Obstructive sleep apnea is a sleep disorder characterised by repeated cessation of respiration (apnea) during sleep. Its symptoms are:
• Loud snoring,
• Excessive daytime sleepiness,
• Gasping or choking during the sleep,
• Witnessed episodes of cessation of respiration,
• Morning headaches,
• Irritability during the day or
• Night time sweating.
Obstructive sleep apnea is caused when the muscles of the pharnygeal region relax too much and the air passage narrows that does not allow normal breathing. These episodes of complete stopping of breathing during sleep may be seen as gasping or choking during the sleep and are followed by episodes of awakening which may be too short and patient might not remember them.
• Excessive weight: It is more commonly seen in patients BMI >30kg/m2.
• Males: OSA is more common in males.
• Chronic nasal congestion/allergic rhinits
• Family history of sleep apnea
• Alcohol consumption
• Uncontrolled Hypertension
• Heart failure
• Motor vehicle accidents due to day time sleepiness
• Loss of libido
The gold standard for the diagnosis of obstructive sleep apnea is polysomnography or sleep study as it commonly called. During the sleep study patient is hooked to wires placed at head, face limbs, chest and abdomen which measure various stages of sleep, heart rhythm, chest and abdominal movements and oxygen status of the patient. A close watch on all the parameters is kept overnight by a trained sleep technician. After the overnight study, the doctor hands over the report and discusses the AHI (apnea hypopnea index) based on which the treatment is planned.
• CPAP therapy: The mainstay of treatment for OSA remains CPAP (continous positive airway pressure) in which air at high pressure is delivered via masks to the patient who acts as a splint to the airway. This opens up the airway which collapses during sleep. The duration of the therapy may vary from patient to patient but “use it to lose it” remains the norm.
• Weight reduction: Weight reduction with exercise and dietary modifications remain the cornerstone along with CPAP.
• Sleep hygiene: Your doctor may advise you to avoid naps during day, avoid watching television before sleep, and avoid alcohol and smoking.
• Surgery: surgery is indicated in cases in which CPAP therapy has failed or is not an option.
• Implants: Few implants are available which the patient keeps on mouth during sleep but are cumbersome to use.