Obstructive Sleep Apnea (OSA)

What is Obstructive Sleep Apnea (OSA)?
Obstructive Sleep Apnea is a common condition affecting over 3 million people in the U.S. each year. It occurs when the throat muscles relax too much during sleep, blocking the airway and causing interruptions in breathing. This leads to low oxygen levels and frequent awakenings during the night, even if you don’t remember them.

Signs and Symptoms of Obstructive Sleep Apnea:

  • Excessive Daytime Sleepiness: Feeling unusually tired during the day, leading to dozing off during work, watching TV, or even driving.
  • Loud Snoring: One of the most common symptoms.
  • Breathing Pauses During Sleep: Witnessed by a partner.
  • Abrupt Awakenings: Often with gasping or choking.
  • Dry Mouth or Sore Throat: On waking.
  • Morning Headache
  • Mood Changes: Including irritability or depression.
  • High Blood Pressure (Hypertension)
  • Night Sweats
  • Decreased Libido

Causes of Obstructive Sleep Apnea:

OSA occurs when the muscles in the back of your throat relax too much during sleep, causing your airway to narrow or close temporarily. As a result, breathing pauses, and the oxygen level in your blood drops. Your brain senses this and briefly wakes you to reopen your airway, though these awakenings are often so short you don’t remember them.

Risk Factors for OSA:

  • Overweight
  • Narrowed Airway
  • High Blood Pressure
  • Diabetes
  • Chronic Nasal Congestion
  • Smoking
  • Male Gender (twice as likely as women to have OSA)
  • Family History of Sleep Apnea
  • Asthma

Complications of Untreated OSA:

  • Memory Problems and Mood Changes: Depression, irritability, and mood swings.
  • Morning Headaches and Frequent Nighttime Urination (Nocturia).
  • High Blood Pressure (Hypertension): OSA is a risk factor for high blood pressure and heart disease.
  • Heart Disease and Stroke: Increased risk of heart attack, heart failure, and stroke.
  • Abnormal Heart Rhythms: Such as atrial fibrillation.
  • Complications with Medications and Surgery: Increased risk under anesthesia.
  • Glaucoma
  • Sleep-Deprived Partners: Your snoring and interruptions can affect your partner’s sleep.

Diagnosis of Obstructive Sleep Apnea:

  1. Home Sleep Apnea Testing: This involves measuring your airflow, breathing patterns, blood oxygen levels, and possibly limb movements and snoring intensity, done from the comfort of your home.
  2. Polysomnography (Sleep Study): A more detailed test conducted in a sleep lab, which monitors your heart, lungs, brain activity, and movements while you sleep.

Treatment for Obstructive Sleep Apnea:

  1. Lifestyle Changes (for Milder Cases):
  • Lose Weight: Even a small reduction in weight can help relieve symptoms.
  • Exercise Regularly.
  • Moderate Alcohol Consumption: Avoid drinking before bed as it relaxes throat muscles.
  • Quit Smoking.
  • Nasal Decongestants or Allergy Medications.
  • Sleep on Your Side: Avoid sleeping on your back to prevent airway blockage.
  1. Continuous Positive Airway Pressure (CPAP):

The most common and effective treatment for OSA. CPAP delivers a constant stream of air through a mask to keep your airway open during sleep.

  1. Positive Airway Pressure Alternatives:
  • Bilevel Positive Airway Pressure (BiPAP): Provides higher air pressure when you inhale and lower pressure when you exhale.
  1. Oral Appliances (Mouthpieces):

Custom-fitted devices that help keep your throat open by repositioning your jaw or tongue.

Surgical Options for Obstructive Sleep Apnea:

  1. Uvulopalatopharyngoplasty (UPPP): Removal of tissue from the back of the throat to widen the airway.
  2. Upper Airway Stimulation (INSPIRE Therapy):
    • This innovative treatment involves a small implantable device that stimulates the airway muscles during sleep to prevent airway closure. INSPIRE is a less invasive option compared to CPAP for patients who are intolerant to CPAP. It is controlled via a remote and works in sync with the patient’s breathing to keep the airway open.
  3. Jaw Surgery (Maxillomandibular Advancement): Repositions the jaw to increase the size of the airway.
  4. Tracheostomy: Creating a hole in the windpipe to bypass blocked airways, used only in severe cases.
  5. Nasal Surgery: To remove polyps or correct a deviated septum.
  6. Tonsil and Adenoid Removal: Especially useful in children with OSA.

New Advanced Treatment: INSPIRE

  • INSPIRE Therapy is a surgically implanted device for moderate to severe OSA. Unlike CPAP, which uses air pressure, INSPIRE stimulates the muscles that control the airway, ensuring that it stays open while you sleep. It’s recommended for patients who cannot tolerate CPAP or other standard treatments. The device is turned on and off by a handheld remote.

Summary of OSA: Obstructive sleep apnea is a serious but treatable condition. Left untreated, it can lead to significant health risks, including heart disease, high blood pressure, and stroke. Treatment options range from lifestyle changes to CPAP therapy, oral appliances, and advanced solutions like INSPIRE therapy for patients intolerant to CPAP. Early diagnosis and consistent treatment are key to improving quality of life and reducing the risk of complications.