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What is sleep apnea?

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If you have exhausted patients who fall asleep during the day and whose partners complain about snoring, they may have sleep apnea. Early intervention could improve their overall health, relationships and quality of life

What is sleep apnea?

Obstructive sleep apnea (OSA) is a condition caused by the pharyngeal muscles relaxing too much during deep sleep and obstructing the patient’s airway.

OSA causes the patient to snore, stop breathing, awaken a little to gasp for air, and fall back asleep. The constant awakenings disrupt sleep and the patient is often exhausted the next day

Patients usually say they suffer from exhaustion, depression, or ‘brain fog’ which is an inability to focus. They  are often referred by their partner due to loud snoring or decreased sex drive, or following an accident from falling asleep at work or while driving.

Sleep apnea patients may also have hypertension, diabetes, depression, and/or morning headaches. Although these are often treated separately, the root cause may be sleep apnea.

While up to 20% of adults suffer from sleep apnea1,2 and experience related co-morbidities, 80% of those are believed to be undiagnosed.3 Many do not know that they have it, or do not recognize the severity of their symptoms.

There are three types of sleep apnea

  • Obstructive sleep apnea (OSA) – the most common – where relaxation of the pharyngeal muscles obstruct the airway, causing breathing to stop throughout the night
  • Central sleep apnea – which is not as common as obstructive sleep apnea –  where the brain or nerves fail to trigger the breathing muscles to breathe during the night
  • Combination, or complex sleep apnea, where obstructive and central sleep apnea occurs together

Relative severities of sleep apnea

The physiological process of sleep apnea – the blocking of the airway, waking, breathing, etc. – is normal when it happens infrequently. However, a cycle of more than five times per hour indicates sleep apnea:

Normal Fewer than 5 interruption per hour
Mild sleep apnea Between 5 and 15 interruptions per hour
Moderate sleep apnea 15 to 30 interruptions per hour
Severe sleep apnea More than 30 interruption per hour

Affected populations

Sleep apnea can occur in all age groups and body types but there are several risk factors that dramatically increase the likelihood of having sleep apnea:

  • Obesity – around 77% of obese patients suffer from sleep apnea4
  • Advanced age – sleep apnea is more likely in populations over 50 years old
  • Thyroid conditions or goiter that constrict the neck or airway
  • Physical characteristics of the throat such as enlarged tonsils, and a small airway or nasal passages
  • Ingestion of alcohol, sedatives or sleeping pills before bed 

Symptoms

If you identify two or three of these common symptoms of sleep apnea in your patient, a sleep test may be an appropriate next step in the diagnosis. Symptoms include: 5

  • Snoring – many sleep apnea patients are referred to the doctor because their snoring keeps their partners awake
  • Gasping for air – patients or their bed partners may notice breathing pauses followed by choking or gasping
  • Feeling sleepy during the day – some people seek treatment after they have fallen asleep while driving or at work
  • Poor concentration
  • Feeling irritable or moody
  • Suffering from a reduced sex drive or erectile dysfunction
  • Frequent urination at night
  • Nightmares

Co-morbidities

Co-morbidities of sleep apnea include:

Poor cardiovascular health6,7

Hypertension8,9

Stroke9

Type 2 diabetes10,11,12,13

Self assessment

You can share this sleep apnea assessment with your patients, and review the likely presence of sleep apnea to determine if further testing is required.

References:

  1. O’Keefe, et.al., Evidence supporting routine Polysomnography before bariatric surgery, in,Obesity Surgery, January 2014
  2. Young, T., Peppard, P.E., & Gottlieb, D.J. (2002). Epidemiology of obstructive sleep apnea: a population health perspective. Am. J. Respir. Crit. Care Med, 165, 1217-1239.
  3. Obstructive sleep apnea – a guide for GP’s, British Lung Foundation (NHS.
  4. Sleep breathing disorders, in, European Respiratory Society Whitebook, Chapter 23
  5. Patient information series – Sleep mini series #4, in, Obstructive Sleep Apnea and Heart Disease, American Thoracic Society.
  6. Logan, et.al.High prevalence of unrecognized sleep apnoea in drug-resistant hypertention, in, Journal of Hypertension, 2001
  7. Einhorn, et.al., Prevalence of sleep apnea in a population of adults with type 2 diabetes Mellitus, in, Endocrine Practice, 2007; 13(4):355-362
  8. Peppard PE, Young T, Palta M, Skatrud J (2000): Prospective study of the association between sleep-disordered breathing and hypertension. NEJM 342(19): 1378-1384
  9. Logan, et.al.High prevalence of unrecognized sleep apnoea in drug-resistant hypertention, in, Journal of Hypertension, 2001
  10. Einhorn, et.al., Prevalence of sleep apnea in a population of adults with type 2 diabetes Mellitus, in, Endocrine Practice, 2007; 13(4):355-362 
  11. Peppard PE, Young T, Palta M, Skatrud J (2000): Prospective study of the association between sleep-disordered breathing and hypertension. NEJM 342(19): 1378-1384.
  12. Bottini P, Dottorini ML, Cristina Cordoni M, Casucci G, Tantucci C (2003): Sleep-disordered breathing in nonobese diabetic subjects with autonomic neuropathy. Eur Respir J 22: 654- 660
  13. Elmasry A, Lindberg E, Berne C, Janson C, Gislason T, Awad Tageldin M, Boman G (2001): Sleep-disordered breathing and glucose metabolism in hypertensive men: a population-based study. J Intern Med 249(2): 153-161
     

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