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 10-30 seconds. When these episodes occur repeatedly, sleep apnea can seriously disrupt the quality of sleep.

	Blocked Airway
	© 2008 Nucleus Medical Art, Inc.

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

A risk factor is something that increases your chance of getting a disease or condition.

• Sex: male
• Overweight
• 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

In addition, patients with chronic untreated sleep apnea may be at risk for motor vehicle accidents, depression , hypertension , and 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 perform:

• 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. 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 may help improve the ability to regulate breathing. A review of studies done on drug therapy for obstructive sleep apnea concluded that the evidence supporting use of medications was not adequate.

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:

The Canadian Lung Association
http://www.lung.ca

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 .

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.

Obstructive sleep apnea. DynaMed website. Available at: http://dynamed102.ebscohost.com/ . Accessed October 22, 2007.

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

Smith I, Lasserson TJ, Wright J. Drug therapy for obstructive sleep apnea. Cochrane Database Syst Rev . 2006;19(2):CD003002.

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