Obstructive sleep apnea

Content

Introduction

Obstructive sleep apnea (OSA) is a relatively common disorder consisting of relaxation and narrowing of the throat walls during sleep and consequent momentary interruption of breathing.

This condition can cause, in the person suffering from it, a constantly disturbed sleep with a consequent deterioration in the quality of life and an increased risk of developing certain diseases.

There are two characteristic types of breath interruption:

  • apnea: occurs when the muscles of the throat tissues relax and collapse so much that the airways are completely blocked with a lack of air flow for 10 seconds or more
  • hypoapnea: consists of a partial blockage of the airways that produces a reduction in air flow of 50% or more, for 10 seconds or more

People with obstructive sleep apnea (OSA) experience repeated episodes of apnea and hypoapnea during the night. In severe cases, these events can occur about once a minute or every two minutes.

Since many people with OSA have episodes of both apnea and hypoapnea, doctors usually refer to this condition as sleep apnea and obstructive sleep apnea syndrome (OSAHS). The term "obstructive" distinguishes OSA from rarer forms of sleep apnea, such as central sleep apnea, in which the brain does not send the signal to the breathing muscles during sleep.

Symptoms

The disorders (symptoms) caused by obstructive sleep apnea (OSA) are often referred to the person suffering from it by their partner, friend or family member.

During sleep, the following may occur:

  • loud snoring
  • noisy and labored breathing
  • repeated pauses in which breathing is interrupted by panting or snorting

Some people with OSA may experience night sweats and frequently wake up during the night to urinate.

During an episode of obstructive sleep apnea, the lack of oxygen causes the brain to move out of deep sleep and into lighter sleep or a state of alertness. This way the airways can reopen and the person can continue to breathe normally. However, repeated sleep interruptions could cause the person to feel very tired during the day. Usually, there is no memory of the interruption of breathing, so you may not be aware that you have this disorder.

Diagnosis

Obstructive sleep apnea (OSA) is a disorder that is not always discovered immediately (under diagnosed) because people may not realize they have it. Upon awakening, in fact, there is no memory of the interruptions in breathing that occurred during the night.

If you suspect that you have OSA, you should first ask your partner or a friend or family member to be observed while you sleep, to see if any interruptions in breathing occur during the night. If so, it is necessary to go to the general practitioner or neurologist who will assess the situation and after having carried out the medical examination will decide whether it is necessary to go to a specialized center for sleep disorders to carry out the assessment test (diagnosis) of the DARE.

Causes

It is normal for the soft tissues and muscles of the throat to relax and collapse to some degree during sleep.In most people, this does not cause breathing problems.

In those with obstructive sleep apnea (OSA) the airways are narrowed due to various factors which include:

  • overweight: Excessive body fat increases the mass of the soft tissues of the neck, putting a strain on the muscles of the throat; Excessive stomach fat can also cause shortness of breath, making ailments worse
  • male sex: it is not known why OSA is more frequent in males than in females, but it could be due to the different distribution of fat in the two sexes
  • age: Although OSA can develop at any age, it is more common in people over 40
  • wide neck: Men with a neck circumference larger than approximately 43 cm have a higher risk of developing OSA
  • drugs with a sedative effect: taking sleeping pills or tranquilizers
  • unusually narrow neck structure: narrow airways, large tonsils, adenoids or tongue, or a small lower jaw
  • alcohol: Drinking alcohol, particularly before going to bed, can worsen both snoring and sleep apnea
  • smoke: the onset of sleep apnea is more likely if you have a habit of smoking
  • menopause (in women): changed hormone levels during menopause can cause the throat muscles to relax more than usual
  • familiarity for the OSA: Genes can be inherited from parents that make them more susceptible to developing OSA
  • nasal congestion: OSA occurs more often in people with nasal congestion, such as people with a deviated nasal septum, in which the cartilage tissue in the nose that divides the two nostrils is folded to one side, or in people who have nasal polyps that can form due to narrow airways

Therapy

There are many treatments that can reduce OSA disorders (symptoms):

  • lifestyle change: losing excess body weight, reducing alcohol consumption especially before going to bed, quitting smoking, avoiding sleeping pills or sedative drugs (read the Hoax), sleeping on one side instead of on the back
  • device for continuous positive pressure mechanical ventilation (CPAP): the use of this device prevents the closing of the airways during sleep by providing a flow of compressed air through a face mask
  • mandibular advancement device (MAD): this device is applied inside the mouth like a normal orthodontic appliance that serves to bring the jaw and tongue forward during sleep, in order to increase the space in the back of the throat

Surgery may only be useful if obstructive sleep apnea (OSA) is the result of a physical problem that needs to be corrected surgically, such as an unusual internal structure of the neck. For most people, surgery is not appropriate and can be considered the last resort after other treatments have proved ineffective.

Obstructive sleep apnea (OSA) can become a chronic disease and, in many cases, may require lifelong therapy. In addition to lifestyle changes, you may need a medical device such as CPAP or MAD.

CPAP

At first it may be difficult to get used to CPAP, so much so that you may be tempted to stop using it, but persevering in using it will cause the ailments (symptoms) to improve significantly. CPAP is provided by the National Health Service (NHS) and is the most effective therapy in severe cases of obstructive sleep apnea (OSA). In addition to reducing ailments (symptoms) such as snoring and fatigue, it can reduce the risk of complications such as increased blood pressure (arterial hypertension).In addition to the discomfort of wearing the face mask, the possible side effects of CPAP are:

  • nasal congestion
  • runny or sore nose
  • difficulty breathing through the nose
  • headache and ear pain
  • stomach pain and wheezing (flatulence)

Early versions of CPAP often caused problems such as dry nose and sore throat. However, modern versions tend to include the humidifier preventing these unwanted effects (side effects). If CPAP becomes particularly troublesome, you need to talk to your doctor as the device can be modified by specialized NHS personnel, in order to become more comfortable. For example, you can use a CPAP that starts with a low blood pressure and then gradually raises it to the highest pressure after you fall asleep.

MAD

Sometimes, in mild cases of obstructive sleep apnea (OSA), a mandibular advancement device, similar to a dental appliance, is used. MAD is not recommended for more severe cases, unless CPAP has been ruled out because it is not well tolerated. MAD devices can also be found for sale on specialized websites but most experts do not recommend buying it on the internet, as if the MAD device does not fit perfectly on the person it could cause a worsening of the ailments (symptoms). It is therefore recommended that it be tailor-made by a dentist with experience in the treatment of sleep apnea. MAD is not provided by the National Health Service (SSN) and must be purchased privately. It cannot be used by people with few or no teeth. In the case of dental caps, crowns or bridges, the dentist must ensure that they cannot be damaged by the MAD.

Surgery

Surgery is not recommended for the treatment of obstructive sleep apnea (OSA) as it is not as effective as CPAP and, in addition, carries the risk of serious complications. Surgery is usually only recommended after all other treatments have failed. if the present disturbances have an important impact on the quality of life.

The surgical operations that can be performed are:

  • tonsillectomy: the tonsils that are too large and block the airways during sleep are removed
  • adenoidectomy: adenoids that are too large are removed and could obstruct breathing during sleep
  • tracheostomy: a tube is inserted directly into the neck, which allows you to breathe freely even if the airways in the upper part of the throat are blocked
  • weight loss surgery (bariatric): in the case of severe obesity and severe sleep apnea, the volume of the stomach is reduced

Surgery to remove excess tissue in the throat and to open the airways has in the past been commonly practiced in the treatment of OSA. Today it has become rarer due to the greater effectiveness of CPAP. The use of surgery also prevents the use of CPAP in the future.

Soft palate implants

These implants serve to make the soft palate more rigid and less subject to vibrations and obstructions. They are inserted into the soft palate under local anesthesia. They are believed to be safe but are not currently recommended for the treatment of OSA because their effectiveness is uncertain. Instead, they are recommended in exceptional cases to treat snoring associated with OSA.

Mutual aid group

Obstructive sleep apnea (OSA) can have a significant impact both on the life of the person who suffers from it and on that of family and friends. It can, in fact, have consequences on the emotional experience and negatively influence relationships with others.In this case, the help of a psychologist and the support of psychological support groups is recommended.

Bibliography

NHS. Obstructive sleep apnoea (English)

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