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Obstructive Sleep Apnea Syndrome (OSA) is the most prevalent of the hypersomnolence disorders and affects some 4% of adult males and 2% of adult females. It is characterized by heavy snoring and the recurrent collapse of the throat airway during sleep which generally requires arousal to re-establish an open airway and resume breathing. Patients suffer from both sleep fragmentation (frequent arousal) and the recurrent lack of oxygen with possible cardiovascular complications. It is therefore important to recognize this condition and treat it.
Incidence; Causes & Development; Risk Factors
It is thought that up to 10% of adults are affected by OSA.
OSA occurs when part of the airway is closed off (usually at the back of the throat) while a person is trying to inhale during sleep, and breathing stops for more than 10 seconds before resuming again. These breathless episodes can occur as many as several hundred times per night.
Obesity, especially obesity in the neck, can increase the risk of developing OSA, because the fat tissue tends to narrow the airway.One of the best predictors of whether there are upper airway problems during sleep is neck circumference. More than 16" - could be a snorer, more than 17" - could have sleep apnea. One can still have sleep apnea with smaller necks but it is less common.
Age and ethnicity are also risk factors.
Signs & Symptoms
The common symptoms are:- Loud snoring
- Frequent pauses in breathing while asleep
- Waking up tired and/or suffer from sleepiness during the day
- Waking up with headaches, or dry mouth
- Waking up during the night with a choking sensation
- Waking up gasping for air
- Perspiring excessively during the night
- Depression
- Heartburn
- Reduced libido
- Insomnia
- Restless sleep, tossing and turning
Treatment & Prevention
Supportive treatment of obstructive sleep apnea includes maximizing nasal breathing, and more intensive approaches such as dental appliances and upper airway surgery. There are several different styles of devices available over-the-counter to enhance nasal breathing. Some remain on the outside of the nose, sticking to the skin and supplying a lifting action. Others insert into the nostrils, forcing them to remain open.
Treatment of OSA has been shown to improve both quality of life and may reduce medical complications. Strychnine has been tried to cure sleep apnoea - it works to a certain extent, but there are worries that spouses might be tempted to give an overdose when the snoring is particularly bad!
Prognosis
The bad news is that sleep apnea is a serious, potentially life-threatening condition that can cause many health problems if left untreated (particularly increasing risk of heart disease). But the good news is that it can be very easily managed. If suspected, it is wise to go to a doctor and order a "sleep study."
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Signs, symptoms & indicators of Obstructive Sleep Apnea (OSA): | | | | | Symptoms - General |  Constant fatigue | The frequent arousals caused by OSA and the inability to achieve or maintain the deep stages of sleep can lead to excessive daytime sleepiness and nonrestorative sleep. Patients often complain of waking up feeling like they had not slept at all, and often feel worse after taking a nap than before napping. |
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Symptoms - Metabolic |
Waking up with a headache| | Waking up with a headache or dry mouth is a symptom of OSA. |
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Symptoms - Reproductive - General |
Weak sexual desire |
Symptoms - Sleep |
 Waking up with choking sensation
Waking up with a dry mouth
Drowsiness| | Some patients suffering from OSA fall asleep in a nonstimulating environment, such as while reading something uninteresting or in a quiet room. Others may fall asleep in a stimulating environment, such as during business meetings, while eating, and even while having sex.
So-called "drowsy driver syndrome", which some believe is responsible for many automobile accidents, may result from OSA. Drivers may fall asleep at the wheel or suffer from a lack of alertness because of sleep deprivation. Decreased alertness places the person at risk in a variety of potentially hazardous situations. |
Tossing and turning at night
Being a light sleeper| | Patients rarely complain about frequent awakenings due to obstruction, but it does occur. |
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Conditions that suggest Obstructive Sleep Apnea (OSA): | | | | | Circulation | Coronary Disease / Heart Attack| | Obstructive sleep apnea is a significant risk factor for myocardial infarction. |
Hypertension (High Blood Pressure)| | Hypertension is prevalent in patients with OSA, although the exact relationship is unclear. It has been shown, however, that treating OSA can modestly lower blood pressure.
A study from the University of Wisconsin School of Medicine suggests that sleep apnea is a risk factor for chronic hypertension and heart disease. [New England Journal of Medicine, May 2000] |
Stroke| | There is evidence suggesting that individuals with obstructive sleep apnea may be at increased risk of stroke. |
Arrhythmias/Dysrhythmias| | Sleep apnea can also result in cardiac arrhythmias. Most often, the heart slows while the person stops breathing, and increases when the apneic episode ends. In 90% of those patients studied with nocturnal bradyarrythmia (slowed heart rate), there was no sign of heart rhythm abnormalities while awake. Bradyarrhythmias occurred only during sleep and varied considerably in frequency and severity. [American Heart Journal 2000; 139: pp.142-8] |
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Digestion |
Heartburn / GERD / Acid Reflux |
Mental |
Poor Memory
Depression |
Metabolic |
Insomnia |
Respiratory |
 Problems Associated With Snoring| | Sleep apnea manifests itself in most people as loud snoring interrupted by periods of obstructed breathing or breath holding. If you snore, it may be a symptom of a more serious disorder called obstructed sleep apnea (OSA). People with OSA almost always snore heavily, because the same narrowing of the airway that causes snoring can also cause OSA. Snoring may actually attribute to OSA as well, because the vibration of the throat tissues which occurs in snoring can cause the tissue to swell. |
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Skin-Hair-Nails |
Night Sweats |
Symptoms - Sleep |
Sleep apnea (confirmed) |
Uro-Genital |
Nocturia |
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Risk factors for Obstructive Sleep Apnea (OSA):
Obstructive Sleep Apnea (OSA) suggests the following may be present:
Obstructive Sleep Apnea (OSA) can lead to: | | | | | Circulation | Arrhythmias/Dysrhythmias| | Sleep apnea can also result in cardiac arrhythmias. Most often, the heart slows while the person stops breathing, and increases when the apneic episode ends. In 90% of those patients studied with nocturnal bradyarrythmia (slowed heart rate), there was no sign of heart rhythm abnormalities while awake. Bradyarrhythmias occurred only during sleep and varied considerably in frequency and severity. [American Heart Journal 2000; 139: pp.142-8] |
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Recommendations and treatments for Obstructive Sleep Apnea (OSA): | | | | | Diet |  Alcohol Avoidance| | Alcohol is useful for relaxation but unfortunately it also relaxes the throat muscles and provokes snoring and obstructive apneas. Alcohol or sedative use near bedtime may thus further depress breathing mechanisms. |
Weight Loss |
Hormone |
Not recommended:
 Testosterone| | More serious complications arising from testosterone supplementation include exacerbation of sleep apnea. |
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Physical Medicine |
 Physical Supports and Devices| | Although every patient is treated individually, continuous positive airway pressure (CPAP) is the most common treatment. It is simple, safe, effective, and non-invasive. CPAP treats Obstructive Sleep Apnea by providing a gentle flow of positive-pressure air through a mask to help keep the airway open during sleep. It stops the snoring, restores restful sleep, improves the quality of life, and reduces risk of heart complications. |
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KEY | | Weak or unproven link | | | Strong or generally accepted link | | | Proven definite or direct link | | | Likely to help | | | Highly recommended | | | Reasonably likely to cause problems |
GLOSSARY
Apnea
Cessation of breathing.
Arrhythmia (Arrhythmias)
A condition caused by variation in the regular rhythm of the heartbeat. Arrhythmias may cause serious conditions such as shock and congestive heart failure, or even death.
Cardiac
Pertaining to the heart, also, pertaining to the stomach area adjacent to the esophagus.
Cardiovascular
Pertaining to the heart and blood vessels.
Chronic (Chronicity)
Usually referring to chronic illness: Illness extending over a long period of time.
Hypertension
High blood pressure. Hypertension increases the risk of heart attack, stroke, and kidney failure because it adds to the workload of the heart, causing it to enlarge and, over time, to weaken; in addition, it may damage the walls of the arteries.
Hypothyroidism (Hypothyroid)
Diminished production of thyroid hormone, leading to low metabolic rate, tendency to gain weight, and sleepiness.
Over-The-Counter (OTC, Over The Counter)
A drug or medication that can legally be bought without a doctor's prescription being required.
Sedative
Calming, quieting; drug that quiets nervous excitement.
Stroke (Stroke-Type Event)
A sudden loss of brain function caused by a blockage or rupture of a blood vessel that supplies the brain, characterized by loss of muscular control, complete or partial loss of sensation or consciousness, dizziness, slurred speech, or other symptoms that vary with the extent and severity of the damage to the brain. The most common manifestation is some degree of paralysis, but small strokes may occur without symptoms. Usually caused by arteriosclerosis, it often results in brain damage.
Syndrome
A medical condition characterized by a collection of related symptoms (what the patient feels) and signs (what a doctor can observe or measure).
Testosterone
The principal male sex hormone that induces and maintains the changes that take place in males at puberty. In men, the testicles continue to produce testosterone throughout life, though there is some decline with age. A naturally occurring androgenic hormone.
Last updated: Nov 14, 2009
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