OBSTRUCTIVE SLEEP APNEA

What is obstructive sleep apnea?

Obstructive sleep apnea (OSA) is a common chronic sleep disorder affecting about 2–4% of the adult population, with the highest prevalence reported among middle-aged men. (1) The average prevalence is reported to be as high as 22% in men and 17% in women. It is a condition that causes occasional cessation of breath during sleep causing one to snore loudly or create choking noises while trying to breathe. The body slowly becomes deprived of oxygen and makes the patient to wake up abruptly. It is a common yet serious disorder that might even cause one to stop breathing once or even a hundred times during sleep. The airway repeatedly becomes blocked, limiting the quantity of air that reaches your lungs.

What is the difference between snoring and sleep apnea?

Snoring is a sound caused by the vibration of loose tissues in your mouth, nose, and throat. These tissues become relaxed as we sleep, so they are prone to vibrating when air passes over them. If airway becomes narrowed, then the speed of airflow over these tissues increases, which can cause more vibration and snoring. As a result, snoring is more likely if airflow through your nose or throat becomes partially blocked during sleep. In OSA, breathing stops or slows for seconds at a time at various points during sleep. This causes brief and partial awakenings, fragmented sleep, and daytime sleepiness. In contrast, normal snoring does not involve reductions or pauses in breathing. (2)

What are the symptoms?

The signs and symptoms can be divided based on those present during sleep and those present during the day as a consequence of the disturbed sleep. Individuals can suffer from snoring, disturbed sleep, gasping/chocking and frequent need to micturate. In the morning individuals can feel tiered, excessive day time sleepiness, unable to concentrate on any task, and frequently fall asleep during routine activities. (3)

How is it diagnosed?

The diagnoses of obstructive sleep apnea include multiple modalities. Following a through history and clinical examination, the individuals are subjected to specific questionnaires e.g. STOP Bang, Epworth sleepiness scale to assess the severity of the symptoms. The patient is then subjected to complete physical examination, nasal endoscopy, drug induced sleep endoscopy and polysomnography (sleep study) which is the gold standard for the diagnosis of sleep apnea. Different individuals depending on the specific requirement maybe subjected to a combination of these investigations for the appropriate diagnosis and to assess the severity of the condition and plan a management protocol.

The above figures represents the 2 most used questionnaire for the diagnosis of obstructive sleep apnea.

The above figure describes the drug induced sleep study and the different area of airway obstruction.(DISE) This is used to assess the problem as it mimics the sleep state of the individual as closely as possible.(4)

The above figure depicts the sleep study and the graph the result of the sleep study in an individual. The study can be done in a sleep lab, or a modified version can be done at home of the individual. (5)

Why should it be treated?

The reason obstructive sleep apnea needs to be treated is, can lead to daytime sleepiness, decreased productivity, increased motor vehicle accidents, and worsening hypertension, atrial fibrillation, and stroke. Many studies have linked the condition with heart disease, neurological disorders and decreased life span.

What are the treatment protocols?

The individuals after through evaluation will be assessed on the severity of the disease and associated comorbidities. The treatment options available will depend on these factors. The above chart describes broadly the protocols generally followed which can be tailor made for everyone.

At Bangalore Head and Neck Sciences & Bangalore ENT Institute, individuals with obstructive sleep apnea can get comprehensive care from our expert doctors with vast experience.

References:

1. Spicuzza L, Caruso D, Di Maria G. Obstructive sleep apnoea syndrome and its management. Ther Adv Chronic Dis. 2015 Sep;6(5):273-85. doi: 10.1177/2040622315590318. PMID: 26336596; PMCID: PMC4549693.

2. https://www.hunterdonent.com/ear-nose-throat/snoring-sleep-apnea/

3.https://www.mayoclinic.org/diseases-conditions/obstructive-sleep-apnea/symptoms-causes/syc-20352090

4. M.S., Dedhia, R.C. Current Techniques and Role of Drug-Induced Sleep Endoscopy for Obstructive Sleep Apnea. Curr Sleep Medicine Rep 3, 152–163 (2017).

5. https://comprehensivesleepcare.com/2020/04/16/sleep-study-faq/

6. Massimo R. Mannarino, Francesco Di Filippo, Matteo Pirro, Obstructive sleep apnea syndrome,European Journal of Internal Medicine,Volume 23, Issue 7,2012,Pages 586-593,ISSN 0953-6205