TODAY, Obstructive Sleep Apnea (OSA), as a distinct medical entity, is becoming more known and understood, compared to ten or twenty years ago. It’s relationship to increased risk of cardiovascular diseases, such as heart attack and stroke, diabetes T2, and other major illnesses, including cancer, and sudden death, is now more clinically recognized fully. There was a time when even physicians did not know what sleep apnea was as a medical condition. Snoring was obvious, with its breath holding episodes, but not sleep apnea as a condition in itself.
About one in five Americans (60 million) have Obstructive Sleep Apnea. Extrapolated figures for Hong Kong is 7 percent, the Philippines, about 4 percent, and in India, 13.7 percent. Ninety percent are undiagnosed, 40 percent of those with high blood pressure have OSA and about 60 percent of those with OSA have high blood pressure.
What is sleep apnea?
Usually but not always associated with snoring, sleep apnea means the cessation of breathing during sleep. This breath holding initially lasts for 10 seconds and progresses to 20 to 30 seconds, and each episode is immediately followed by gasping for air. As a result the body does not get enough oxygen, and the tissues suffer, leading to various illnesses, including heart attack, diabetes, and cancer, sometimes sudden death. This cycle could repeat itself several times (20 to 100 times per hour) the whole night long. The snorer is totally oblivious of all this and only the roommate is aware of this bothersome snoring and scary sleep apnea. The bed partner is also adversely affected and is also deprived of a good restful sleep. This is why snoring could be a legal ground for a divorce.
What are the types of sleep apnea?
There are two types: Central Sleep Apnea (CSA) and Obstructive Sleep Apnea (OSA). CSA is much less common, less than 10 percent of cases comprises this group, and is due to the brain’s failure to send a signal for the person to breathe. This can happen among individuals with cardiac or neurological diseases. In OSA, part of the back of the throat collapses and blocks the airway during sleep, preventing airflow to the lungs. This causes decreased oxygenation and a low blood oxygen level, which is unhealthy.
What side effects does sleep apnea have?
The person wakes up with a dry mouth and throat, perhaps with a headache, and a lousy feeling akin to a hungover. There may also be fatigue and sleepiness throughout the day, together with some memory deficiency, poor attention and concentration, and bad mood— all signs of lack of sleep, due to sleep apnea. The psychological stress of all this impacts negatively on the individual and the bed partner. The recurrent transient hypoxemia (low blood oxygen level) and daily impairment of sleep are added risk factors for the development of hypertension and coronary heart disease, cancer, and even sudden death.
What causes snoring?
In some people, especially after middle age, the muscles of the upper airways in the back of the throat, like the soft palate (the back end of the roof of the mouth), the uvula (tiny appendage that hangs down), tonsils, adenoids, become flabby and vibrate with the airflow, causing the various classical noises of snoring. They also cave in and out (like a floppy valve) with respiration, blocking the upper airway and causing sleep apnea. Not all snorers have OSA. A Sleep Study is essential to confirm the presence of OSA or not.
Are “snore stoppers” effective?
“Snore aids” advertised in the various media, such as nostril clips, nasal or throat sprays, magnetic wrist bands DO NOT work to stop snoring, much less cure sleep disorders. Only those fraudulent vendors who make bundles of money by duping the ignorant public could sleep well, minus their conscience. CPAP is the proper and effective treatment for OSA. Untreated OSA, or not using a prescribed CPAP treatment, could increase the risk for death during sleep.
What is the non-specific therapy?
Weight loss for those who are overweight can minimize the episodes of sleep apnea. Avoidance of sleeping pills, sedatives and alcohol, all of which increase the frequency and duration of sleep apnea, is most essential. Lying flat on the back induces sleep apnea for a lot of people. This could be avoided by placing a pillow at the back and lying on the side.
What is the standard of care for OSA?
The standard of care today includes confirming the diagnosis of OSA with a Sleep Study, and when confirmed, use of a CPAP machine while asleep, with pressure tailored to each individual person based on data obtained during the Sleep Study. View CPAP use on YouTube.
What is the surgical treatment?
Surgery removes tissues, like nasal polyps, adenoids, tonsils, and any oro-pharyngeal deformities that cause obstruction to airflow. One of them is called uvulopalatopharyngoplasty, which excises tissues at the back of the throat. The success rate is low, between 30-60 percent and it is hard to know which patients will benefit from it, side effects and eventual outcome. However, today, the standard treatment, which is less invasive than surgery and more effective, is the use of CPAP machine. Only severe anatomical deformities require surgery.
What are the adverse effects of OSA??
Obstructive Sleep Apnea increases the risk for a variety of medical ailments, heart diseases and cardiac failure, diabetes, stroke, and others conditions like arthritis, acid reflux in the esophagus (food pipe), Alzheimer’s, and even cancer, not to mention sometimes sudden death. Anxiety disorders and depression are also associated with sleep disturbances, not to mention poor performance at work and at home due to fatigue from lack of rest and poor body oxygenation. Consultation with a sleep specialist is critical for proper diagnosis and management of these disorders.
What is Overlap Syndrome?
This new entity is the combination of COPD (Chronic Obstructed Pulmonary Disease, seen among smokers and also among those with chronic gastric acid reflux disease) and Obstructive Sleep Apnea (OSA). Their treatments are individualized, entity-specific, and simultaneously done for better success. More clinical studies are being done on this entity.
Remember, Sleep Apnea is nothing to snore about!
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Philip S. Chua, MD, FACS, FPCS, Cardiac Surgeon Emeritus in Northwest Indiana and chairman of cardiac surgery from 1997 to 2010 at Cebu Doctors University Hospital, where he holds the title of Physician Emeritus in Surgery, is based in Las Vegas, Nevada. He is a Fellow of the American College of Surgeons, the Philippine College of Surgeons, and the Denton A. Cooley Cardiovascular Surgical Society. vHe is the chairman of the Filipino United Network – USA, a 501(c)(3) humanitarian foundation in the United States. Email: [email protected]
