Understanding Obstructive Sleep Apnea

Understanding Obstructive Sleep Apnea

According to a study published in The Lancet Respiratory Medicine, obstructive sleep apnea (OSA) is a common but underdiagnosed sleep disorder that affects close to 936 million adults worldwide. In this figure, nearly 425 million people are found to be moderately to severely afflicted. In India alone, experts estimate that 4%-13% of the population may have OSA, but many remain undiagnosed. It reveals that this condition is quite prevalent, necessitating an understanding of the same, i.e., how to recognise symptoms and seek timely intervention.

What Is Obstructive Sleep Apnea?

Sleep apnea is a sleep disorder characterised by repeated episodes of interruption or decreased airflow during sleep, commonly known as apneas and hypopneas. In layman's terms, apnea is a complete pause in breathing for 10 seconds or more, with hypopnea denoting superficial or low breathing. Sleep apnea has two variants:
• Central Sleep Apnea
• Obstructive Sleep Apnea (OSA).

In Central Sleep Apnea, there is a failure of the brain to send proper signals to the muscles that control breathing. In contrast, OSA is due to an obstructive process somewhere in the upper airway that stops the normal passage of air while the brain continues to send signals to breathe.

In obstructive sleep apnea, obstruction can occur at several levels in the upper respiratory tract:

• Nasal cavity and soft palate: Obstructed air passage due to narrowed nasal openings or a collapsed soft palate.
• Oropharynx: Enlarged tonsils or other tissues in the throat can obstruct airflow.
• Base of the tongue and epiglottitis: The tongue may fall backwards in sleep and block the passageway, especially when sleeping supine.

This cycle of recurrent airway obstruction during sleep will consist of a series of mini-awakenings in which the OSA patient subconsciously goes in and out of consciousness to re-establish breathing. These interruptions can occur dozens and even hundreds of times during the night and can greatly fragment sleep.

Symptoms of Obstructive Sleep Apnea

One of the major challenges of OSA is that many patients are unaware of having it. This is because the major symptoms occur during sleep; often, it is a spouse or family member who first brings it to the attention of the patient. Symptoms include:

• Loud and chronic snoring: Snoring is often punctuated with pauses and choking or gasping sounds.
• Daytime drowsiness: Persons feel sleepy during the day despite having had a sufficient number of hours of sleep in bed.
• Frequent awakenings at night: These include disturbances to urination as well as sensations of choking, gasping, or waking up with a sense that they just stopped breathing.
• Unrefreshing sleep: Many of those who suffer from Obstructive Sleep Apnea will arise in the morning feeling as if they have never slept at all, despite having taken a full night of sleep.
• Morning headaches: Due to low oxygen levels and poor quality of sleep.
• Irritability, changes in mood, or depression: Disruption of sleep can take a major toll on emotional and mental well-being.
• Loss of memory and poor concentration: These cognitive impairments are alarming but very often go unnoticed.

Obstructive sleep apnea affects people severely in an untreated state, and its complications include a variety of health issues, including:

• High blood pressure, namely hypertension
• Heart disease and stroke
• Type 2 diabetes
• Weight gain and obesity
• Increased accidental injuries, especially while driving due to drowsiness

In children, obstructive sleep apnea may bring on behavioural problems, together with poor school performance, and it may even impact growth towards the end.

When these symptoms are recognised early, patients can receive a timely diagnosis and treatment, improving their quality of life tremendously. Anyone with loud snoring and excessive daytime sleepiness should consult an ENT specialist or a sleep medicine expert, who will be able to offer a detailed assessment. This often also includes a sleep study (polysomnography) to validate the diagnosis.

Diagnosis generally involves:
• Examination setup of the airway
• Comprehensive past medical history
• Overnight sleep study of breathing, oxygen levels, and brain activity during sleep.

Treatment for the condition depends on its severity and may involve:

• Lifestyle changes: These include losing weight or refraining from smoking, alcohol consumption, and exercising to maintain a healthy lifestyle.
• CPAP Therapy: Continuous airway positive pressure; a machine that keeps the airway open by delivering air pressure through a mask.
• Surgical Options: Surgery is required if there is an obstruction in the nasal passage and in the airway, and depending upon the sites of obstruction, the surgery is tailor-made according to the necessity of each individual patient.
Surgery may include: correction of the nasal septum, reduction of the turbinates, removal of adenoids (if there are any), shrinking or interiorly advancement of the soft palate, reduction of the tongue base, and removal of the tonsils. The patient may either require all the procedures or a single one, depending on the extent of the sleep apnea, which will depend on the CT scan findings and the endoscopic findings of each patient.

Obstructive Sleep Apnea is not just about loud snoring. It is a serious medical issue that poses an even greater threat to the physical and mental well-being of the uninitiated. In a condition where it exists at its greatest prevalence, diagnosis is often quite poor. Awareness is, therefore, the first step towards recovery. Put simply, any symptoms from those mentioned above should not be ignored. Seek consultation with a qualified ENT specialist in Delhi like Dr. Satinder Singh for a proper evaluation.