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Obstructive sleep apnoea

Overview

Sleep apnoea is a serious sleep disorder; the patient’s breathing stops repeatedly during the course of sleep. Loud snoring during sleep and fatigue despite getting a full night's sleep may be indicative of sleep apnoea.

Obstructive sleep apnoea is a consequence of the excessive relaxing of the muscles in the back of the throat; while the relaxation of these muscles enables proper breathing, excessive relaxation may cause the airways to narrow or close as air is breathed in. This, in turn, can cause the oxygen level in the blood to plummet and a buildup of carbon dioxide. As the brain senses this impairment in breathing, it briefly rouses the body during the sleep so that the airway can be reopened. This awakening is so brief that usually, patients do not remember it. Throughout the night, this pattern is repeated 5 to 30 times or more per hour. Because these disruptions prevent patients from attaining the deep, restful phases of sleep, they often feel sleepy during the waking hours. While obstructive sleep apnoea can affect any individual, certain factors are associated with an increased risk for developing this condition:

  • Excess weight: Fat deposits surrounding the upper airway can obstruct breathing.
  • Older age: the risk of developing this condition increases with ageing; however, this risk appears to level off after the 60s and 70s.
  • Narrowed airway: a naturally narrow airway is a hereditary trait. Moreover, the enlargement of the tonsils or adenoids could also cause airway blockage.
  • Hypertension and/or diabetes: This condition has been reported to be more common in patients with high blood pressure and/or diabetes.
  • Chronic nasal congestion: The incidence of this condition has been reported to be two times higher in people who have consistent nasal congestion (than in those who do not) at night, regardless of the cause.
  • Smoking: Smokers are more likely to have this condition.
  • Asthma: Asthma has been found to serve as a risk factor for obstructive sleep apnoea.
  • Male sex: Men may be twice or thrice as likely to develop obstructive sleep apnoea than premenopausal women. However, menopause has been reported to increase the risk of developing this condition in women.
  • Family history: Having family members this condition may be associated with an increased risk of developing this condition.

  • Loud snoring
  • Episodes of apnoea, i.e., the stoppage of breathing, during sleep (usually reported by another person)
  • Gasping for air during sleep
  • Insomnia, i.e., difficulty staying asleep
  • Waking up with xerostomia, i.e., dry mouth
  • Morning headaches
  • Irritability and/or inattention while awake
  • Hypersomnia, i.e., excessive sleepiness during the day

The diagnosis of sleep apnoea involves the following steps:

  • Physical examination: The back of the nose, mouth, and throat of the patient are examined. The patient’s neck and waist circumference and blood pressure may also be measured. Further evaluations are performed by sleep specialists, who can diagnose the condition and ascertain its severity and accordingly, plan the treatment. These evaluations often involve monitoring the breathing and other body functions of the patients overnight while they are asleep.
  • Tests: The following tests can help detect obstructive sleep apnoea:
    • Polysomnography (sleep study): Devices and sensors that monitor the brain, heart, and lung activities and breathing patterns are attached to the patients while they sleep. These devices also measure the blood oxygen levels and arm and leg movements. The patients are monitored for the entirety or a specific duration of the night.
    • Home sleep apnoea testing: In certain cases, at-home polysomnography kits may be used to diagnose this condition; however, using these kits, only a limited set of apnoea-related variables can be analysed during sleep.

The following treatments can be used for the management of sleep apnoea:

  • Mandibular advancement device (or mandibular repositioning device): This device temporarily moves the jaw and tongue forward, widening the airway space decreasing the degree of throat constriction; thus, it helps prevents sleep apnoea and snoring.
  • Transcutaneous electrical nerve stimulation (TENS): Small devices (TENS units) administer low-voltage electrical currents at or near the nerves; this blocks or alters pain perception, thereby providing pain relief.
  • Positive airway pressure (PAP): During sleep, air pressure is delivered by a machine through a small piece that is either fit into the nose or placed over the nose and mouth. PAP is helpful in reducing the frequency of apnoea episodes during sleep and mitigating daytime sleepiness; thus, it greatly improves the quality of life of patients. The most common method for administering PAP is continuous positive airway pressure (CPAP). This treatment stabilises breathing during sleep by continuously delivering air at a constant pressure; this pressure is slightly higher than the surrounding air pressure (hence, the term positive pressure) and is sufficient to ensure that the upper airway remains open. Thus, CPAP prevents obstructive sleep apnoea and notably reduces the intensity of snoring.
  • Surgical procedures: For patients with mild obstructive sleep apnoea, uvulopalatopharyngoplasty (UPPP; the removal of tissues from the throat) is recommended; tonsil and adenoid removal may also be advised. These procedures serve to widen the airways. For UPPP, which is usually performed in a hospital, a general anaesthetic is administered to induce a sleep-like state.
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