By: Seth Spotnitz, MD
Obstructive Sleep Apnea (OSA) is a disease characterized by repetitive episodes of upper airway obstruction during sleep which often causes a reduction in blood oxygen levels.
As many as 24% of males and 9% of females may suffer from OSA. Many of these people are unaware that they suffer from a dangerous disease. Untreated OSA can have severe medical consequences.
The most common symptoms of OSA are snoring, excessive daytime sleepiness, pauses in breathing at night and feeling unrefreshed upon awakening in the morning.
Excessive sleepiness has been found to be responsible for more motor vehicle accidents than drunk driving. It also results in numerous work-related accidents. The Exxon Valdez oil spill in Alaska was found not to be due to alcohol abuse, but due to sleep deprivation.
OSA can also cause:
• Excessive daytime sleepiness (EDS)
• Impaired school and work performance
• Produces depression and irritability
• Marital problems
• Impaired memory and concentration
One study found that patients with OSA had an IQ 10 points below normal than patients without sleep apnea.
Interestingly, in children, OSA may result in hyperactivity rather than excessive sleepiness. As many as one-third of children diagnosed with attention deficit disorder are suffering from OSA. Symptoms in children include noisy breathing during sleep, rib cage retractions and irregular body positions in sleep.
There are several predisposing factors to OSA. Males are more likely to have it than females. Obesity is strongly correlated with obstructive sleep apnea. Alcohol usage is likely to exacerbate OSA. Most people with OSA are between the ages of 40-60, but OSA may occur at any age. Other physical findings included increased neck size, enlarged tonsils and an elongated palate.
OSA can have serious cardiovascular consequences. It can produce hypertension, congestive heart failure and heart disturbances. It may also produce myocardial infarction and sudden death from cardiac arrhythmias. People who snore and have underlying cardiovascular disease have a mortality rate four times greater than patients with underlying cardiovascular disease who do not snore. Even snorers who have no cardiovascular risk factors have twice the mortality rate of people who do not snore and have no cardiovascular risk factors.
OSA can produce systemic hypertension. One-third of patients with OSA have hypertension. Also, one-third of patients with hypertension have OSA. Often OSA produces hypertension which is resistant to most drugs. Eighty-three percent of patients who have drug resistant hypertension have been found to have OSA.
People with OSA have a drop in their blood oxygen levels at night. This results in increased heart irritability and produces irregular cardiac rhythms. This is especially dangerous for those people with underlying heart disease. People with OSA are four times more likely to develop heart attacks than people without OSA. Patients with OSA are also five times more likely to develop a stroke. The average person with OSA loses 7 out of every 20 years of life.
OSA can be diagnosed by having an all-night sleep study known as a polysomnogram. During this study different stages of sleep are recorded as well as snoring, oxygen saturation, breathing, chest and abdomen movements and limb movement activity. After this test, physicians can tell numerous things about a person’s sleep physiology including whether that person has OSA.
The most common treatment for OSA is known as continuous positive airway pressure (CPAP). A CPAP machine provides a continuous flow of air through a mask that is either placed over the patient’s nose or the patient’s nose and mouth. The air flow keeps the patient’s upper airway open and prevents snoring and apneic episodes.
Sometimes other treatments can also be used for OSA. Oral appliances may work in some patients. Throat surgery may be effective for some patients with mild to moderate OSA.
In summary, snoring can be dangerous especially if it is a symptom of OSA. Sleep apnea can be easily diagnosed and treated. Following treatment, the adverse health consequences of having OSA completely disappear.