Sleep Apnea

Apnea is defined as cessation of airflow for more than 10 seconds. A related event, hypopnea, is characterized by a reduction in airflow associated with a decrease in oxygen saturation.

What it is:

  • Characterized by 20 to 30 or more "apneic events" (involuntary breathing pauses) per hour which cause reduction in blood oxygen
  • Occurs commonly in heart failure and stroke
  • Often associated with snoring
  • Widely under diagnosed, 90% of victims have unrecognized sleep apnea.

What it does:

  • Potentially life-threatening sleep disorder which compromises driving and job safety
  • Compromises quality of life by causing;
    • Chronic daytime sleepiness and fatigue
    • Impotence
    • Cognitive disorders
    • Mood dysfunction

Why wait and wonder about the sleep health of your patients?

Types of Sleep Apnea

Obstructive Sleep Apnea (OSA)

Is the repeated obstruction of breathing during sleep caused by collapse of the pharyngeal airway (throat air passage).

  • While snoring commonly accompanies OSA, not all snorers have sleep apnea
  • The most common form; occurring in 5% and 9% of middle aged women and men respectively(1) Current estimates indicate that 17% of adults have sleep apnea.
  • Afflicts both children and adults
  • Occurs when breathing is obstructed (impaired) due to closure of the throat air passage, resulting in cessation of airflow despite persistent ventilatory effort
  • Mechanical blockage results from upper airway collapse due to anatomic narrowing of the pharynx (throat air passage)
  • While awake, this structural narrowing is overcome by increased activity of dilating muscles. While asleep, however, this compensatory activity is lost and severe narrowing or closure occurs.
  • Factors associated with OSA include; obesity, aging, abnormality of the facial bones, smoking cigarettes, and alcohol consumption
  • OSA adversely affects other coexisting illnesses, such as, heart failure and stroke

Central Sleep Apnea (CSA)

Is caused by a high gain oscillation in chemical feedback loops, common in heart failure.

  • Occurs commonly in patients with heart failure or cerebrovascular disease and in newborns
  • Occurs when the brain fails to send the appropriate signals to the breathing muscles to initiate respiration, resulting in no respiratory effort
  • Breathing may be inhibited due to immaturity of the respiratory centres of the brain (pediatric cases), the presence of drugs, seizures, brain injury, or neuromuscular disorders

A small percentage of both infants and adults may suffer from "mixed apnea", showing symptoms of both central and obstructive sleep apnea.

Patients at high risk for suffering from sleep apnea are those who exhibit loud, chronic snoring(2) and choking or gasping during sleep. Obesity(3) (particularly upper body obesity) is a risk factor for sleep apnea and has a significant effect on the severity of symptoms. Sleep apnea is worsened by drinking alcohol or taking sleeping medicines. It is usually more severe when sleeping on the back.

Diagnosis of Sleep Apnea

The Remmers Sleep Recorder identifies sleep apnea. All the essential signals are included and a Remmers test stands as a valid diagnosis. Having an physician provide an expert interpretation of these results will guide your next steps.

Now, the convenient, easily accessible, low cost diagnostic method of portable testing can help patients get their results and begin urgent treatment.

Possible Treatments for Obstructive Sleep Apnea:

  • Weight Loss
  • Modification of Sleep Position
  • Use of Nasal CPAP (Continuous Positive Airway Pressure)
  • Dental Appliances (including so-called mouth guards, dental or tongue retaining devices.).
  • Medications
  • Surgery: removal of enlarged tonsils and/or adenoids is usually helpful. However, uvulopalatopharyngoplasty or laser assisted uvulopalatopharyngoplasty do not generally improve sleep apnea. These procedures do help snoring in many cases
  • Follow up evaluation of respiratory status during sleep is essential

If you suffer from Obstructive Sleep Apnea, you should discuss these options with your physician in order to find out which is the best treatment for you.

Notes / Bibliography

  1. Young T, Palta M, Dempsey J et al., The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med 1993; 328: 1230-5
  2. Snoring sounds are caused when there is an obstruction to the free flow of air through the passages at the back of the mouth and nose.
  3. Defined as greater than 120% of ideal body weight.
  4. The cost varies depending on the measurements made, how often the tests are to be repeated, and fees for the sleep laboratory. Average around $1,000-$2,000 for an in-lab study, compared with $150-$700 for in-home studies.