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Posted on Jan 09, 2017 by admin

Sleep Apnoea/Apnea

Sleep apnoea or apnea is a serious sleep disorder in which you have periods of shallow breathing or pauses in breathing while you sleep. "Apnoea" is a Greek word, which means "without breath." Sleep apnoea is primarily characterized by snoring and feeling tired despite getting a full night sleep and is more commonly seen in men than in women.

There are 3 main types of sleep apnoea:

  1. Obstructive sleep apnoea (OSA) is the most common type of sleep apnoea. It occurs during sleep when your pharyngeal airway repetitively narrows or collapses due to a significant decrease in your upper airway muscle tone. Obesity plays a role in the development of OSA. The amount of fat tissue around the neck may compress the airway when the tone of the pharyngeal muscles decreases with sleep onset.
    Obstructive Sleep Apnoea
    Obstructive Sleep Apnoea
  2. Central sleep apnoea occurs because of the way the brain functions. A person who has suffered a stroke or heart failure may experience this type of apnoea. Central sleep apnoea occurs because the brain does not send proper signals to the muscles that control breathing. Sleeping at a high altitude also may cause this type of apnoea.
    Central Sleep Apnea
    Central Sleep Apnea

Conditions which may cause or lead to central sleep apnea include:

  • Problems that affect the brain stem, including brain infection, stroke, or conditions of the cervical spine (neck)
  • Heart Failure
  • Severe obesity
  • Certain medicines, such as narcotic painkillers 3. Complex sleep apnoea syndrome, also known as treatment-emergent central sleep apnoea, occurs when a person has both obstructive and central sleep apnoeas.
    Pressure on the Brainstem can lead to sleep apneo
    Conditions Affecting the Brain Stem, brain infection and pressure on the Cerebellum

WHAT ARE THE SIGNS AND SYMPTOMS OF SLEEP APNOEA(Apnea)?

It is difficult to differentiate between obstructive sleep apnoea and central sleep apnoea. They have similar signs and symptoms, making the type of sleep apnoea difficult to determine. The most common signs and symptoms of obstructive and central sleep apnoeas are:

  • Heavy snoring—loud snoring produces pharyngeal trauma that may lead to inflammation or oedema of the pharyngeal tissues. The oedema or inflammation in turn may not only further narrow the upper airway but might also impair the normal function of the reflexes affecting upper airway size.
  • Episodes of breathing cessation during sleep witnessed by another person or documented by a sleep study.
  • Waking up with a dry mouth or a very sore or dry throat.
  • Abrupt awakenings with a choking or gasping sensation.
  • Morning headaches.
  • Difficulty staying asleep (insomnia)
  • Excessive daytime sleepiness (hypersomnia)
  • Lack of energy during the day and attention problems
  • Irritability, forgetfulness and decreased libido.
Annoyed wife blocking her ears from noise of husband snoring
Annoyed wife blocking her ears from noise of husband snoring

WHEN TO SEE A DOCTOR?

If sleep apnoea is left untreated, it can increase the risk of, or worsen, high blood pressure and heart disease and may make arrhythmias or irregular heartbeats more likely. It also increases the risk of stroke, obesity and diabetes. It increases the chance of having work-related or driving accidents caused by falling asleep at work or at the wheel. It can cause, or worsen, depression and other ailments.

You need to consult your doctor if you experience, or if your partner notices, the following:

  • Snoring loudly and heavily, enough to disturb the sleep of others or yourself.
  • When your partner notices your breathing stops, you gasp for air or choke while you sleep.
  • Excessive daytime drowsiness, which may cause you to fall asleep at inappropriate times, such as while you are working, eating or even driving.
    Falling asleep at work, in class or studying
    Falling asleep at work, in class or studying

HOW IS SLEEP APNOEA DIAGNOSED?

A board-certified sleep medicine physician has the training and expertise in diagnosing and treating sleep apnoea. You will need to provide the sleep medicine physician details of your symptoms and whether they began when you gained weight or stopped exercising. The physician may ask you to keep a sleep diary for two weeks to help him see your sleep patterns. This includes the time you went to bed each night, when you woke up in the morning and how many times you woke up each night. This information is important in making a correct diagnosis and treating your sleep problem.

An objective test may be needed before your physician can make a diagnosis. Objective evaluation of sleep apnoea falls into two categories: Polysomnography and limited channel monitoring.

A Polysomnogram (PSG) is considered the gold standard for diagnosing sleep

Polysomnography
Polysomnography

apnoea. This type of sleep study requires you to sleep overnight in a sleep laboratory while being monitored by a sleep technician. This study records brain waves, eye movements, chin muscle activity, air flow from the nose and mouth, chest and abdominal movement, blood oxygen levels, heart rate and rhythm and leg movements through the use of a combination of electroencephalogram (EEG), electrooculogram (EOG), electromyogram (EMG) and oximetry. This study is the more expensive option and is usually recommended for more complex cases because it provides the most complete information.

Home Sleep Study
Home Sleep Study

A limited channel monitoring records physiologic signals that are mostly focused on breathing and blood oxygen levels. The amount of information collected is lesser than those collected during polysomnography. This test, however, is less expensive and allows you to sleep in the comfort of your own home. The small testing equipment is less complicated to use and the sleep centre staff will show you how to set it up yourself. After the test, you can take the small monitor back to the sleep centre or send it by mail. This type of sleep study is also utilized for followup testing of people with OSA.

  Another way to assess if you are at risk of sleep apnoea is to take a self-evaluation test, the STOP-BANG survey. However, you must see your primary physician or sleep medicine physician to get a proper diagnosis. To access the self-evaluation test, please visit http://healthysleep.med.harvard.edu/sleep-apnea/diagnosing-osa/self-evaluation.

TREATMENT and THERAPY

  1. Weight loss. Losing weight can significantly improve and, in some cases, completely eliminate OSA. It is perhaps the single most effective way to reduce OSA. Since OSA is highly associated with obesity, losing weight is a priority for those who have OSA and are overweight or obese. Healthy lifestyle changes such as low fat diet and regular exercise will improve overall health and may lead to better sleep. If attempts to lose weight are unsuccessful, weight loss surgery might be necessary to lose weight and improve OSA for extremely obese persons.
    Weight Loss
    Weight Loss
  2. Continuous positive airway pressure (CPAP). CPAP is the most common treatment for OSA. It keeps your airway open by gently blowing compressed air through a mask or nose tube that you wear while you sleep. This type of treatment in general is successful; however, in order to be effective, the device has to be worn during sleep, which makes some people feel uncomfortable, anxious, claustrophobic and unable to sleep.
  1. Oral appliance therapy. This treatment is ideal for patients who cannot tolerate CPAP. This involves wearing a removable oral appliance in your mouth as you sleep. The dental device positions your lower jaw forward, which moves your tongue forward and keeps it from obstructing the back of your throat. The custom-made oral appliance is individually designed and constructed by a dental sleep medicine specialist or a dentist who specializes in treatment of OSA. Some people prefer this kind of treatment over CPAP because the device is small and easy to use. However, individuals with poor dentition and those who do not have their natural teeth cannot wear dental devices. Excessive saliva, jaw pain and tooth shifting are often experienced by patients with this kind of treatment.
    Orald Devices
    Orald Devices
  2. Positional Therapy. Some individuals experience OSA when they sleep flat on their back and positional therapy, such as avoiding back sleeping, often helps.
  3. Surgery Options. Surgical treatments for OSA are less common than nonsurgical treatments. The board-certified sleep medicine specialist may indicate surgery when applicable conservative therapies have failed to improve your symptoms. He may refer you to an otolaryngologist-head and neck surgeon (ENT) or oral surgeon who can perform the surgery. The goal of surgery is to address the parts of your airway that collapse and block your breathing while you sleep.
Surgery Options
Surgery Options

Uvulopalatopharyngoplasty (UPPP) is the most common surgery performed to treat sleep apnoea. It removes excess tissue from the sides of the throat behind the tongue, shortens the soft palate and removes the uvula to make the airway wider.

Tonsillectomy and adenoidectomy (T&A) surgery, on the other hand, is often performed on children who have enlarged tonsils and adenoids that cause their sleep apnoea.

Nasal surgery, such as removal of nasal polyps or turbinates or straightening of deviated septum, may not completely eliminate OSA, but it may improve breathing and may facilitate better CPAP use.

Maxillomandibular advancement (MMA) surgery can be an effective surgical treatment for sleep apnoea. By moving the upper and lower jaws forward, the airway can be enlarged. The results of this operation suggest that the improvement rate is greater than for UPPP. However, this surgery is more complicated than UPPP and has greater risk and longer recovery period.

As for central sleep apnoea, treatments may involve treating existing conditions that cause the apnoea, such as heart failure and stroke.

Resources:Sleep

https://www.nhlbi.nih.gov/health/health-topics/topics/sleepapnea/ http://www.sleepapnea.org/learn/sleep-apnea.html http://www.mayoclinic.org/diseases-conditions/sleep-apnea/basics/definition/con-20020286/ https://www.ncbi.nlm.nih.gov/pubmed/1735286/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2628457/ http://www.webmd.com/sleep-disorders/sleep-apnea/sleep-apnea/ http://www.sleepeducation.org/essentials-in-sleep/sleep-apnea/ http://healthysleep.med.harvard.edu/sleep-apnea/diagnosing-osa/testing/