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Sleep apnea

Sleep apnea

Sleep apnea is a potentially serious sleep disorder in which breathing repeatedly stops and starts. If you snore loudly and feel tired even after a full night's sleep, you might have sleep apnea.

Sleep apnea is a serious sleep disorder that occurs when a person's breathing is interrupted during sleep. sometimes hundreds of times. This means the brain and the rest of the body may not get enough oxygen.

There are two types of sleep apnea:

  • Obstructive sleep apnea (OSA): The more common of the two forms of apnea, it is caused by a blockage of the airway, usually when the soft tissue in the back of the throat collapses during sleep.
  • Central sleep apnea: Unlike OSA, the airway is not blocked, but the brain fails to signal the muscles to breathe, due to instability in the respiratory control center.
  • Mixed sleep apnea: occurs when there is both central sleep apnea and obstructive sleep apnea.

Sleep apnea facts

  • Sleep apnea is defined as a reduction or cessation of breathing during sleep,
  • The three types of sleep apnea are central apnea, obstructive apnea, and a mixture of central and obstructive apnea.
  • Central sleep apnea is caused by a failure of the brain to activate the muscles of breathing during sleep.
  • Obstructive sleep apnea is caused by the collapse of the airway during sleep.
  • The complications of obstructive sleep apnea include high blood pressure, strokes, heart disease, automobile accidents, and daytime sleepiness as well as difficulty concentrating, thinking and remembering.
  • Obstructive sleep apnea is diagnosed and evaluated by history, physical examination and polysomnography (sleep study).
  • The nonsurgical treatments for obstructive sleep apnea include behavior therapy, including weight loss, medications, dental appliances, continuous positive airway pressure, bi-level positive airway pressure, and auto-titrating continuous positive airway pressure.
  • The surgical treatments for obstructive sleep apnea include nasal surgery, palate surgery (including uvulopalatopharyngoplasty [UPPP]), upper airway stimulation therapy, tongue reduction surgery, genioglossus advancement, maxillo-mandibular advancement, tracheostomy, and bariatric surgery.

Symptoms

Common sleep apnea symptoms include:

  • Waking up with a very sore or dry throat
  • Loud snoring
  • Forgetfulness, mood changes, and a decreased interest in sex
  • Sleepiness or lack of energy during the day
  • Occasionally waking up with a choking or gasping sensation
  • Sleepiness while driving
  • Recurrent awakenings or insomnia
  • Morning headaches
  • Restless sleep

Children’s Sleep Apnea
Does your child snore? Does your child show other signs of disturbed sleep: long pauses in breathing, much tossing and turning in the bed, chronic mouth breathing during sleep, night sweats (owing to increased effort to breathe)? All these, and especially the snoring, are possible signs of sleep apnea, which is commoner among children than is generally recognized. It’s estimated than 1 to 4 percent of children suffer from sleep apnea, many of them being between 2 and 8 years old.

Furthermore, while there is a possibility that affected children will “grow out of” their sleep disorders, the evidence is steadily growing that untreated pediatric sleep disorders including sleep apnea can wreak a heavy toll while they persist. Studies have suggested that as many as 25 percent of children diagnosed with attention-deficit hyperactivity disorder may actually have symptoms of obstructive sleep apnea and that much of their learning difficulty and behavior problems can be the consequence of chronic fragmented sleep. Bed-wetting, sleep-walking, retarded growth, other hormonal and metabolic problems, even failure to thrive can be related to sleep apnea. Some researchers have charted a specific impact of sleep disordered breathing on “executive functions” of the brain: cognitive flexibility, self-monitoring, planning, organization, and self-regulation of affect and arousal.

Several recent studies show a strong association between pediatric sleep disorders and childhood obesity. Judith Owens, M.D., director of sleep medicine at the National Children&’s Medical Center in Washington, DC, who is a member of the ASAA board of directors, believes that adequate healthy sleep is as important as proper diet and sufficient exercise in preventing childhood obesity.

Causes

  • Obstructive sleep apnea
    This occurs when the muscles in the back of your throat relax. These muscles support the soft palate, the triangular piece of tissue hanging from the soft palate (uvula), the tonsils, the side walls of the throat and the tongue.

    When the muscles relax, your airway narrows or closes as you breathe in. You can't get enough air, which can lower the oxygen level in your blood. Your brain senses your inability to breathe and briefly rouses you from sleep so that you can reopen your airway. This awakening is usually so brief that you don't remember it

    You might snort, choke or gasp. This pattern can repeat itself five to 30 times or more each hour, all night, impairing your ability to reach the deep, restful phases of sleep.

  • Central sleep apnea
    This less common form of sleep apnea occurs when your brain fails to transmit signals to your breathing muscles. This means that you make no effort to breathe for a short period. You might awaken with shortness of breath or have a difficult time getting to sleep or staying asleep.

Complications

  • High blood pressure or heart problems
    Sudden drops in blood oxygen levels that occur during sleep apnea increase blood pressure and strain the cardiovascular system. Having obstructive sleep apnea increases your risk of high blood pressure (hypertension).

    Obstructive sleep apnea might also increase your risk of recurrent heart attack, stroke and abnormal heartbeats, such as atrial fibrillation. If you have heart disease, multiple episodes of low blood oxygen (hypoxia or hypoxemia) can lead to sudden death from an irregular heartbeat.

  • Type 2 diabetes
    Having sleep apnea increases your risk of developing insulin resistance and type 2 diabetes.

  • Metabolic syndrome
    This disorder, which includes high blood pressure, abnormal cholesterol levels, high blood sugar and an increased waist circumference, is linked to a higher risk of heart disease.

  • Liver problems
    People with sleep apnea are more likely to have abnormal results on liver function tests, and their livers are more likely to show signs of scarring (nonalcoholic fatty liver disease)

  • Sleep-deprived partners
    Loud snoring can keep anyone who sleeps near you from getting good rest. It's not uncommon for a partner to have to go to another room, or even to another floor of the house, to be able to sleep.

Risk Factors

Adult obstructive sleep apnea (OSA) is a common condition. One frequently cited study suggests that 4% of middle-aged men and 2% of middle-aged women in the United States have OSA.1 However, this is a conservative estimate, and the number is likely much higher.

Several factors can increase the risk of developing OSA. Some are hereditary; others are the result of age and/or lifestyle. Do any of these risk factors apply to you?

  • Obesity: approximately two-thirds of people with OSA are overweight or obese
  • Family history of OSA or snoring
  • Small lower jaw and certain other facial configurations
  • Male gender
  • Large neck circumference
  • Large tonsils
  • Alcohol consumption at bedtime
  • Post-menopausal (for women)
  • Hypothyroidism (low levels of thyroid hormone)
  • Acromegaly (high levels of growth hormone)

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