What you need to know about OSA

Apnea is a Greek word which means "without breath." Obstructive Sleep Apnea (OSA) is the most common form of apnea characterized by repetitive partial or complete upper airway obstruction in sleep lasting a minute or longer and can occur as frequent as hundreds of times during a single night.

This is often associated with drops in blood oxygen levels, which may be quite severe. Airway collapse occurs most commonly from the level of the soft palate to the region at the base of the tongue where no rigid structures are present to hold the airway open when muscles relax during sleep.

When the airway closes, the sleeper breathes harder and awakens to open the airway to restore normal breathing. Those with severe OSA may have more than 100 waking episodes in a single night, which disrupt sleep and prevent sleep from reaching the deep stages where the body can rest and replenish its strength.

OSA may develop in all age groups. The prevalence is estimated to be two to four percent in adults and one to two percent in children.

In children, OSA is equally prevalent in both sexes and peaks from age two to five. However, in adults over the age of 35, this is estimated to occur approximately more among males (four percent men to two percent women). There have been some observations that this gender-related difference is narrowed when men are compared with postmenopausal women.

The exact cause of OSA remains unclear. The postulated mechanisms involved in its causation may be a combination of the following: decreased upper airway patency, reduced capacity to maintain airway patency, and decreased drive to breathe in the face of reduced upper airway patency.

Several risk factors have been identified for OSA. Obesity is considered to be a primary risk factor in adults and even in children. The accumulation of fat on the sides of the upper airway causes it to become narrow.

Age is another prominent risk factor given that loss of muscle mass goes with the aging process; as it is replaced with fat, the airway becomes soft and floppy. Men are said to have greater risk because of hormonal effect.

Other risk factors include anatomic abnormalities in craniofacial syndromes, enlarged tonsils and adenoids (being the main cause of OSA in children), family history of OSA, use of alcohol and sedative drugs, smoking, hypothyroidism, neuromuscular disorders, chronic nasal congestion, etc.

OSA is commonly presented clinically with excessive daytime sleepiness (more common in adults than in children), habitual snoring, mouth breathing, awkward positioning, sweating, witnessed aprenas and increased work of breathing during sleep, morning headaches, insomnia, nocturia, short-term memory loss, chronic fatigue, and even impotence.

Mood changes, acting out behaviors, ADHD-like symptoms and academic problems have been encountered in the pediatric age group.

Evaluation for OSA includes history of signs and symptoms, physical examination and overnight sleep study (polysomnography). To date, sleep study is still considered the gold standard in its diagnosis.

This study allows the recording of numerous physiological signals that evaluate a patient’s sleep quality, breathing, sleep behavior and oxygen levels in the blood.

Why do we need to treat OSA? There are no published longitudinal studies which looked into the long-term effect of OSA. However, cross-sectional studies have linked OSA to a number of complications.

The most obvious complication is diminished quality of life brought on by chronic sleep deprivation. Some linkages between OSA, coronary artery disease, stroke and hypertension have been demonstrated.

OSA was shown to aggravate congestive heart failure by placing stress on the heart during sleep. In the pediatric group, this disorder has been linked to heart enlargement and heart failure, pulmonary hypertension, school and daytime behavioral problems and poor growth.

It is important to emphasize that the urgency and choice of treatment for OSA may vary from one individual to another. This is dictated by the attending physician’s clinical judgment based on patient’s age, severity of OSA, underlying predisposing risk factors and presence of complications.

There are several treatment options (weight reduction, positional, positive pressure therapy, surgical options, and oral applications), but generally the use of the nasal Continuous Positive Airway Pressure (CPAP) device remains the mainstay treatment for adults, and tonsillectomy plus adenoidectomy for children.

The Comprehensive Sleep Disorders Center of St. Luke’s Medical Center is well-equipped to evaluate and treat patients who have OSA.

Since the establishment of the center, it has served people from different walks of life and has performed more than a thousand sleep studies for patients suspected to be afflicted with this disorder.

The center caters to all ages from infants to adults and offers a range of consultation services, clinical evaluation that includes polysomnography and treatment options for OSA.

The center is dedicated to teaching and clinical research as well. For more information on Obstructive Sleep Apnea, call the Comprehensive Sleep Disorders Center at 723-0101 extension 47290 or 5559 or direct line 727-5559.