Sleep Apnea

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Introduction

What is sleep apnea?

Sleep apnea is the name of a common disease characterized by interruption of breathing during sleep. This interruption of breathing causes an abnormal blood oxygen level, resulting in fatigue, as well as cardiovascular, cognitive and emotional disorders.

Sleep apnea is a common sleep disorder in the United States. The disease is more common in men, African Americans, Hispanics, and Pacific Islanders than in other groups. Further, at least one in 10 people older than 65 has sleep apnea (Source: NHLBI).

Sleep apnea occurs due to two causes: obstruction of the airways and irregular brain signals. Most commonly, people develop sleep apnea from relaxation of soft tissue in the back of the throat that blocks the passage of air, resulting in obstructive sleep apnea (OSA). Central sleep apnea (CSA) is caused by irregularities in the brain’s normal signals to breathe.

The signs and symptoms of sleep apnea can last indefinitely or come and go. The disease course varies among individuals. Some people with sleep apnea have no symptoms, while others may have severe problems with sleep, decreases in blood oxygen levels (hypoxia), difficulty concentrating, irritability, and fatigue. Fortunately, sleep apnea can be treated successfully with lifestyle changes, breathing devices, and, in severe cases, surgery.

Seek immediate medical care (call 911) for serious symptoms, such as chest pain, headache, shortness of breath, severe sweating, or weakness or numbness on one side of the body.

Symptoms

What are the symptoms of sleep apnea?

Sleep apnea causes frequent drops in your oxygen level, and reduced sleep quality triggers the release of stress hormones. This raises your heart rate and increases your risk of high blood pressure, heart attack, stroke, and arrhythmias (irregular heartbeats).

Common symptoms of sleep apnea

You may experience sleep apnea symptoms daily or just once in a while. At times, any of these sleep symptoms can be severe:

  • Decreased libido
  • Dryness in your throat when you wake up
  • Excessive daytime sleepiness
  • Irritability
  • Memory problems
  • Morning headaches
  • Poor concentration
  • Snoring that can be loud and persistent
  • Urination at night

Serious symptoms that might indicate a life-threatening condition

In some cases, sleep apnea can be life threatening. Seek immediate medical care (call 911) if you, or someone you are with, have any of these life-threatening symptoms:

  • Chest pain or pressure
  • Difficulty breathing
  • Profuse sweating
  • Weakness (loss of strength) on one side of the body
Causes

What causes sleep apnea?

Sleep apnea is the result of obstruction or irregular brain signaling. The disease is characterized by brief interruptions of breathing during sleep.

The most common type of sleep apnea is obstructive sleep apnea (OSA), caused by soft tissue or structural obstructions that restrict air flow through the windpipe. For this reason, sleep apnea occurs most frequently in people who are obese.

Central sleep apnea (CSA) is much less common, and occurs due to the brain failing to signal the respiratory system to breathe. Heart disease and stroke are commonly associated with CSA. Similar to OSA, this disorder results in awaking with shortness of breath, snoring, and fatigue.

OSA causes of sleep apnea

Obesity is one obstructive cause of sleep apnea. Extra soft tissue (fat) can thicken the wall of the windpipe and narrow the opening, which makes it more difficult to keep open.

Other OSA causes of sleep apnea include:

  • Alcohol or drug use before bedtime
  • Large tongue and tonsils compared with the opening of the windpipe
  • Low soft palate
  • Shape of the head and neck that creates a smaller airway size
  • Throat muscles and tongue relax more than normal

CSA causes of sleep apnea

CSA causes of sleep apnea include any brain disorder or disease that decreases the brain’s signals to the respiratory system to breathe, as well as the aging process, which limits the ability of the brain signals to keep the throat muscles stiff during sleep. This increases the likelihood that the airway will narrow or collapse.

What are the risk factors for sleep apnea?

A number of factors increase the risk of developing sleep apnea. Not all people with risk factors will get sleep apnea. Risk factors for sleep apnea include:

  • Acromegaly
  • African American, Hispanic, and Pacific Islander race
  • Age over 40
  • Alcohol or sedative use
  • Excess weight
  • Family history of sleep apnea
  • Male gender
  • Narrow airway
  • Nasal obstruction, such as polyps, deviated septum, etc
  • Neck circumference greater than 17 inches (or 43 centimeters)
  • Male gender
  • Tonsillar hypertrophy in children

Reducing your risk of sleep apnea

You may be able to lower your risk of sleep apnea by:

  • Avoiding alcohol and sleeping medications
  • Avoiding driving or operating heavy machinery when feeling sleepy
  • Keeping nasal passages open
  • Losing excess weight
  • Sleeping on your side or on your stomach
Treatments

How is sleep apnea treated?

Treatment for sleep apnea begins with seeking medical care from your health care provider. To determine if you have sleep apnea, your health care provider will ask you to undergo diagnostic testing.

The type of treatment for sleep apnea depends on cause and severity of the condition and medical history of the individual.

Main treatment for sleep apnea

The mainstay of treatment for sleep apnea is lifestyle changes including:

  • Avoiding alcohol and sleeping medications
  • Keeping nasal passages open
  • Losing excess weight
  • Sleeping on your side or on your stomach
  • Sleeping with a special pillow or mouthpiece to keep your airway open

Additional treatments for sleep apnea

Additional treatments for sleep apnea are sleeping devices including:

  • Automatic positive airway pressure (APAP)
  • Continuous positive airway pressure (CPAP)
  • Variable positive airway pressure (VPAP)

Finally, surgery may be performed to remove tissue and widen the airway. Some individuals may need a combination of therapies to successfully treat their sleep apnea.

What are the potential complications of sleep apnea?

Hypoxia, a complication of sleep apnea, can be serious and even life threatening in some cases. You can minimize your risk of serious complications by following the treatment plan you and your health care professional design specifically for you and taking all medication as prescribed.

If left untreated, prolonged hypoxia can lead to serious consequences including:

  • Adverse effects of treatment
  • Arrhythmias (irregular heartbeats)
  • Heart attack (myocardial infarction)
  • Myocardial infarction
  • Transient ischemic attack (temporary stroke-like symptoms that may be a warning sign of an impending stroke)
  • Work-related and driving accidents
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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2018 Nov 18
  1. MacKay, Stuart (June 2011). "Treatments for snoring in adults". Australian Prescriber (34): 77–79.
  2. Domino FJ (Ed.) Five Minute Clinical Consult. Philadelphia: Lippincott Williams & Wilkins, 2013.
  3. What is sleep apnea? National Heart, Lung, and Blood Institute Diseases and Conditions Index. http://www.nhlbi.nih.gov/health/dci/Diseases/SleepApnea/SleepApnea_WhatIs.html.
  4. NINDS sleep apnea information page. National Institute of Neurological Disorders and Stroke. http://www.ninds.nih.gov/disorders/sleep_apnea/sleep_apnea.htm.
  5. Dempsey JA, Veasey SC, Morgan BJ, O'Donnell CP. Pathophysiology of sleep apnea. Physiol Rev 2010; 90:47.
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