Sleep apnea

Obstructive Sleep Apnea

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Obstructive sleep apnea (OSA) is a condition characterized by interrupted breathing during sleep. Mild cases of OSA might not be significant, but severe cases require treatment to prevent hypoxemia, sleep deprivation, and other complications.

Risk Factors

• Obesity and low muscle tone around the airway
• Structural features causing a narrowed airway
• Elderly individuals
• Men
• Increased body weight
• Active smoking
• Age
• Diabetes or borderline diabetes

Symptoms and Diagnosis

• Loud snoring
• Restless sleep
• Daytime sleepiness
• Home oximetry or polysomnography for diagnosis

Treatment

Lifestyle changes

• Avoiding alcohol or muscle relaxants
  • Losing weight
  • Quitting smoking

Sleeping at a 30-degree elevation Lateral sleeping positions Oral appliances, such as the Mandibular advancement splint Continuous positive airway pressure (CPAP) for severe cases Surgical procedures to widen the airway

Associated Conditions

• Snoring
• Hypersomnolence
• Obesity (BMI > 30)
• Large neck circumference
• Enlarged tonsils and large tongue volume
• Micrognathia
• Morning headaches
• Irritability, mood swings, and depression
• Learning and memory difficulties
• Sexual dysfunction

Sleep-Disordered Breathing

Sleep-disordered breathing is a term used to describe various breathing problems during sleep, including hypopnea and apnea. It is associated with an increased risk of cardiovascular disease, stroke, high blood pressure, arrhythmias, diabetes, and sleep-deprived driving accidents.

Obstructive Sleep Apnea and Health Problems

Obstructive sleep apnea can lead to memory loss due to tissue loss in brain regions responsible for memory storage Daytime functioning problems

• • Daytime sleepiness
  • Motor vehicle crashes
  • Psychological problems
  • Decreased cognitive functioning
  • Reduced quality of life
  • Cerebrovascular diseases (hypertension, coronary artery disease, and stroke)
  • Diabetes

Central Sleep Apnea

Central sleep apnea (CSA) is a type of sleep apnea characterized by an imbalance in the brain's respiratory control centers during sleep, causing the person to stop breathing and then start again without any effort to breathe during the pause.

Causes

Imbalanced neurological controls for breathing rate Failure to signal inhalation, causing missed breathing cycles Hypoxia (low oxygen levels) and hypercapnia (high carbon dioxide levels)

Effects on the Body

• Increased heart rate
• Cyanosis (bluish or dusky skin color)
• Brain damage or death (in severe cases)
• Seizures (triggered by low oxygen levels)
• Angina, arrhythmias, or heart attacks (in adults with coronary artery disease)
• Respiratory acidosis (due to long-term, recurrent episodes of apnea)

=== Mixed Apnea === Mixed apnea is a combination of both obstructive sleep apnea (OSA) and central sleep apnea. It can be detected when OSA is treated with continuous positive airway pressure (CPAP) and central sleep apnea emerges. The exact cause of the loss of central respiratory drive during sleep in OSA is unclear, but it may be related to incorrect CPAP settings or other medical conditions.

Continuous positive airway pressure (CPAP) is the most common treatment for moderate to severe obstructive sleep apnea. It works by using pressurized air to splint the person's airway open during sleep. The person wears a plastic facial mask connected to a small bedside CPAP machine through a flexible tube. This treatment has been shown to improve outcomes when used properly, but long-term compliance can be an issue.

Another treatment option for obstructive sleep apnea is the use of custom-made oral appliances called mandibular advancement devices. These devices help open the airway by shifting the lower jaw forward and opening the bite slightly.

Weight loss is also an important factor in treating sleep apnea, as excess body weight is often a significant cause. Losing weight can lead to reduced apnea frequencies and improved apnea-hypopnea index (AHI).

Surgery is another option for treating sleep apnea, though it is usually considered a third line of treatment for those who do not respond to CPAP or dental appliances. Several surgical procedures are available, including procedures to address nasal and pharyngeal obstructions, as well as base-of-tongue advancement and other multi-level surgeries. However, surgical intervention carries potential complications, and postoperative swelling may negate some of the immediate benefits of the procedure.

Additional treatments for sleep apnea include neurostimulation, medications, oral appliances, nasal EPAP, and oral pressure therapy. However, the evidence for the effectiveness of these treatments varies, and some are only recommended under specific circumstances.

It is crucial for people with sleep apnea to inform their doctors and anesthetists about their condition before undergoing any medical treatment, as alternative or emergency procedures may be needed to maintain their airway during treatment.

Continuous positive airway pressure (CPAP) and other treatments for sleep apnea require consistent use and follow-up with healthcare professionals to ensure the best possible outcomes. People with sleep apnea should regularly monitor their symptoms, adjust treatments as necessary, and maintain an open line of communication with their healthcare providers.

Lifestyle changes can also play a significant role in managing sleep apnea. In addition to weight loss, patients are often advised to adopt healthy sleep habits, such as maintaining a consistent sleep schedule, creating a comfortable sleep environment, and avoiding caffeine and alcohol close to bedtime. Regular exercise and a balanced diet can contribute to overall health and may help reduce sleep apnea symptoms.

For those who struggle with compliance or experience discomfort while using CPAP, there are alternative treatments such as bilevel positive airway pressure (BiPAP) or adaptive servo-ventilation (ASV) devices. These devices work similarly to CPAP but offer different pressure settings or adjust pressure automatically based on the user's breathing patterns. It is essential to discuss any issues with the healthcare provider to find the most suitable treatment option.

In addition to medical treatments and lifestyle changes, support from family members, friends, and sleep apnea support groups can be invaluable in managing the condition. Sharing experiences and tips with others can help patients cope with the challenges of living with sleep apnea and adhere to their treatment plans.

See also

• Congenital central hypoventilation syndrome
• Modes of mechanical ventilation
• Periodic breathing
• Obesity hypoventilation syndrome
• Respiratory disturbance index (RDI)
• Upper airway resistance syndrome

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