Sleep apnea
Sleep apnea, also spelled sleep apnoea, is a sleep disorder where a person has pauses in breathing or periods of shallow breathing during sleep.[1] Each pause can last for a few seconds to a few minutes and they happen many times a night.[1] In the most common form, this follows loud snoring.[2] There may be a choking or snorting sound as breathing resumes.[1] Because the disorder disrupts normal sleep, those affected may experience sleepiness or feel tired during the day.[1] In children it may cause hyperactivity or problems in school.[2]
Sleep apnea may be either obstructive sleep apnea (OSA) in which breathing is interrupted by a blockage of air flow, central sleep apnea (CSA) in which regular unconscious breath simply stops, or a combination of the two.[1] Obstructive (OSA) is the most common form.[1] Risk factors for OSA include being overweight, a family history of the condition, allergies, a small breathing airway, and enlarged tonsils.[4] Some people with sleep apnea are unaware they have the condition.[1] In many cases it is first observed by a family member.[1] Sleep apnea is often diagnosed with an overnight sleep study.[5] For a diagnosis of sleep apnea, more than five episodes per hour must occur.[7]
Treatment may include lifestyle changes, mouthpieces, breathing devices, and surgery.[1] Lifestyle changes may include avoiding alcohol, losing weight, stopping smoking, and sleeping on one's side.[8] Breathing devices include the use of a CPAP machine.[8] Without treatment, sleep apnea may increase the risk of heart attack, stroke, diabetes, heart failure, irregular heartbeat, obesity, and motor vehicle collisions.[1]
OSA affects 1 to 6% of adults and 2% of children.[3][6] It affects males about twice as often as females.[3][9] While people at any age can be affected, it occurs most commonly among those 55 to 60 years old.[1][3] CSA affects less than 1% of people.[10] A type of CSA was described in the German myth of Ondine's curse where the person when asleep would forget to breathe
Sleep apnea may be either obstructive sleep apnea (OSA) in which breathing is interrupted by a blockage of air flow, central sleep apnea (CSA) in which regular unconscious breath simply stops, or a combination of the two.[1] Obstructive (OSA) is the most common form.[1] Risk factors for OSA include being overweight, a family history of the condition, allergies, a small breathing airway, and enlarged tonsils.[4] Some people with sleep apnea are unaware they have the condition.[1] In many cases it is first observed by a family member.[1] Sleep apnea is often diagnosed with an overnight sleep study.[5] For a diagnosis of sleep apnea, more than five episodes per hour must occur.[7]
Treatment may include lifestyle changes, mouthpieces, breathing devices, and surgery.[1] Lifestyle changes may include avoiding alcohol, losing weight, stopping smoking, and sleeping on one's side.[8] Breathing devices include the use of a CPAP machine.[8] Without treatment, sleep apnea may increase the risk of heart attack, stroke, diabetes, heart failure, irregular heartbeat, obesity, and motor vehicle collisions.[1]
OSA affects 1 to 6% of adults and 2% of children.[3][6] It affects males about twice as often as females.[3][9] While people at any age can be affected, it occurs most commonly among those 55 to 60 years old.[1][3] CSA affects less than 1% of people.[10] A type of CSA was described in the German myth of Ondine's curse where the person when asleep would forget to breathe
Signs and symptoms
People with sleep apnea have problems with excessive daytime sleepiness (EDS), impaired alertness, and vision problems.[12] OSA may increase risk for driving accidents and work-related accidents. If OSA is not treated, people are at increased risk of other health problems, such as diabetes. Death could occur from untreated OSA due to lack of oxygen to the body.[13]
Due to the disruption in daytime cognitive state, behavioral effects may be present. These can include moodiness, belligerence, as well as a decrease in attentiveness and energy.[14] These effects may become intractable, leading to depression.[15]
There is evidence that the risk of diabetes among those with moderate or severe sleep apnea is higher.[16] There is increasing evidence that sleep apnea may lead to liver function impairment, particularly fatty liver diseases (see steatosis).[14][17][18][19] Finally, because there are many factors that could lead to some of the effects previously listed, some people are not aware that they have sleep apnea and are either misdiagnosed or ignore the symptoms altogethe
People with sleep apnea have problems with excessive daytime sleepiness (EDS), impaired alertness, and vision problems.[12] OSA may increase risk for driving accidents and work-related accidents. If OSA is not treated, people are at increased risk of other health problems, such as diabetes. Death could occur from untreated OSA due to lack of oxygen to the body.[13]
Due to the disruption in daytime cognitive state, behavioral effects may be present. These can include moodiness, belligerence, as well as a decrease in attentiveness and energy.[14] These effects may become intractable, leading to depression.[15]
There is evidence that the risk of diabetes among those with moderate or severe sleep apnea is higher.[16] There is increasing evidence that sleep apnea may lead to liver function impairment, particularly fatty liver diseases (see steatosis).[14][17][18][19] Finally, because there are many factors that could lead to some of the effects previously listed, some people are not aware that they have sleep apnea and are either misdiagnosed or ignore the symptoms altogethe
Risk factors
Sleep apnea can affect people regardless of sex, race, or age. However, risk factors include:
being male
obesity
age over 40
large neck circumference (greater than 16–17 inches)
enlarged tonsils or tongue
small jaw bone
gastroesophageal reflux
allergies
sinus problems
a family history of sleep apnea
deviated septum[20]
Alcohol, sedatives and tranquilizers may also promote sleep apnea by relaxing throat muscles. People who smoke tobacco have sleep apnea at three times the rate of people who have never done so.[21]
Central sleep apnea is more often associated with any of the following risk factors:
being male
an age above 65
having heart disorders such as atrial fibrillation or atrial septal defects such as PFO
stroke
High blood pressure is very common in people with sleep apnea.[22]
Mechanism
When breathing is paused, carbon dioxide builds up in the bloodstream. Chemoreceptors in the blood stream note the high carbon dioxide levels. The brain is signaled to awaken the person, which clears the airway and allows breathing to resume. Breathing normally will restore oxygen levels and the person will fall asleep again.[23] This carbon dioxide build-up may be due to the decrease of output of the brainstem regulating the chest wall or pharyngeal muscles, which causes the pharynx to collapse.[24] People with sleep apnea experience reduced or no slow-wave sleep and spend less time in REM sleep.[24]
Diagnosis
Sleep apnea may be diagnosed by the evaluation of symptoms, risk factors and observation, (e.g., excessive daytime sleepiness and fatigue) but the gold standard for diagnosis is a formal sleep study (polysomnography, or sometimes a reduced-channels home-based test called "home sleep apnea testing" (HSAT)). A study can establish reliable indices of the disorder, derived from the number and type of event per hour of sleep (Apnea Hypopnea Index (AHI), or Respiratory Disturbance Index (RDI)), associated to a formal threshold, above which a patient is considered as suffering from sleep apnea, and the severity of their sleep apnea can then be quantified. Mild obstructive sleep apnea (OSA) ranges from 5 to 14.9 events per hour, moderate OSA falls in the range of 15–29.9 events per hour, and severe OSA would be a patient having over 30 events per hour.
Despite this medical consensus, the variety of apneic events (e.g., hypopnea vs apnea, central vs obstructive), the variability of patients' physiologies, and the inherent shortcomings and variability of equipment and methods, this field is subject to debate.[26] Within this context, the definition of an event depends on several factors (e.g., patient's age) and account for this variability through a multi-criteria decision rule described in several, sometimes conflicting, guidelines. One example of a commonly adopted definition of an apnea (for an adult) includes a minimum 10-second interval between breaths, with either a neurological arousal (a 3-second or greater shift in EEG frequency, measured at C3, C4, O1, or O2) or a blood oxygen desaturation of 3–4% or greater, or both arousal and desaturation.
Sleep apnea can affect people regardless of sex, race, or age. However, risk factors include:
being male
obesity
age over 40
large neck circumference (greater than 16–17 inches)
enlarged tonsils or tongue
small jaw bone
gastroesophageal reflux
allergies
sinus problems
a family history of sleep apnea
deviated septum[20]
Alcohol, sedatives and tranquilizers may also promote sleep apnea by relaxing throat muscles. People who smoke tobacco have sleep apnea at three times the rate of people who have never done so.[21]
Central sleep apnea is more often associated with any of the following risk factors:
being male
an age above 65
having heart disorders such as atrial fibrillation or atrial septal defects such as PFO
stroke
High blood pressure is very common in people with sleep apnea.[22]
Mechanism
When breathing is paused, carbon dioxide builds up in the bloodstream. Chemoreceptors in the blood stream note the high carbon dioxide levels. The brain is signaled to awaken the person, which clears the airway and allows breathing to resume. Breathing normally will restore oxygen levels and the person will fall asleep again.[23] This carbon dioxide build-up may be due to the decrease of output of the brainstem regulating the chest wall or pharyngeal muscles, which causes the pharynx to collapse.[24] People with sleep apnea experience reduced or no slow-wave sleep and spend less time in REM sleep.[24]
Diagnosis
Sleep apnea may be diagnosed by the evaluation of symptoms, risk factors and observation, (e.g., excessive daytime sleepiness and fatigue) but the gold standard for diagnosis is a formal sleep study (polysomnography, or sometimes a reduced-channels home-based test called "home sleep apnea testing" (HSAT)). A study can establish reliable indices of the disorder, derived from the number and type of event per hour of sleep (Apnea Hypopnea Index (AHI), or Respiratory Disturbance Index (RDI)), associated to a formal threshold, above which a patient is considered as suffering from sleep apnea, and the severity of their sleep apnea can then be quantified. Mild obstructive sleep apnea (OSA) ranges from 5 to 14.9 events per hour, moderate OSA falls in the range of 15–29.9 events per hour, and severe OSA would be a patient having over 30 events per hour.
Despite this medical consensus, the variety of apneic events (e.g., hypopnea vs apnea, central vs obstructive), the variability of patients' physiologies, and the inherent shortcomings and variability of equipment and methods, this field is subject to debate.[26] Within this context, the definition of an event depends on several factors (e.g., patient's age) and account for this variability through a multi-criteria decision rule described in several, sometimes conflicting, guidelines. One example of a commonly adopted definition of an apnea (for an adult) includes a minimum 10-second interval between breaths, with either a neurological arousal (a 3-second or greater shift in EEG frequency, measured at C3, C4, O1, or O2) or a blood oxygen desaturation of 3–4% or greater, or both arousal and desaturation.
Treatment
The management of obstructive sleep apnea was improved with the introduction of continuous positive airway pressure (CPAP), first described in 1981 by Colin Sullivan and associates in Sydney, Australia.[89] The first models were bulky and noisy, but the design was rapidly improved and by the late 1980s CPAP was widely adopted. The availability of an effective treatment stimulated an aggressive search for affected individuals and led to the establishment of hundreds of specialized clinics dedicated to the diagnosis and treatment of sleep disorders. Though many types of sleep problems are recognized, the vast majority of patients attending these centers have sleep-disordered breathing. Sleep apnea awareness day is April 18 in recognition of Colin Sulliva
The management of obstructive sleep apnea was improved with the introduction of continuous positive airway pressure (CPAP), first described in 1981 by Colin Sullivan and associates in Sydney, Australia.[89] The first models were bulky and noisy, but the design was rapidly improved and by the late 1980s CPAP was widely adopted. The availability of an effective treatment stimulated an aggressive search for affected individuals and led to the establishment of hundreds of specialized clinics dedicated to the diagnosis and treatment of sleep disorders. Though many types of sleep problems are recognized, the vast majority of patients attending these centers have sleep-disordered breathing. Sleep apnea awareness day is April 18 in recognition of Colin Sulliva
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