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cpap, osa, sleep apnea

What is Sleep Apnea?

Do you patients complain about poor sleep quality, sleepiness or morning headache? It is possible that they are suffering from sleep apnea.
In fact, Up to 6% of the world’s adult population suffers from they are suffering from sleep apnea2 – increasing to 77% in obese people3– and many people do not know that they have it.

What is sleep apnea?

Sleep apnea  patients would stop breathing during sleep. Such events can happen hundreds of times during sleep and each may last for a few seconds to a few minutes.  
The patient usually snores and wakes exhausted from lack of sleep and oxygen.

There are three types of sleep apnea:

  • Obstructive sleep apnea (OSA) – the most common – where relaxation of the pharyngeal muscles collapse and block the airway, causing breathing to stop.
  • Central sleep apnea (CSA) – which is not as common as OSA – where the central nerve system fails to give proper breathing signals to drive the respiratory efforts.
  • Mixed sleep apnea (MSA) – where obstructive and central sleep apnea occur together.

Affected populations

Sleep apnea can occur in all age groups and body morphologies but there are several factors that dramatically increase the likelihood of sleep apnea:

  • Obesity – around 77% of obese person suffer from sleep apnea3
  • Advanced age – sleep apnea is more likely in populations over 50 years old
  • Thyroid conditions or goitre that constrict the neck or airway
  • Physical characteristics of the throat such as enlarged tonsils, and a small airway or nasal passages
  • Ingestion of alcohol, sedatives or sleeping pills before bed 

Symptoms

Identifying the presence of two or three of the common symptoms of sleep apnea indicates that a sleep test may be an appropriate next step in the diagnosis.
Symptoms include4:

  • Snoring, interrupted by pauses in breathing.
  • Poor concentration, slow in response.
  • Fatique, or loss of energy.
  • Feeling irritable or moody
  • Excessive daytime sleepiness - some people seek treatment after they have fallen asleep while driving or at work
  • Forgetfulness
  • Morning headache
  • Sexual dysfunction

Co-morbidities

Co-morbidities of sleep apnea include:

Clinical studies indicate that the sleep apnea causes oxygen desaturation. Prolonged deficiency in oxygen can cause damage to the normal function of many organs and increase the risk of developing the followings:

  • Poor cardiovascular health5,6
  • Hypertension7,8
  • Stroke8
  • Type 2 diabetes9,10,11,12
  • Fatique-related vehicle accidents13

Relative severities of sleep apnea

A cycle of more than five times per hour indicates sleep apnea:

Normal

Less than 5 interruption per hour

Mild sleep apnea

Between 5 and 15 interruptions per hour

Moderate sleep apnea

16 to 30 interruptions per hour

Severe sleep apnea

More than 30 interruption per hour

References

1.Obsructive sleep apnea – a guide for GP’s, British Lung Foundation (NHS)
2. O’Keefe, et.al., Evidence supporting routine Polysomnography before bariatric surgery, in,Obesity Surgery, January 2014
3. Sleep breathing disorders, in, European Respiratory Society Whitebook, Chapter 23
4. Patient information series – Sleep mini series #4, in, Obstructive Sleep Apnea and Heart Disease, American Throacici Society
5. Logan, et.al.High prevalence of unrecognized sleep apnoea in drug-resistant hypertention, in, Journal of Hypertension, 2001
6. Einhorn, et.al., Prevalence of sleep apnea in a population of adults with type 2 diabetes Mellitus, in, Endocrine Practice, 2007; 13(4):355-362
7. Peppard PE, Young T, Palta M, Skatrud J (2000): Prospective study of the association between sleep-disordered breathing and hypertension. NEJM 342(19): 1378-1384
8. Logan, et.al.High prevalence of unrecognized sleep apnoea in drug-resistant hypertention, in, Journal of Hypertension, 2001
9. Einhorn, et.al., Prevalence of sleep apnea in a population of adults with type 2 diabetes Mellitus, in, Endocrine Practice, 2007; 13(4):355-362 
10. Meslier N, Gagnadoux F, Giraud P, Person C, Ouksel H, Urban T, Racineux JL (2003): Impaired glucose-insulin metabolism in males with obstructive sleep apnoea syndrome. Eur Respir J 22(1): 156-160
11. Bottini P, Dottorini ML, Cristina Cordoni M, Casucci G, Tantucci C (2003): Sleep-disordered breathing in nonobese diabetic subjects with autonomic neuropathy. Eur Respir J 22: 654- 660
12. Elmasry A, Lindberg E, Berne C, Janson C, Gislason T, Awad Tageldin M, Boman G (2001): Sleep-disordered breathing and glucose metabolism in hypertensive men: a population-based study. J Intern Med 249(2): 153-161
13. Teran-Santos J., Jimenz-gomez Al., & Cordero-Guevara, J. (1999). The association between sleep apnoea and the risk of traffic accidents. N Engl J Med., 340(11), 881-3