Sleep Disorders: Obstructive Sleep Apnea (OSA)

Obstructive sleep apnea is a disorder that is extremely common in the USA today, affecting about 10% of the population over the age of 40. It occurs twice as much in men as it does in women and is more common in women after menopause. However, it can affect people of all ages and even children.

The airway above the larynx (voice box) is held open only by muscle, which naturally goes slack when people fall asleep. Sometimes this causes the airway to collapse so much that a person can’t breathe. This then results in them waking up at night gasping for air, but they go back to sleep so quickly they don't usually remember doing it. This then happens over and over again, many times per hour. As a result, patients often wake up in the morning feeling just as tired as when they went to bed and then feel tired and sleepy all day long. Sleep apnea can also affect a patient’s health later in life, leading to a higher risk of strokes, heart failure, heart attacks, abnormal heart rhythms (most commonly atrial fibrillation) and dementia.

What are the signs and symptoms?

Signs and symptoms of sleep apnea include waking up in the morning unrefreshed, falling asleep during the day, excessive fatigue, being irritable, weight gain, snoring, waking up at night gasping for air, waking up with a dry mouth or a headache, decreased sex drive, mood swings, forgetfulness and problems with concentration.

What are the risk factors and triggers?

Risk factors for obstructive sleep apnea include being overweight or obese, drinking alcoholic beverages, smoking, male gender or having a narrowed airway as a result of a large tongue, large tonsils or a small or set-back lower jaw.

How is it diagnosed?

Sleep apnea is easily diagnosed by either a home sleep study or an in-lab sleep study requested by your physician.

What is the treatment?

The main treatment for obstructive sleep apnea is a device known as a CPAP machine. The patient wears a mask attached via tubing to a device that sits at the bedside and is the size of a large clock radio. This device generates pressurized air, pushing it into the airway and inflating it open. This takes away snoring and breath-holding spells, and as a result, patients sleep better at night and feel better during the daytime. Not only that, but CPAP can also decrease blood pressure, prevent abnormal heart rhythms and cut down the risk of ending up in the hospital as a result of heart failure.

Some people can be treated with mouthpieces made by dentists, called oral appliances. These are less cumbersome than wearing CPAP and work best for patients who are less overweight and have mild to moderate sleep apnea. They are not as effective for more severe cases.

In some people, sleep apnea can be treated effectively with weight loss. However, it can take a long time to lose weight, and then it is important to keep the weight off long-term. Most patients need to be treated initially with either CPAP or an oral appliance, and then after they lose weight, a sleep study should be repeated to see if the sleep apnea is cured. Weight loss does not cure sleep apnea in everybody.

Also, some surgeries are effective in curing sleep apnea. Some people who can’t lose weight on their own can be treated with weight-loss surgery. Others can be treated with a pacemaker device which is implanted in the chest and causes the tongue to move forward every time the patient takes a breath while asleep. Not everyone is a candidate for this type of surgery, but if the patient is a good candidate, the cure rate is about 70%. Lastly, there is a surgery called maxillomandibular advancement, where both the upper and lower jaws are moved forward about 1 cm. This is a fairly radical surgery, and afterward, the jaws have to be wired in place for 10 weeks while the bone heals.

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