What is obstructive sleep apnea?
Obstructive sleep apnea (OSA) is a condition characterized by repetitive collapse of the upper airway during sleep, hence limiting the amount of air reaching the lungs. When this happens, the body and brain becomes oxygen deprived and you wake up, even though you might not be conscious at each awakening. This can occur hundreds of times in one night. OSA only happens during sleep, as it is a lack of muscle tone in your upper airway that causes the airway to collapse. During the day we have sufficient muscle tone to keep the airway open allowing for normal breathing.
The cardinal features of obstructive sleep include:
- Short periods of absent or decreased breathing during sleeping
- Daytime symptoms attributable to disrupted sleep, such as sleepiness, fatigue, low energy or poor concentration.
- Signs of disturbed sleep, such as snoring, restlessness, or resuscitative snorts.
The prevalence increases as one ages and is more common in men than in women.
What is the impact of obstructive sleep apnea on my health?
Obstructive sleep apnea may contribute to:
- Heart disease
- High blood pressure
What are the risk factors for obstructive sleep apnea?
The most common risk factors are:
- Obesity (BMI above 30) or large neck circumference (above size 17 in men and 16 in women)
- Increased age
- Male gender
- Smoking and alcohol
- Nose congestion
- Family history
- Abnormalities of the bones of the face and skull
- Narrow airway around the throat
What are the symptoms of obstructive sleep apnea?
Sleep apnea can make you wake up in the morning feeling tired or irritable and complaining of daytime sleepiness. But it is normally the bed partner, family or friends who notice the symptoms first. Sufferers may experience some of the following:
- Extremely loud heavy snoring, often interrupted by pauses and gasps
- Excessive daytime sleepiness, e.g., falling asleep at work, whilst driving, during conversation or when watching TV. (This should not be confused with excessive tiredness with which we all suffer from time to time)
- Non-refreshing sleep
- Irritability, short temper
- Morning headaches
- Changes in mood or behaviour
- Anxiety or depression
- Decreased interest in sex
- Frequently waking up at night to urinate
- Gasping or choking at night
How is obstructive sleep apnea diagnosed?
Obstructive sleep apnea ranges from mild to severe depending on the symptoms and sleep test.
- Mild OSA- Such patients may be relatively symptom free or report sedentary (ie, passive) daytime sleepiness e.g boring monotonous converasations. The daytime sleepiness often does not impair daily life, although it may be recognized by family members. Alternatively, daytime sleepiness may become apparent to the patient only after it improves due to weight loss, alcohol abstinence, or treatment of OSA.
- Moderate OSA-Such patients are typically aware of daytime sleepiness and take steps to avoid falling asleep at inappropriate times (eg, taking a nap or avoiding driving long distances). They are able to continue their daily activities, but at reduced levels.
- Severe OSA- Such patients more often have daytime sleepiness that interferes with normal daily activities. They tend to fall asleep often during the day (and in a sitting posture) and are at risk for accidental injury from sleepiness.
Testing for obstructive sleep apnea include:
- Sleep endoscopy (passing camera down your throat),
- Imaging like Xray or MRI
- Home sleep apnea test (HSAT). The HSAT allows you to sleep at home wearing equipment that collects information about how you breathe during sleep. You will usually set up the testing equipment yourself.
Is there a self-test for obstructive sleep apnea?
How do I know if I have a sleep obstructive apnea. Take the Epworth Sleepiness Scale test.
What are the treatment options?
- Weight loss-if your BMI is above 30 or collar size is above size 17 in men and 16 in women, loss of weight coupled with an exercise regime will lead to improvement.
- Tobacco and alcohol-these can cause your tongue and throat muscles to relax; avoid tobacco or alcohol for at least 4 hours before bed.
- Sleep position-risk of snoring is higher when you sleep on your back rather than your side. A simple device that can be made at home is a snug-fitting T-shirt with a pocket sewn over the spine and tennis balls placed in the pocket.
- Nasal decongestants-the nose is the narrowest part of the airways. Nasal congestion can impair airflow through the nose. We suggest that individuals who snore only during a common cold receive a trial of decongestant therapy before bedtime during colds
- Intranasal steroids-nasal congestion from allergic rhinitis (nasal allergies) or chronic sinusitis may improve on intranasal steroids.
- Nasal dilators-these are devices that aim to open up the front of the nose which is the narrowest part of the airway.
- Oral appliances-Oral appliances fit in your mouth or over your teeth while you sleep and increase the size of the upper airway, which decreases snoring. They are indicated to treat snoring when conservative therapies have failed or are inappropriate for the individual patient. OA typically work by advancing the lower jaw, changing the position of the roof of the mouth or pulling forward the tongue. They are fitted by a dentist.
- CPAP- CPAP therapy keeps your airway open during the night by gently providing a constant stream of air through a mask you wear while you sleep.
- UPPP-This is the most common surgery to reduce or eliminate the bulky tissue in your throat.
- Palatal implants-this procedure stiffens the roof of your mouth making it less floppy.
- MMA-this aim at adjusting the bony structures and advancing the jaw
- Dental surgery-the bony structures of the mouth and jaw are adjusted
- Nasal surgery-correction of a deviated nasal septum, enlarged nasal turbinates or nasal polyps improve airflow through the nose
The content on the Nairobi ENT website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions.
- Kushida, Clete A., et al. “Practice parameters for the treatment of snoring and obstructive sleep apnea with oral appliances: an update for 2005.” Sleep 29.2 (2006): 240-243.
- Force, A.O.S.A.T, and American Academy of Sleep Medicine. “Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults.” Journal of clinical sleep medicine: JCSM: official publication of the American Academy of Sleep Medicine 5.3 (2009): 263.
Aurora, R. Nisha, et al. “Practice parameters for the surgical modifications of the upper airway for obstructive sleep apnea in adults.” Sleep 33.10 (2010): 1408-1413.