Obstructive Sleep Apnea: Symptoms, Causes, And Treatments

Obstructive sleep apnea  (OSA) is the most common type of sleep apnea , it is a condition in which breathing involuntarily stops for short periods of time during sleep. Normally, air flows smoothly from the mouth and nose into the lungs at all times, periods when breathing stops are called apnea or apneic episodes (literally, “no breath”), usually lasting between 20 and 40 seconds. In OSA, the normal flow of air stops repeatedly during the night.

Airflow stops because the airway space in the throat area is too narrow, snoring is characteristic of obstructive sleep apnea and is caused by airflow going through the narrowed airway space .

Symptoms of obstructive sleep apnea

Common symptoms include:

• Unexplained daytime sleepiness
• Restless dream
• Loud snoring (with periods of silence followed by gasping).

Less common symptoms are:

• Morning headaches
• Insomnia.
• Trouble concentrating
• Mood swings such as irritability, anxiety, and depression .
• I forget.
• Increased heart rate and / or blood pressure.
• Decreased sexual desire
• Unexplained weight gain
• Increased urination and / or nocturia.
• Frequent heartburn or gastroesophageal reflux disease.
• Heavy night sweats.

Adults

The hallmark symptom of OSA syndrome in adults is excessive daytime sleepiness . Generally, an adult or adolescent with this long-term condition will fall asleep for very short periods in the course of normal activities if given the opportunity to sit or rest. This behavior can be quite dramatic, sometimes occurring during conversations with others in social gatherings.

The hypoxia (lack of oxygen supply) related syndrome can cause changes in neurons of the hippocampus and the right frontal cortex. Neuroimaging research revealed evidence of hippocampal atrophy in people who suffered from it, they found that obstructive sleep apnea can cause problems in mental manipulation of non-verbal information, in executive functions and in working memory .

The diagnosis of obstructive sleep apnea is significantly more common among people in relationships, who are alerted to their condition by being informed by their sleeping partner, as they are often unaware of the condition. There is a stigma associated with loud snoring, and it is not considered a female trait.

Consequently, couples are less likely to tell women that they snore, or to admit it to themselves or to doctors.

Kids

Although this so-called ” hypersomnolence ” (excessive sleepiness) can also occur in children, it is not at all typical of young children with sleep apnea , because they, on the other hand, behave as if they are “tired” or “hyperactive.” Adults and children with the very severe syndrome also differ in typical body habit.

Adults are generally heavy, with particularly short necks, young children, on the other hand, are generally not only thin, but may have ‘growth failure’, where growth is reduced and occurs for two reasons: breathing is intense enough that calories are burned at high rates even at rest, and the nose and throat are so clogged that eating is tasteless and physically uncomfortable.

OSA in children, unlike adults, is caused by obstructive tonsils and adenoids and can sometimes be cured with tonsillectomy and adenoidectomy. This problem can also be caused by excess weight in children AND In this case, the symptoms are more like symptoms than adults, such as restlessness, exhaustion, etc.

What Causes Obstructive Sleep Apnea?

When we sleep, our muscles relax, this includes the muscles in the back of the throat that help keep the airway open. In obstructive sleep apnea, these muscles can relax too much and collapse the airways, making it difficult to breathe, this is especially true if someone has enlarged tonsils or adenoids (germ-fighting tissues in the back of the nasal cavity), which they can block the airway during sleep. In fact, enlarged tonsils and adenoids are the most common cause in children.

Risk factors for developing OSA include:

• Family history of obstructive sleep apnea.
• Being overweight
• Medical conditions such as Down syndrome or cerebral palsy.
• Children with large tonsils and adenoids.
• Men with a neck size of 17 inches or more.
• Women with a neck 16 inches or more.
• Large tongue, which can block the airway.
• Retrognathia, which is when your lower jaw is shorter than your upper jaw
• A narrow palate or airway that collapses more easily.

Heart disease is more common in obese people, and obesity is a risk factor for heart disease, high blood pressure, and sleep apnea.

Less commonly, sleep apnea can occur when someone does not get enough oxygen during sleep because the brain does not send signals to the muscles that control breathing, this is called central sleep apnea.

How is obstructive sleep apnea diagnosed?

Diagnosis begins with a complete medical history and physical examination, a history of daytime sleepiness and snoring are important clues. Your doctor will examine your head and neck to identify any associated physical factors and may ask you to fill out a questionnaire about daytime sleepiness, sleep habits, and quality of sleep. Tests that can be done include:

Polysomnogram

A polysomnogram usually requires you to spend the night in a hospital or sleep study center. The test lasts all night, while you sleep, it will measure the activity of different organ systems associated with sleep. It may include:

Electroencephalogram and electrooculogram

During an EEG, electrodes are attached to your scalp that will monitor brain waves before, during, and after sleep. The electrooculogram records eye movement, a small electrode is placed 1 centimeter above the outer corner of the right eye, and another is placed 1 centimeter below the outer corner of the left eye. When the eyes move away from the center, this movement is registered.

Brain waves and eye movements inform doctors when different phases of sleep occur. The phases of sleep are non-REM (non-rapid eye movement) and REM (rapid eye movement). The sleep , decreased muscle tone, movement, and paralysis occur during REM sleep .

Electromyogram

During the electromyogram, two electrodes are placed on the chin: one on the jaw line and the other under the chin, another electrode is placed on each shin, these collect the electrical activity generated during muscle movements. Deep muscle relaxation should occur during sleep and is recovered when muscles relax and move during sleep.

Electrocardiogram

A 12-lead EKG can help your doctor determine if you have heart disease. Long-lasting high blood pressure can also cause changes, heart rate and rhythm monitoring allows doctors to see if heart disorders occur during apnea episodes.

Pulse oximetry

In this test, a small device called a pulse oximeter is attached to a thin area of ​​your body that has good blood flow, such as your fingertip or earlobe.

The pulse oximeter uses a small emitter with red and infrared LEDs to measure the amount of oxygen in your blood, the amount of oxygen in your blood, or the oxygen saturation decreases during apnea episodes. Normally the saturation is around 95-100 percent. Your doctor will interpret your results.

Gasometría arterial

In this study, a syringe is used to obtain blood from an artery. Arterial blood gas measures several factors in arterial blood, including:

• Oxygen content.
• Oxygen saturation.
• Partial pressure of oxygen.
• Carbon dioxide partial pressure.
• Bicarbonate levels.

This test will give your doctor a more detailed picture of the amount of oxygen, carbon dioxide, and acid-base balance in your blood, it will also help your doctor know when and when you need extra oxygen.

What is the treatment for obstructive sleep apnea?

Numerous treatment options are used, it is recommended to avoid alcohol and smoking, as well as to avoid medications that relax the central nervous system (for example, sedatives and muscle relaxants).

Weight loss is recommended in those who are overweight, continuous positive airway pressure, and mandibular advancement devices are used frequently and are considered to be equally effective. Physical training, even without losing weight, improves sleep apnea, there is insufficient evidence to support the widespread use of medications or surgery.

Physical intervention

The most widely used current intervention is positive airway pressure, whereby a breathing machine pumps a controlled flow of air through a mask that is worn over the nose, mouth, or both. The extra pressure keeps relaxed muscles open. There are several variants:

Continuous positive airway pressure

It is effective for both moderate and severe disease. It is the most common treatment for obstructive sleep apnea.

It is administered through a mask worn at night, which gently provides positive airflow to keep the airway open at night. Positive airflow supports open airways.

A dental appliance may also be necessary to keep the lower jaw positioned forward.

Variable positive airway pressure

It uses an electronic circuit to control the patient’s breathing and provides two different pressures, a higher one during inhalation and a lower pressure during exhalation. This system is more expensive and is sometimes used with patients who have other coexisting respiratory problems and / or find that breathing against increased pressure is uncomfortable or disturbing to their sleep.

Surgery

Surgical treatments to modify the anatomy of the airways, known as sleep surgery, are varied and must be tailored to the specific airway obstruction needs of a patient.

Surgery is not considered a first-line treatment for obstructive sleep apnea, as prospective, randomized, and comparative clinical evidence against current first-line treatments is lacking. For those obstructive sleep apnea patients who are unable or unwilling to comply with first-line treatment, a properly selected surgical intervention will be the result of considering an individual’s specific anatomy and physiology, personal preferences, and the severity of the disease.

There is little evidence from randomized clinical trials for all types of sleep surgery.

• The UPPP involves removing extra tissue from the back of the throat, is the most common type of surgery for obstruction sleep and helps relieve snoring. However, this surgery has not been proven to completely eliminate sleep apnea, and it can have complications.
• The tracheostomy can be done as a last resort procedure, spuds an opening in the trachea prevents clogging of the throat.
• The septoplasty is a corrective surgical procedure for the deviation of the nasal septum where the septum is straightened.
• Tonsillectomy and / or adenoidectomy in an attempt to increase the size of the airway.
• The turbinectomy is a surgical procedure in which all or some of the turbinate bones to relieve nasal obstruction is removed.
• Tongue base reduction , either with laser excision or radiofrequency ablation.
• Genioglossal advancement , in which a small portion of the lower jaw that attaches to the tongue is moved forward, to bring the tongue out of the back of the airway.
• Hyoid suspension , in which the hyoid bone in the neck, another attachment point for the tongue muscles, is pulled forward in front of the larynx.
• Maxillomandibular advancement.

Other surgical procedures may be required to correct structural problems in the face and elsewhere when sleep apnea does not respond to treatments like the ones above. About 75 percent of children due to enlarged tonsils or adenoids get relief from surgery.

The American Sleep Apnea Association says that the American Academy of Pediatrics has endorsed surgical removal of the tonsils and adenoids as the treatment of choice for children with sleep problems due to enlarged tonsils.