Sleep Apnea

Overview:

Obstructive Sleep Apnea (OSA):

• Most common sleep-related breathing disorder.
• Characterized by repeated pauses in breathing during sleep.
• Linked to relaxation of throat muscles, obstructing the airway intermittently.
• Snoring often accompanies OSA.

Types of Sleep Apnea:

• OSA: Throat muscles relax and block the airway.
• Other types include central sleep apnea and complex sleep apnea syndrome.

Treatments for OSA:

• Positive airway pressure devices: Maintain airway openness during sleep.
• Mandibular advancement devices: Thrust lower jaw forward to prevent airway blockage.
• Surgery: Considered in certain cases.

Symptoms:

• Symptoms of obstructive sleep apnea encompass:
• Excessive daytime fatigue.
• Noisy snoring.
• Instances of breathing cessation are noticed during sleep.
• Nighttime awakenings with gasping or choking sensations.
• Waking up with a parched mouth or throat discomfort.
• Morning headaches.
• Difficulty concentrating throughout the day.
• Mood fluctuations, including feelings of depression or irritability.
• Elevated blood pressure.
• Reduced libido.

Dr. Boonipat offers a comprehensive treatment approach tailored to your needs. He specializes in treating sleep apnea syndrome with jaw advancement surgery, which successfully resolves sleep apnea in the majority of patients with upper airway blockage-related causes. Dr. Boonipat will diagnose your condition during your assessment and devise a detailed treatment plan. Treatment may include addressing nasal and jaw deformities contributing to obstruction and soft tissue procedures to ensure proper airway function.

Causes:

Obstructive sleep apnea results from excessive relaxation of throat muscles, hindering proper breathing. These muscles, supporting the soft palate, tongue, and throat sidewalls, become too lax during sleep. Muscle relaxation causes airway constriction or closure during inhalation, reducing blood oxygen levels and increasing carbon dioxide buildup. Brief awakenings occur as the brain detects compromised breathing, prompting airway reopening. Typically, these awakenings are too brief to be recalled consciously. Awakening may involve shortness of breath, alleviated swiftly by a few deep breaths or accompanied by snorting, choking, or gasping sounds. This cycle can repeat frequently throughout the night, ranging from 5 to over 30 episodes per hour. Such interruptions disrupt deep, restorative sleep phases, leading to daytime sleepiness. Individuals with obstructive sleep apnea may not recognize their fragmented sleep, often unaware of their poor sleep quality.

Risk factors:

Obstructive sleep apnea can affect anyone, with certain factors increasing susceptibility, such as:

• Excess weight: Fat accumulation around the upper airway can obstruct breathing and is often associated with obesity-related conditions like hypothyroidism and polycystic ovary syndrome.
• Advanced age: Risk rises with age, plateauing in the 60s and 70s.
• Naturally narrow airway: Genetics or enlarged tonsils/adenoids can contribute to airway blockage.
• Hypertension: Commonly coexists with obstructive sleep apnea.
• Chronic nasal congestion: Those with persistent nighttime congestion, regardless of cause, face twice the risk.
• Smoking: Smokers are more prone to obstructive sleep apnea.
• Diabetes: Occurrence might be higher in diabetic individuals.
• Male gender: Men are generally 2 to 3 times more likely than premenopausal women to have obstructive sleep apnea, though postmenopausal women see increased risk.
• Family history: Having relatives with obstructive sleep apnea elevates personal risk.
• Asthma: Research suggests a link between asthma and obstructive sleep apnea risk.

Diagnosis:

Evaluation Process:

• A healthcare team member assesses your condition based on symptoms, examinations, and tests.
• Referral to a sleep specialist may be recommended for further evaluation.

Physical Examination:

• Examination of throat, mouth, and nose.
• Measurement of neck and waist circumference.
• Blood pressure check.

Role of Sleep Specialist:

• Further evaluates and diagnoses the condition’s severity.
• Plans and initiates treatment.
• The evaluation may involve an overnight stay at a sleep center for monitoring.

Diagnostic Tests:

• Polysomnography monitors various body functions during sleep, including heart, lung, and brain activity and breathing patterns.
• Split-night sleep study: Part of the night is monitored, with possible intervention if obstructive sleep apnea is diagnosed. This study also identifies other sleep disorders, like periodic limb movement disorder or narcolepsy.

Home Sleep Apnea Testing:

• Under specific circumstances, at-home polysomnography may be conducted. Kits monitor limited variables to detect breathing pauses during sleep.

Treatment:

• The most common treatment is a CPAP mask, which is bothersome for some patients, who cannot maintain long-term compliance.

Positive Airway Pressure Therapy:

• Beneficial for obstructive sleep apnea by delivering air pressure via a machine while you sleep.
• Reduces breathing pauses during sleep and daytime sleepiness and enhances quality of life.

Continuous Positive Airway Pressure (CPAP):

• The most common type is maintaining constant air pressure slightly higher than the surrounding air.
• Keeps upper airway passages open, preventing sleep apnea and snoring.

CPAP Considerations:

• Some find the mask uncomfortable or loud, but newer models are quieter and smaller.
• Various mask designs cater to individual comfort, with options like nasal masks, nasal pillows, or face masks.
• Adaptive pressure functions and humidifiers can enhance comfort.

CPAP Variations:

• Fixed CPAP: Maintains constant pressure throughout sleep.
• Autotitrating CPAP (APAP): Adjusts pressure levels based on airway resistance.

Bilevel Positive Airway Pressure (BPAP):

• Provides different pressure levels during inhalation and exhalation.

Treatment Considerations:

• CPAP is widely used and studied for obstructive sleep apnea treatment.
• Those struggling with fixed CPAP may explore BPAP or APAP options.
• Consult your healthcare team for adjustments to improve comfort.

Monitoring and Follow-up:

• Contact your healthcare team if snoring persists, recurs, or if weight fluctuates significantly.

Oral Appliances as Alternatives:

• Occasionally preferred over CPAP, but this is usually less effective.
• Resemble sports mouthguards, aiming to reposition the jaw downward and forward mildly.
• This positioning helps keep the tongue away from the airway’s back, potentially easing breathing and relieving apnea.

Surgery:

• Surgery is considered if other treatments don’t work.
• Surgery can help people who have trouble breathing due to airway blockage.
• Obstructive sleep apnea happens when air can’t properly pass through the nose, mouth, or throat.
• Nasal airway blockage can be caused by narrow nostrils, a crooked nose, swollen turbinates, adenoids, or nasal polyps.
• Small jaws, a weak chin, teeth that do not line up right, a big tongue or a long soft palate can cause oral airway blockage.

Types of surgery include:

• Uvulopalatopharyngoplasty (UPPP): Removes tissue from the throat.
• Upper airway stimulation: Implants a device to control tongue movement.
• Jaw surgery: Moves the jaw forward to make breathing easier.

Other surgeries can help by:

• Removing nasal polyps or fixing a crooked nose.
• Taking out enlarged tonsils or adenoids.
• Dr. Boonipat specializes in moving the jaw forward to help treat obstructive sleep apnea.