Sleep Apnea - What Is Obstructive Sleep Apnea?

Obstructive Sleep Apnea Syndrome - Causes And Treatment

Obstructive Sleep Apnea – Introduction and Definition

This is a condition in which a person doesn't get oxygen into his or her lungs despite the respiratory derive. In other words due to some hindrance, oxygen doesn't reach to the lungs in the presence of well functioning respiratory system. In obstructive sleep apnea, there is a significant airflow limitations down the lungs in the presence of good breathing. Hence if there is no problem in the breathing then the only thing which hinders the airflow could be obstruction or hurdle in the airway passage that doesn't allow the air to go inside the body.

Obstructive Sleep Apnea - Mechanism 

Note that, the respiratory passage or tubes of air starts from the nose or mouth and from there air enters in a cavity called as pharynx. Down the pharynx another tube takes the air delivery which is called as larynx. From larynx wind pipe or trachea arises. From the trachea air enters in to another passage or tube called as bronchus. There are further divisions of these tubes inside the lungs but the description of them is beyond the scope of present discussion.

Obstructive Sleep Apnea - How Develops? 

In brief, some thing in the throat, trachea or larynx prevents the air entry into the lungs and hence a person for short period of time gets air hunger (apnea means no air or breathing). As the name suggests, this episode usually happens during sleep times, when a person wakes up with air hunger. This episodes repeats on and off. Some of the people get more episodes and severe apnea (1-2 times per minute during sleep)

Obstructive Sleep Apnea – Strong Associations

1. Hypertension
2. Cardiovascular Disease
3. Coronary Artery Disease (Heart Attack and Angina)
4. Insulin Resistance Diabetes Mellitus
5. Depression
6. Sleepiness related Road Traffic Accidents ( As the person remain sleepy most of the time)

Obstructive Sleep Apnea – Risk Factors

1. Male, with elderly age and positive family history
2. Overweight and obese, having large neck
3. Alcohol use and smoking
4. Sleeping straight with mouth facing the roof all the time
5. Patients with Diabetes, Heart and lung problems and having stroke
6. Environmental exposure to smoke, allergens etc
7. Endocrinal problems and Hypothyroidism
8. Abnormal neck and jaw posture, tracheal tug etc during sleep
9. Nasal and pharyngeal airway resistance and problems
10. Any structure of throat and neck that decrease the air passage

Symptoms and Signs of Sleep Apnea:

1. Snoring
2. Sleepiness (Good Sleeper, can sleep any time any where)
3. Breathlessness
4. Usually the spouse or other family members reports these events and patients may some times remain unaware
5. Chocking and gasping sensations at night
6. Memory and intellectual impairment
7. Personality and mood changes, Depression and Anxiety
8. Coming up of stomach contents in mouth during sleep (Gastro-esophageal Reflux)
9. Confusion
10. On examination, compressed pharynx and abnormalities are found in throat structures, tongue etc

Obstructive Sleep Apnea – Treatment: 

1. First line therapy for mild to moderate cases is OA. The passage for the airway is corrected. Whatever is the problem either in the mouth, nasal cavity or pharynx etc, with different appliances, they are corrected and patient is advised for good posture during sleep. Associated problems mentioned above if found are treated.
2. CPAP – Continuous Positive Airway Pressure. In this technique via machine positive pressure of air is delivered via face mask to the patient. Since the air is delivered through high pressure, therefore; the tension of oxygen in the lungs remains high during sleep and patient doesn't get sleep apnea
3. BIPAP – Biphasic Intermittent Positive Airway Pressure: In this method, another machine is used to deliver the oxygen which works in two phases, one for inhalation and other for exhalation. This machine is used when the patient starts to accumulate CO2 in his body.

Very nice elaboration

Doctor KK