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Obstructive Sleep Apnea

Suspected sleep apnea is the most common reason people are referred for a sleep evaluation. Characterized by the patient’s snoring and/or gasping sounds throughout the night, sleep apnea causes daytime fatigue and drowsiness for many people. Recent population studies have indicated one in five adults have some degree of sleep apnea.

An “apnea” is actually a cessation of breathing that can last from 10 seconds to more than a minute. It occurs when the muscles in a person’s upper airway fail to work properly during sleep, causing the airway to collapse and close. For some people, apneas can occur hundreds of times a night. Each time an apnea occurs, the person is momentarily—although unknowingly—awakened in the struggle to restore breathing. It’s no wonder that a person with sleep apnea is always exhausted!

Mild forms of obstructive sleep apnea, which are characterized by simple loud snoring, may still cause frequent brief arousals during the night and lead to excessive fatigue.

In addition to causing constant drowsiness, sleep apnea has other potential side effects, including weight gain, elevated blood pressure, depression, irritability, memory lapses and even heart attack or stroke.

Obstructive sleep apnea may also occur in children, with significant impact on daytime behavior and scholastic abilities. The daytime symptoms of childhood sleep apnea may be mistaken for Attention Deficit Hyperactivity Disorder.

The physiology of obstructive sleep apnea
The most common type of sleep apnea is obstructive sleep apnea, during which breathing is blocked by a temporary obstruction of the main airway in the back of the throat. This occurs when the tongue and throat muscles relax, causing the main airway to close. The sleeping patient continues to make breathing efforts, but the obstruction prevents any airflow into the lungs.

After a short interval—lasting seconds to minutes—the oxygen level in the body drops, causing breathing efforts to become more vigorous, which eventually opens the obstruction and allows airflow to resume. This often occurs with a loud snort and jerking of the body, causing the patient to partially wake up.

After a few breaths, the oxygen level returns to normal, the patient falls back asleep, the muscles in the main airway relax, and the obstruction occurs again. This cycle can repeat itself hundreds of times each night.

Normally, the main airway in the throat remains open, allowing the patient to breathe normally.

During obstructive sleep apnea, the tongue and throat muscles relax, blocking the main airway.

The gold standard for treating obstructive sleep apnea is continuous positive airway pressure therapy (CPAP), which uses slightly pressurized air to help keep the main airway open.

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