleep Apnea,
please do not hesitate to sign into your eDocAmerica account and send us your questions.
We are ready to help you however possible.
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