Sleep Apnea, and 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 central nervous system (brain). This could be due to problems with gas (CO2) feedback mechanisms or other problems at respiratory areas of the brain.
Obstructive Sleep Apnea (OSA):
9% of women and 24% of men have Obstructive Sleep Apnea (OSA). But, 2% of men and 4% of women have OSA and sleepiness.
In children, around 2% of girls and 4% of boys have OSA
Symptoms of OSA, 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. Other symptoms, including morning headaches, restless sleep, sweating at night.
Children have two types of symptoms:
One group is hyperactive and have normal weight. They have features of Attention Deficit Hyperactivity Disorder (ADHD). Their hyperactivity is probably due to fighting sleepiness.
The second group is children who are sleepy, tired, and often overweight.
Children may have sleepwalking, bed wetting, neck extension while sleeping, or frequent awakening
Severity of OSA in adults:
Based on American Academy of Sleep Medicines parameters:
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No OSA: RDI < 5
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Mild OSA: RDI between 5 and 15
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Moderate OSA: RDI between 15-30
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Severe OSA: RDI > 30
Based on criteria that are used for many clinical trials:
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Mild OSA: RDI 5-20
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Moderate OSA: RDI 20-40
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Severe OSA: RDI > 40
OSA consequences in adults:
Care accidents due to sleepiness, drowsiness, or judgment failure to 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, data on this is still preliminary.
Treatment of OSA:
OSA is a mechanical problem that presents with closure of airway (mostly at 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:
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Keeping the airway open by forcing air in it. That can be achieved by Continuous Positive Airway Pressure devices (CPAP). There are many ways that this air pressure can be manipulated.
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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.
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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 to optimal outcome.
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Medications may help through different mechanisms, but in general, they are not very effective at this time.