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What is Snoring?
What is Sleep-Disordered Breathing?
What is Obstructive Sleep Apnea (OSA)?
Obstructive Sleep Apnea in Children?
Symptoms of Sleep Apnea?
Risk Factors of Sleep Apnea?
Diagnosis of Sleep Apnea?
Treatment Options
Sleep-Disordered Breathing & Cardiovascular Diseases
What is Snoring?
Snoring is defined as a coarse sound made by vibrations of the soft palate and other tissue in the mouth, nose & throat (upper airway). It is caused by turbulence inside the airway during inspiration. The turbulence is caused by a partial blockage that may be located anywhere from the tip of the nose to the vocal chords. Snoring may be a symptom of a sleep-disordered breathing that requires medical attention.Back to top
What is Sleep-Disordered Breathing?
This condition, sometimes referred to as sleep apnea, involves repeated arousals from sleep--not necessarily to full awakening because breathing has ceased. In the most important form (obstructive sleep apnea) it is because the upper airway for breathing has momentarily been obstructed.Back to top
What is Obstructive Sleep Apnea (OSA)?
When loud snoring is interrupted by frequent episodes of totally obstructed breathing, it is known as obstructive sleep apnea. Serious episodes last more than ten seconds each and occur more than seven times per hour. Apnea patients may experience 30 to 300 such events per night. These episodes can reduce blood oxygen levels, causing the heart to pump harder.
The immediate effect of sleep apnea is that the snorer must sleep lightly and keep his muscles tense in order to keep airflow to the lungs. Because the snorer does not get a good rest, he may be sleepy during the day, which impairs job performance and makes him a hazardous driver or equipment operator. After many years with this disorder, elevated blood pressure and heart enlargement may occur.Back to top
Obstructive Sleep Apnea in Children?
Obstructive sleep-disordered breathing is common in children. From 3 percent to 12 percent of children snore, while obstructive sleep apnea syndrome affects 1 percent to 10 percent of children. The majority of these children have mild symptoms, and many outgrow the condition. Consequences of untreated obstructive sleep apnea include failure to thrive, enuresis, attention-deficit disorder, behavior problems, poor academic performance, and cardiopulmonary disease.Back to top
Symptoms of Sleep Apnea?
Snoring loudly at night.
Feeling tired and sleepy during the day.
Falling asleep when sedentary. (Meetings, watching TV or driving)
Waking up choking or gasping for breath.
Recent weight gain.
Having someone tell you that you quit breathing in your sleep at night.
Obtaining treatment for poor control of 'High blood pressure.'
Morning headaches
Dry mouth upon awakening
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Risk Factors of Sleep Apnea?
There are several factors that may predispose a person towards sleep apnea.
Gender. More men than women appear to have sleep apnea. Sleep apnea may be under-diagnosed in women. In general, older women have the same incidence as men their own age. A range of studies has reported apnea or hypopnea in between 9% and 24% of men and 4% to 15% of women.
Age. Sleep apnea affects people of all ages. Although it is most common in older adults, it has been reported in between 1.6% to 3.4% of children. Some experts believe that sleep disorder breathing may occur in as many as 11% of children. Interestingly, one study suggested that although prevalence of sleep apnea increases with age, its health consequences decline. In the study, apnea posed more of a threat to a person's health before age 45 than afterward.
Ethnicity. African Americans face a higher risk for sleep apnea than any other ethnic group in the United States.
Geography. According to one study, although urban dwellers are more likely to report disturbed sleep, particularly as a result of stress, rural dwellers have a significantly higher risk for apnea.
Obesity. Obesity, particularly having fat around the abdomen (the so-called apple shape), is a particular risk factor for sleep apnea, even in adolescents and children. (It should be noted, however, that many people with sleep-disordered breathing, particularly women and small children, are not obese.)
Immune abnormalities. High levels of certain immune factors are present in people with sleep apnea, including tumor necrosis factor alpha (TNF-alpha) and interleukin 6 (IL-6). Elevated levels of TNF-alpha can cause fatigue, shortness of breath, and weakness in the heart's pumping action. IL-6 and TNF-alpha may both play a role in obesity as well.
Body position. Body position greatly affects the number and severity of episodes of obstructive sleep apnea, with at least twice as many apneas occurring when a person lies face upward than when the person lies on his or her side. This may be due to the effects of gravity, which cause the throat to narrow when a person lies on the back.
Other medical conditions. Individuals with severe heartburn (Gastroesophageal reflux disease, or GERD) appear to be at higher risk for sleep apnea. Sleep apnea is also associated with higher rates of heart failure.
Smoking. Smokers are at higher risk for apnea, with heavy smokers (more than 2 packs a day) having a risk 40 times greater than nonsmokers.
Alcohol. Alcohol use has been associated with apnea, although studies are mixed.Back to top
Diagnosis of Sleep Apnea?
Your doctor will do a physical exam and take a medical history that includes asking you and your family questions about how you sleep and how you function during the day. As part of the exam, your doctor will check your mouth, nose, and throat for extra or large tissues; for example, tonsils, uvula (the tissue that hangs from the middle of the back of the mouth), and soft palate (the roof of your mouth in the back of your throat).
Your doctor may order a sleep recording of what happens with your breathing while you sleep. A sleep recording is a test that is often done in a sleep center or sleep laboratory, which may be part of a hospital. You may stay overnight in the sleep center, although sleep studies are sometimes done in the home. The most common sleep recording used to find out if you have sleep apnea is called a polysomnogram (poly-SOM-no-gram), or PSG. This test records:
Brain activity
Eye movement
Muscle activity
Breathing and heart rate
How much air moves in and out of your lungs while you are sleeping
The percentage of oxygen in your blood
A PSG is painless. You will go to sleep as usual. The staff at the sleep center will monitor your sleep throughout the night. The results of your PSG will be analyzed by a sleep medicine specialist to see if you have sleep apnea, how severe it is, and what treatment may be recommended.Back to top
Treatment Options
Physical devices and mechanical therapies are effective in treating many cases of sleep apnea. These treatments for sleep apnea are:
Continuous Positive Airway Pressure (CPAP)
Dental appliances or jaw adjustment devices
Surgery
| Physical and Mechanical Treatments for Sleep Apnea | |
| Treatment | Details |
| Continuous Positive Airway Pressure (CPAP) | To keep your airway open during sleep, a machine at your bedside blows pressurized air into a mask that you wear over your nose or face. This has been found to be the most effective treatment. |
| Dental appliances, oral devices, and lower jaw adjustment devices | Opens your airway by bringing your lower jaw or your tongue forward during sleep. Most dental devices are acrylic and fit inside your mouth, much like an athletic mouth guard or orthodontic appliance. Some others fit around your head and chin to adjust the position of your lower jaw. Two common oral devices are the Mandibular Repositioning Device and the Tongue Retaining Device. |
| Surgery | Increases the size of your airway by surgically removing tissues. The surgeon may remove tonsils, adenoids, or excess tissue at the back of the throat or inside the nose. Or the surgeon may reconstruct the jaw. The surgeon operates with a scalpel, a laser, or a microwaving probe (radiofrequency energy). Surgery has been found to be an effective way to treat sleep apnea, but its success rate is low. |
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Sleep-Disordered Breathing & Cardiovascular Diseases
Sleep-Disordered Breathing (SDB) & Hypertension
Sleep-disordered breathing (SDB) and the related clinical syndrome, sleep apnea, have been associated with hypertension in clinical reports since the early 1980s. About one half of patients who have essential hypertension have obstructive sleep apnea, and about one half of patients who have obstructive sleep apnea have essential hypertension. A growing body of evidence suggests that obstructive sleep apnea is a major contributing factor in the development of essential hypertension.
Sleep-Disordered Breathing (SDB) & Congestive Heart Failure
Some evidence suggests that OSA may also be an important contributor in the development of coronary heart disease, stroke, cardiac arrhythmia, and congestive heart failure, because about one half of all patients with coronary heart disease, stroke, and congestive heart failure have OSA. Additionally, retrospective studies have shown that successful treatment of OSA is associated with a marked reduction in hospitalization and mortality, and prospective studies have shown that successful treatment of OSA improves congestive heart failure.
Sleep-Disordered Breathing (SDB) & Stroke
One reason obstructive sleep apnea / SDB may increase stroke risk is that it has been shown to cause high blood pressure, which is the most common risk factor for stroke. When airflow is blocked during sleep apnea, level of oxygen in the body decreases, hence the heart needs to pump harder to distribute oxygen into the brain. Sometimes, the blood vessels in the brain form a blood clot that blocks or plugs a blood vessel in the brain or a blood vessel breaks and bleeds into the brain, thus causing stroke to occur..
Obstructive sleep apnea is associated with lower cardiac output and reduced cerebral blood flow, in which both contribute further noxious stimuli to a brain already damaged by stroke. In this setting, the stroke could potentially be extended, the brain might become susceptible to further strokes, or the lack of oxygen might cause the generation of neural inhibitory peptides, which can impair brain function.
Sleep-Disordered Breathing (SDB) & Traffic Accident
Frequent sleep apnea episodes, each followed by awakening, result in sleep fragmentation and daytime sleepiness. When a person gets sleepy during driving, traffic accidents may result. Because of drowsiness and lack of concentration, persons with obstructive sleep apnea also are two to seven times more likely than healthy persons to have a traffic accident. A case-controlled study of 210 persons with sleep apnea showed that treatment could decrease the auto collision rate of persons with obstructive sleep apnea to that of drivers in the general population.Back to top
