Obstructive sleep apnea

• Alternative Names

  Sleep apnea - obstructive; Apnea - obstructive sleep apnea syndrome; Sleep-disordered breathing

• Causes, incidence, and risk factors

  Normally, the muscles of the upper part of the throat help keep the airway open and allow air to flow into the lungs. Even though these muscles usually relax during sleep, the upper throat remains open enough to let air pass by.

  However, some people have a narrower throat area. When the muscles in their upper throat relax during sleep, their airway may completely close. This prevents air from getting into the lungs. Loud snoring and labored breathing occur. During deep sleep, breathing can stop for a period of time (often more than 10 seconds). This is called apnea.

  An apnea episode is followed by a sudden attempt to breathe, and a change to a lighter stage of sleep. The result is fragmented or interrupted sleep that is not restful. As a result, those with sleep apnea feel more drowsy or sleepy during the day, called excessive daytime drowsiness.

  Older obese men seem to be at higher risk, although many people with obstructive sleep apnea are not obese. The following factors may also increase your risk for obstructive sleep apnea:

  • Certain shapes of the palate and jaw
  • Large tonsils and adenoids in children
  • Large neck or collar size
  • Large tongue
  • Narrow airway
  • Nasal obstruction
  • Obesity

  Drinking alcohol or using sedatives before sleep may make you more likely to have an episode of apnea.

• Symptoms

  A person who has obstructive sleep apnea often is not aware of the apnea episodes during the night. Often, family members, especially spouses, witness the periods of apnea.

  A person with obstructive sleep apnea usually snores heavily soon after falling asleep. The snoring continues at a regular pace for a period of time, often becoming louder. It is then interrupted by a long silent period during which there is no breathing. This is followed by a loud snort and gasp, and the snoring returns. This pattern repeats frequently throughout the night.

  The main symptoms are usually associated with excessive daytime sleepiness:

  • Abnormal daytime sleepiness, including falling asleep at inappropriate times
  • Awakening unrefreshed in the morning

  Other symptoms may include:

  • Depression (possibly)
  • Memory difficulties
  • Morning headaches
  • Personality changes
  • Poor concentration
  • Restless and fitful sleep
  • Frequent waking up during the night to urinate
  • Insomnia

  Other symptoms that may occur with this disease:

  • Hyperactive behavior, especially in children
  • Leg swelling (if severe)
• Signs and tests

  The health care provider will perform a complete history and physical exam. This will involve carefully checking your mouth, neck, and throat. You may be given a survey that asks a series of questions about daytime sleepiness, sleep quality, and bedtime habits.

  A sleep study (polysomnogram) is used to confirm obstructive sleep apnea.

  Other tests that may be performed include:

  • Arterial blood gases
  • Electrocardiogram (ECG)
  • Echocardiogram
  • Thyroid function studies
• Treatment

  The goal is to keep the airway open so that breathing does not stop during sleep.

  The following lifestyle changes may relieve symptoms of sleep apnea in some individuals:

  • Avoiding alcohol or sedatives at bedtime
  • Avoiding sleeping on the back
  • Losing weight

  CPAP is now regarded as the first-line treatment for obstructive sleep apnea in most people. Many patients cannot tolerate CPAP therapy. Good follow-up and support from a sleep center can often help overcome any problems in using CPAP. For information on this treatment, see: CPAP.

  Some patients may need dental devices inserted into the mouth at night to keep the jaw forward.

  Surgery may be an option in some cases. This may involve:

  • Uvulopalatopharyngoplasty (UPPP) -- to remove excess tissue at the back of the throat
  • More invasive surgeries -- to correct abnormal structures of the face in rare cases when patients have severe sleep apnea or treatment has not helped
  • Tracheostomy -- to create an opening in the windpipe to bypass the blocked airway if there are anatomical problems (rarely done)
  • Surgery on the nose and sinuses

  Surgery to remove the tonsils and adenoids may cure the condition in children; it does not seem to help most adults.

• Expectations (prognosis)

  With treatment, the symptoms of sleep apnea should be totally corrected.

• Complications

  Because of daytime sleepiness, people with sleep apnea have an increased risk of:

  • Motor vehicle accidents from driving while sleepy
  • Industrial accidents from falling asleep on the job

  Untreated obstructive sleep apnea may lead to, or worsen cardiovascular disease, such as:

  • High blood pressure
  • Heart failure
  • Stroke
  • Heart arrhythmias
• Calling your health care provider

  Call your health care provider if:

  • You have excessive daytime sleepiness
  • You or your family notice symptoms of obstructive sleep apnea
  • You have this condition, and symptoms do not improve with treatment or new symptoms develop

  Seek immediate medical attention or call your local emergency number (such as 911) if you experience the following signs of a medical emergency:

  • Decreased consciousness
  • Extreme sleepiness
  • Hallucinations
  • Personality changes
  • Persistent confusion
• Prevention

  Children with very large tonsils and adenoids may develop sleep apnea and related problems. They should be checked by a health care provider to determine whether they need further evaluation.

  See: Tonsillectomy

• References

  Bradley TD, Floras JS. Obstructive sleep apnoea and its cardiovascular consequences. The Lancet. 2009;373:82-93.

  Patel NP, Ahmed M, Rosen I. Split-night polysomnography. Chest. 2007 Nov;132(5):1664-71.

  Basner RC. Continuous positive airway pressure for obstructive sleep apnea. N Engl J Med. 2007 Apr 26;356(17):1751-8.

  Patil SP, Schneider H, Schwartz AR, Smith PL. Adult obstructive sleep apnea: pathophysiology and diagnosis. Chest. 2007 Jul;132(1):325-37.

  Darrow DH. Surgery for pediatric sleep apnea. Otolaryngol Clin North Am. 2007 Aug;40(4):855-75.

Review Date: 8/21/2009

Reviewed By: Andrew Schriber, MD, FCCP, Specialist in Pulmonary, Critical Care, and Sleep Medicine, Virtua Memorial Hospital, Mount Holly, New Jersey. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.