Obstructive Sleep Apnea (OSA)
Overview
Obstructive Sleep Apnea (OSA) is closure of airway passage that occurs only during sleep. This could be a complete closure (an apnea) or a partial closure (a hypopnea). Central Sleep Apnea (CSA) is cessation of breathing, due to a pause induced by the central nervous system (brain). This could be due to problems with gas (CO2) feedback mechanisms or other problems in respiratory areas of the brain.
Obstructive Sleep Apnea (OSA)
Statistically, 9% of women and 24% of men have Obstructive Sleep Apnea (OSA), but 2% of men and 4% of women have OSA as well as sleepiness. In children, around 2% of girls and 4% of boys have OSA.
Symptoms in children:
Children have two types of symptoms. The first group are hyperactive and have normal weight and show signs of Attention Deficit Hyperactivity Disorder (ADHD). Their hyperactivity is most-likely due to fighting sleepiness. The second group of children are sleepy, tired, and are often overweight. Children may be involved in sleepwalking, bed wetting, neck extension while sleeping or frequent waking.
Symptoms in adults:
1. Tiredness and fatigue
2. Sleepiness
3. Frequent nocturnal awakening
4. Nocturia (nighttime urination)
5. Loud snoring and snorts
6. Witnessed cessation of breathing
7. Dry mouth
8. Others include morning headaches, restless sleep, sweating at night
Severity in adults:
Based on American Academy of Sleep Medicines parameters:
• No OSA: RDI < 5
• Mild OSA: RDI between 5 and 15
• Moderate OSA: RDI between 15-30
• Severe OSA: RDI > 30
Based on criteria that are used for many clinical trials:
• Mild OSA: RDI 5-20
• Moderate OSA: RDI 20-40
• Severe OSA: RDI > 40
Consequences in adults:
• Accidents due to sleepiness, drowsiness, or judgment failure
because of fatigue.
• Higher chance for stroke, heart attack, hypertension, cardiac
arrhythmia, including atrial fibrillation.
• There are new evidence that relates OSA to insulin resistance,
metabolic syndrome, and possibly diabetes mellitus type-2, but,
current data is still preliminary.
Treatment
OSA is a mechanical problem dealing with airway closure (mostly in throat area) during sleep. There are anatomical and physiological mechanisms involved. Treatment options mostly include keeping the airway open during sleep. The available options are:
• Keeping the airway open by forcing air into it, can be achieved
OSA is a mechanical problem dealing with airway closure (mostly in throat area) during sleep. There are anatomical and physiological mechanisms involved. Treatment options mostly include keeping the airway open during sleep. The available options are:
• Keeping the airway open by forcing air into it, can be achieved
by Continuous Positive Airway Pressure devices (CPAP). There are
many ways that this air pressure can be manipulated.
• Keeping the airway open by pulling the base of the tongue forward.
• Keeping the airway open by pulling the base of the tongue forward.
This helps if the problem area is the base of the tongue. Surgical
techniques could achieve this or an oral appliance could achieve this
by pulling the mandible forward, or at least prevent the mandible
from falling back during sleep.
• Surgical techniques to improve other areas of obstruction. (Phase
1 sleep surgery). If the nose is obstructed, improvement of nasal
airway should be achieved for most of the above treatments to
produce an optimal outcome.
• Medications may help through different mechanisms, but in
• Medications may help through different mechanisms, but in
general, they are not very effective at this time.