Do you find yourself waking up at night gasping for air? Maybe your significant other tells you that your snoring annoys them. Do you feel excessively tired or sleepy during your day? These are signs of possible sleep apnea and can have health impacts beyond just affecting your quality of sleep.
Obstructive sleep Apnea (OSA) is a condition where you have repeated episodes of upper airway collapse and obstruction during sleep associated with arousal from sleep and possibly oxygen desaturation. The airway obstruction can be partial or complete. Sleep is fragmented from these episodes, which can number 5- >30 per hour. It is actually considered normal to have a few of these mild apnea events every night. 5-14 apnea events per hour during sleep is considered mild, 15-30 is moderate and over 30 is severe.
OSA is prevalent but the studies are mixed on just what percentage of the population actually suffer from it. It is clear that more men than women have OSA as well as more elderly than young. Depending on what study you read anywhere from 20-40% of men and 10-23% of women have OSA. Some studies show more black men than white men have OSA while others show no difference at all. Chinese men do have a higher prevalence as well as possibly native Americans.
The most well known symptom of OSA is snoring. Other symptoms are: excessive daytime sleepiness, observed episodes of stopped breathing during sleeping, abrupt awakenings with gasping or choking, dry mouth or sore throat, mood changes like irritability or depression, high blood pressure, night time sweating, morning headaches and decreased libido.
The major risk factors for sleep apnea are being obese, male and older. Other factors are having craniofacial abnormalities, deviated septum, hypothyroidism, polycystic ovarian syndrome, smoking and alcohol use. Taking medicines that can relax muscles such as valium or narcotics like vicodin can cause problems too.
Sleep apnea is also associated with a number of comorbid illnesses. If you are diagnosed with OSA then you are at higher risk of also having strokes, heart attacks, hypertension, diabetes, congestive heart failure, depression and arrhythmias like atrial fibrillation. So far there has not been a clear causal relationship found between these illnesses and OSA. It makes sense though, that most people with OSA are overweight or obese and so people that are overweight are more likely to have those other conditions listed too.
How do you diagnose OSA? You start with a history and physical exam by your doctor. The Epworth sleepiness scale and the STOP-BANG questionnaires can be used to screen for OSA. IF your doctor decides after examining you that you qualify for testing then they may order either a polysomnography test or a home sleep apnea test. The home test is a good test and can easily make the diagnosis of OSA but it isn’t as good at defining the severity of the disease. The polysomnography test is the gold standard but requires the patient to go to a sleep lab for an overnight test. Obviously it is less hassle for the patient to just do a home test and to make things even easier now there is a company, Blackstone Medical Services that offers an online evaluation for people who think they may have sleep apnea.
How do you treat obstructive sleep apnea? Since so many of the patients with OSA are overweight the first line of treatment is weight-loss. The next line of therapy is a device used to keep positive pressure in your airway so it can’t collapse. There are several options available, continuous positive airway pressure (CPAP) or bilevel positive airway pressure (BIPAP). Most devices use a mask that covers your nose and mouth but there is also a nasal only option. These devices can feel awkward at first but once you get comfortable wearing them most patients report feeling much better. Research is still being done on whether these devices also improve outcomes on the comorbid conditions like strokes and heart attacks. As of now the results are mixed. Other things you can do for yourself is cut down on alcohol intake, exercise regularly and stop smoking. If you think you might suffer from OSA then go see your doctor about getting tested.
John Turner MD
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