What Is Obstructive Sleep Apnea? What Causes Obstructive Sleep Apnea?

What  Is  Obstructive  Sleep  Apnea? Obstructive  sleep  apnea  (OSA)  is  a  condition  where  breathing  involuntarily  stops  for  brief   periods ...
Author: Alexis Mitchell
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What  Is  Obstructive  Sleep  Apnea? Obstructive  sleep  apnea  (OSA)  is  a  condition  where  breathing  involuntarily  stops  for  brief   periods  of  time  during  sleep.  Normally,  air  flows  smoothly  from  the  mouth  and  nose  into   the  lungs  at  all  times.  Periods  when  breathing  stops  are  called  “apnea”  or  “apneic  episodes.”   In  obstructive  sleep  apnea,  the  normal  flow  of  air  is  repeatedly  stopped  throughout  the   night.  The  flow  of  air  stops  because  airway  space  in  the  area  of  the  throat  is  too  narrow.   Snoring  is  characteristic  of  obstructive  sleep  apnea.  Snoring  is  caused  by  air  flow  squeezing   through  the  narrowed  airway  space.  Untreated  sleep  apnea  can  cause  serious  health   problems  such  as  hypertension,  heart  disease,  stroke,  and  diabetes.  Proper  diagnosis  and   treatment  are  essential  to  preventing  complications.

Types  of  Sleep  Apnea The  three  types  of  sleep  apnea  are:  obstructive,  central,  and  mixed.  Obstructive  sleep  apnea   is  the  most  common  cause  of  sleep  apnea.  In  central  sleep  apnea,  there  is  no  blockage  of  the   airway,  but  the  brain  doesn’t  signal  the  respiratory  muscles  to  breathe.  Mixed  sleep  apnea   is  a  combination  of  obstructive  and  central  sleep  apnea.  [RM2]  

What  Causes  Obstructive  Sleep  Apnea? There  are  several  types  of  sleep  apnea,  but  OSA  is  the  most  common.  OSA  is  more  likely  to   occur  in  older  people  and  people  who  are  over  weight.  In  fact,  seventy  percent  of  people   with  obstructive  sleep  apnea  are  obese.  Anecdotal  evidence  shows  that  weight  loss  causes   marked  improvement  in  symptoms.  Sleep  apnea  is  aggravated  by  sleeping  on  the  back.   Technically,  anyone  can  develop  sleep  apnea.

Who  Is  at  Risk  for  Obstructive  Sleep  Apnea? Risk  for  OSA  occurs  with  any  problem  that  narrows  the  upper  airway.  Risk  factors  of  OSA   include: ● ● ● ● ●

children  with  large  tonsils  and  adenoids men  with  a  collar  size  of  17  inches  or  more  and  women  with  a  collar  size  of  16   inches  or  more large  tongue  (which  can  block  the  airway) retrognathia  (lower  jaw  that’s  shorter  than  the  upper  jaw) shape  of  the  palate  or  airway  that’s  narrow  or  collapse  more  easily

Symptoms  of  Sleep  Apnea Sleep  apnea  causes  episodes  of  decreased  oxygen  supply  to  the  brain  and  other  parts  of  the   body.  Sleep  quality  is  poor,  which  causes  daytime  drowsiness  and  causes  people  with  this   problem  to  not  feel  rested  and  refreshed  in  the  morning.  People  with  sleep  apnea  may  also   experience  the  following  symptoms: ● ● ● ● ●

headaches  that  are  difficult  to  treat feeling  disgruntled  (grumpy) forgetfulness drowsiness  and  falling  asleep  at  work,  while  watching  TV,  etc. drowsiness  and  falling  asleep  while  driving

Other  symptoms  include: ● hyperactivity  in  children ● worsening  depression ● poor  job  and  school  performance ● loss  of  interest  in  sex ● leg  swelling  (called  “edema,”  which  can  occur  when  sleep  apnea  is  severe) Daytime  drowsiness  puts  people  with  sleep  apnea  at  risk  for  motor  vehicle  crashes  and   industrial  accidents.  Treatment  is  able  to  totally  relieve  daytime  drowsiness  caused  by   sleep  apnea.

How  Obstructive  Sleep  Apnea  Is  Diagnosed? A  diagnosis  of  sleep  apnea  begins  with  a  complete  history  and  physical  examination.  A   history  of  daytime  drowsiness  and  snoring  are  important  clues.  The  head  and  neck  are   examined  carefully  to  identify  any  physical  factors  that  are  associated  with  sleep  apnea.   The  doctor  may  ask  you  to  fill  out  a  questionnaire  about  daytime  drowsiness,  sleep  habits,   and  quality  of  sleep.  Tests  that  may  be  performed  include: Polysomnogram  [RM3]   This  test  may  require  that  you  stay  overnight  in  the  hospital.  The  test  lasts  for  an  entire   night’s  sleeping  time.  The    polysomnogram  measures  activity  of  different  organ  systems   associated  with  sleep.  It  measures  brain  waves  (EEG),  eye  movement  (electro-­‐oculogram),   heart  rate  and  rhythm  (EKG),  and  muscle  activity  (electromyogram).    Changes  in  oxygen   saturation  are  also  measured  using  pulse  oximetry.  The  polysomnogram  is  administered  in   a  hospital  or  sleep  study  center.   You  lay  down  on  a  bed  just  as  you  do  at  home.  Electrodes  attached  to  the  scalp  monitor   brain  waves  before,  during  and  after  sleep.  2  or  3  EKG  leads  are  attached  to  your  chest  to   monitor  your  heart  rate  and  rhythm.  

The  electro-­‐oculogram  (EOM)  records  eye  movement.  A  small  electrode  is  placed  1  cm   above  the  outer  corner  of  the  right  eye,  and  another  is  placed  1  cm  below  the  outer  corner   of  the  left  eye.  When  the  eyes  move  away  from  the  center,  this  movement  is  recorded.   Brain  waves  and  eye  movements  tell  doctors  about  the  timing  of  the  different  phases  of   sleep.  The  phases  of  sleep  are  non-­‐REM  (non  rapid  eye  movement)  and  REM  (rapid  eye   movement).  Dreaming,  decreased  muscle  tone,  and  paralysis  occur  during  REM  sleep. For  the  EMG,  two  electrodes  are  placed  on  the  chin.  One  is  placed  above  the  jaw  line  and   the  other  is  placed  above  the  jawline.  Another  electrode  is  place  on  each  shin.  The  EMG   electrodes  pick  up  the  electrical  activity  generated  during  muscle  movements.  Deep  muscle   relaxation  occurs  during  sleep.  The  EMG  picks  up  when  your  muscles  relax  and  move   during  sleep.   In  pulse  oximetry,  a  small  device  clips  onto  a  thin  area  of  the  body  that  has  good  blood  flow,     such  as  the  finger  tip  or  earlobe.  The  pulse  oximetry  device  contains  a    tiny  emitter  with   red  and  infrared  LEDs.  Deoxygenated  hemoglobin  absorbs  more  red  light  and  allows  more   red  light  to  pass  through  the  finger  or  earlobe.  Pulse  oximetry  uses  the  differences  in  light   absorption  to  detect  and  record  changes  in  the  oxygen  saturation  of  blood.  Oxygen   saturation  decreases  during  episodes  of  apnea.  No  blood  is  drawn  for  pulse  oximetry.  A  condition  called  narcolepsy  has  symptoms  that  are  similar  to  sleep  apnea.  People  with   narcolepsy  can  enter  REM  sleep  at  any  time.  When  this  occurs,  they  fall  asleep  and  lose   muscle  tone.  The  symptom  of  daytime  drowsiness  is  common  to  both  narcolepsy  and  sleep   apnea.  People  can  have  both  problems  at  the  same  time.   The  polysomnogram  helps  doctors  to  know  if  narcolepsy  is  also  present.  This  is  important,   because  the  treatment  for  narcolepsy  includes  medications  that  may  not  be  used  in   obstructive  sleep  apnea.

Electrocardiogram  (EKG) A  12  lead  EKG  can  reveal  if  heart  disease  is  present.  Long-­‐standing  high  blood  pressure  also   causes  changes  in  the  EKG.  Heart  disease  is  more  common  in  obese  people,  and  obesity  is  a   risk  factor  of  heart  disease,  high  blood  pressure,  and  sleep  apnea.  Monitoring  heart  rate   and  rhythm  lets  doctors  see  if  any  cardiac  disturbances  occur  during  episodes  of  apnea.

Arterial  Blood  Gas  (ABG) In  this  study,  a  syringe  is  used  to  obtain  blood  from  an  artery.  No  tourniquet  is  necessary   because  arteries  are  a  high  pressure  system.  Other  types  of  blood  tests  use  blood  from  a   vein.  The  arterial  blood  gas  measures  the  oxygen  content,  oxygen  saturation,  partial   pressure  of  oxygen,  partial  pressure  of  carbon  dioxide,  and  bicarbonate  levels  of  arterial   blood.  This  gives  the  doctor  more  detailed  information  about  the  amount  of  oxygen  and  

carbon  dioxide,    and  the  acid-­‐base  balance  of  your  blood.  ABG  studies  help  doctors  to  know   if    and  when  you  need  extra  oxygen.  

Treatment The  goal  for  treatment  of  sleep  apnea  is  to  make  sure  air  flow  isn’t  obstructed  during  sleep.   Treatment  methods  include:

Weight  Loss Weight  loss  gives  excellent  relief  from  the  symptoms  of  OSA.

Nasal  Decongestants Nasal  decongestants  are  more  likely  to  be  effective  in  mild  OSA.  They  can  help  to  relieve   snoring.

Continuous  Positive  Airway  Pressure  (CPAP) This  is  the  first  line  of  treatment  for  obstructive  sleep  apnea.  CPAP  is  administered  through   a  face  mask  that  is  worn  at  night.  The  face  mask  is  attached  to  an  oxygen  tank  that  gently   delivers  positive  airflow  to  keep  the  airways  open  at  night.  The  positive  airflow  props  the   airways  open.  CPAP  is  a  highly  effective  treatment  for  sleep  apnea.  Use  of  CPAP  can  be   aided  by  instruction  at  a  sleep  center.  A  dental  device  may  be  necessary  to  keep  the  lower   jaw  positioned  forward.  

Positional  Therapy Since  sleeping  on  the  back  (supine  position)  can  make  sleep  apnea  worse,  positional   therapy  is  used  to  help  sleep  apnea  sufferers  to  learn  to  sleep  in  other  positions.

Surgery Uvulopalatopharyngoplasty  (UPPP)  involves  removal  of  extra  tissues  from  the  back  of  the   throat.  UPPP  is  the  most  common  type  of  surgery  for  OSA,  and  it  helps  to  relieve  snoring.   However,  this  surgery  hasn’t  been  proven  to  totally  eliminate  sleep  apnea,  and  it  can  have   complications. Tracheostomy  may  be  done  as  a  procedure  of  last  resort.  Tracheostomy  puts  an  opening  in   the  wind  pipe  that  bypasses  the  obstruction  in  the  throat.   Other  surgical  procedures  may  be  required  to  correct  problems  with  facial  and  other   structures  when  sleep  apnea  is  very  severe  and  doesn’t  respond  to  CPAP.  Seventy-­‐five  

percent  of  children  with  OSA  due  to  enlarged  tonsils  or  adenoids  get  relief  from  surgery.   The  American  Sleep  Apnea  Association  (ASAA)  says  that  the  American  Academy  of   Pediatrics  has  endorsed  surgical  removal  of  tonsils  and  adenoids  as  the  treatment  of  choice   for  children  with  sleep  problems.  

References American  Sleep  Apnea  Association.  (2011a).  Sleep  apnea. http://sleepapnea.org/learn/sleep-­‐apnea.html American  Sleep  Apnea  Association  (2011b).  OSA,  treatment  options.   http://sleepapnea.org/diagnosis-­‐and-­‐treatment/treatment-­‐options.html Mayo  Clinic.  (June  4,  2011).  Obstructive  sleep  apnea,  risk  factors.   http://www.mayoclinic.com/health/obstructive-­‐sleep-­‐ apnea/DS00968/DSECTION=risk%2Dfactors Oxyimetry.org.  (September  10,  2002).  Principles  of  pulse  oximetry  technology.   http://www.oximetry.org/pulseox/principles.htm   PubMed  Health.  (July  31,  2011).  Obstructive  sleep  apnea.   http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001814/