Obstructive sleep apnea is a sleep-related breathing disorder that involves a decrease or complete halt in airflow despite an ongoing effort to breathe. It occurs when the muscles relax during sleep, causing the soft tissues in the back of the throat to collapse and block the upper airway.

When the airway is blocked, it leads to partial reductions (hypopneas) and complete pauses (apneas) in breathing that usually last 10 to 20 seconds during sleep. This can lead to abrupt reductions in oxygen levels in the body, causing the person to wake up long enough to begin breathing normally again. These awakenings are brief, sometimes only a few seconds, and this is the reason that the person with OSA is often not aware that they have awakenings during sleep. The pattern repeats during the night, and someone with severe sleep apnea may wake up hundreds of times each night. These awakenings fragment and interrupt the sleep cycle. Daytime fatigue and sleepiness result, which is a common symptom of sleep apnea.

Prevalence

• OSA can occur in any age group, but prevalence increases between middle and older age 
• OSA with resulting daytime sleepiness occurs in at least 4 percent of men and 2 percent of women 
• About 24 percent of men and 9 percent of women have the breathing symptoms of OSA with or without daytime sleepiness 
• About 80 to 90 percent of adults with OSA remain undiagnosed 
• OSA occurs in about 2 percent of children and is most common at preschool ages

Risk Factors for OSA

• Overweight 
• Large neck size (greater than 17” for men and 16” for women) 
• Narrowed upper airway 
• A small jaw or enlarged tongue can narrow the upper airway can predispose individuals toward the development of OSA
• Enlarged tonsils and/or adenoids may also restrict the size of the upper airway 
• Family members with OSA 
• Male gender, post-menopausal women 
• Smoking and use of alcohol 
• Smokers are three times more likely to have OSA, and alcohol may relax the muscles in the upper airway and predispose it to collapse 
• High blood pressure and diabetes. OSA is more likely in people who have high blood pressure and up to three times more common in those with diabetes

Common Symptoms of OSA

• Snoring 
• Choking or gasping during sleep 
• Observed pauses in breathing during sleep 
• Feeling tired or sleepy during the day; although some with OSA do not have daytime sleepiness 
• Waking up frequently during the night to use the bathroom 
• Dry mouth/sore throat in the morning 
• Morning headaches 
• Trouble concentrating, forgetfulness 
• Irritability

Spouses or bed partners are usually the first to recognize the symptoms of loud snoring, pauses in breathing, and the resultant struggle to breathe. Often the individual with OSA is unaware he or she has a problem, and should be encouraged to seek assistance for a sleep evaluation.

Diagnosis

A comprehensive history and physical examination by a sleep physician followed by an overnight sleep study (or polysomnogram), is necessary to diagnose OSA in children and adults.

Based on the results of the overnight sleep study, your sleep physician will be able to determine if a sleep-related breathing disorder (OSA) exists and warrants treatment.

Treatment for Obstructive Sleep Apnea

Treatment options need to be discussed with your sleep specialist, as certain treatments may be more likely to be effective than others for an individual person.

• CPAP (Continuous Positive Airway Pressure) is delivered by a mask from a small machine that sits at the bedside. Pressurized air keeps the airway open, allowing for uninterrupted sleep and the elimination of snoring. It is the most common and effective way to treat sleep apnea. 
• Dental Appliance. Repositions the lower jaw. May be effective in mild OSA. 
• Surgery. May involve removal of tissue in the back to the throat or repositioning of the bones of the face or jaw. 
• Weight Loss. A proper diet and exercise program can eliminate pounds and decrease the severity of OSA.

How Does Treatment Help

• Improves symptoms such as daytime sleepiness 
• Decreases blood pressure 
• Decreases the risk of heart attack and stroke 
• Decreases the risk of irregular heart beat 
• Decreases the risk of driving accidents due to drowsy driving

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