Your Health - Sleep Apnea

Sleep Apnea

(Obstructive Apnea; Central Apnea; Mixed Apnea)

Definition

Sleep apnea is a condition in which breathing is repeatedly interrupted during sleep. The time period for which the breathing stops or decreases is usually less than a second to 30 seconds. When these episodes occur repeatedly, sleep apnea can seriously disrupt the quality of sleep.

Blocked Airway

Causes

There are three types of respiratory events:

Obstructive apnea—caused by a temporary, partial, or complete blockage of the airway
Central apnea—caused by a temporary failure to make an effort to breathe
Mixed apnea—combination of the first two types

Risk Factors

These factors increase your chance of developing sleep apnea. Tell your doctor if you have any of these risk factors:

Sex: male
Overweight
Large neck circumference
Age: middle to older age
Family history of apnea
Structural abnormalities of the nose, throat, or other part of the respiratory tract. Examples include:
- Polyps
- Severely enlarged tonsils
- Deviated nasal septum
Hypothyroidism
Medications: sedatives and sleeping aids
Alcohol consumption
Smoking

Symptoms

Symptoms include:

Fatigue and sleepiness during waking hours
Loud snoring
Breathing that stops during the night (noticed by the partner)
Repeated wakening at night
Unrefreshing sleep
Morning headaches
Poor concentration or problems with memory
Irritability or short temper

People with chronic untreated sleep apnea may be at risk for:

Motor vehicle accidents
Depression
Hypertension
Signs of heart disease

Diagnosis

An overnight sleep study is used to help diagnose sleep apnea.

Overnight Sleep Study (Polysomnography)

This test helps detect the presence and severity of sleep apnea. During sleep, it measures your:

Eye and muscle movements
Brain activity (electroencephalogram)
Heart rate
Breathing (pattern and depth)
Percent saturation of your red blood cells with oxygen

Other Studies

In addition to sleep studies, your doctor may order:

Blood tests (eg, to check thyroid function)
Electrocardiogram
Pulmonary function tests

Treatment

There are a number of treatment options for sleep apnea, including:

Behavioral Therapy

Lose weight if you are overweight.
Avoid using sedatives, sleeping pills, alcohol, and nicotine, which tend to make the condition worse.
Try sleeping on your side instead of your back.
Place pillows strategically so you are as comfortable as possible.
For daytime sleepiness, practice safety measures, such as avoiding driving or operating potentially hazardous equipment.

Mechanical Therapy

Continuous positive airway pressure (CPAP) entails wearing a mask over your nose and/or mouth during sleep. An air blower forces enough constant and continuous air through your air passages to prevent the tissues from collapsing and blocking the airway. In some cases, dental appliances that help keep the tongue or jaw in a more forward position may help.

Surgery

In some cases, surgery may be recommended. It is most often beneficial in pediatric patients. Surgery can be used to:

Remove excess soft tissue from the nose and/or throat
Reposition the jawbone and tongue
Create an opening in the windpipe for unobstructed breathing (in life-threatening cases)

Medications

Only used in central apnea, acetazolamide (Diamox) may help improve the ability to regulate breathing. Overall, there is not a lot of evidence to support the use of medications to treat sleep apnea.

Supplemental oxygen may be given if blood levels of oxygen fall too low during sleep, even after opening the airway.

Prevention

You may be able to prevent the onset of sleep apnea by maintaining a healthy weight. Avoid alcohol, nicotine, and sedatives, which may contribute to airway obstruction.

RESOURCES:

American Academy of Sleep Medicine
http://www.sleepeducation.com/

American Sleep Apnea Association
http://www.sleepapnea.org/

National Sleep Foundation
http://www.sleepfoundation.org/

CANADIAN RESOURCES:

Canadian Lung Association
http://www.lung.ca/home-accueil_e.php

Canadian Sleep Society
http://www.css.to/

References:

American Academy of Sleep Medicine. The International Classification of Sleep Disorders. 2nd ed. Westchester, IL; American Academy of Sleep Medicine; 2005.

American Sleep Apnea Association website. Available at: http://www.sleepapnea.org. Accessed July 9, 2009.

Smith I, Lasserson TJ, Wright J. Drug therapy for obstructive sleep apnea. Cochrane Database Syst Rev. 2006;19:CD003002.

Obstructive sleep apnea. DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php. Accessed October 22, 2007.

Kushida CA, Littner MR, Hirshkowitz M, et al. Practice parameters for the use of continuous and bilevel positive airway pressure devices to treat adults with sleep-related breathing disorders. Sleep. 2006;29:375-380.

Littner MR, Kushida C, Wise M, et al. Practice parameters for clinical use of the multiple sleep latency test and the maintenance of wakefulness test. Sleep. 2005;28:113-121.

Morgenthaler TI, Kapen S, Lee-Chiong T, et al. Practice parameters for the medical therapy of obstructive sleep apnea. Sleep. 2006;29:1031-1035.

Pack AI, Maislin G. Who should get treated for sleep apnea? Ann Intern Med. 2001;134:1065-1067.

Last reviewed October 2009 by Rimas Lukas, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.