Sleep apnea goes beyond snoring and fretful, disrupted sleep and is actually a progressive condition which can become life threatening…Dr. Suresh Puri, Consultant Pulmonologist at JTS Medical Centre in Dubai elaborates that in our day-to-day living, an adequate amount of restful sleep at night plays an important role in our daytime functioning. “Restful adequate sleep means about seven hours of night sleep in which there is a normal architecture of sleep,” he says which essentially means encompassing the normal components of REM and NREM sleep. And as a result of this, normally such person will wake up fresh in the morning and will be energetic and alert throughout the day.
For individuals who snore, it’s a different story altogether. “It’s common to observe spouses, friends, and/or relatives snoring while they sleep, at times even loud snoring which can be heard in other rooms, associated with choking gasping sounds and at times silent gaps between snoring followed by a loud snoring, snorting sound and brief arousal and sleep fragmentation,” he says and in fact, these cycles are actually seen repetitively throughout the night. “These are the individuals who subsequently then wake up in the morning still feeling sleepy, groggy and lethargic and often fall asleep during the daytime,” he says and in fact, it is these silent gaps in between snoring that are indicators of sleep apnea. “Obstructive sleep apnea (OSA) is one of the commonest cause of sleep related breathing disorder and is largely goes undiagnosed and untreated,” explains Dr. Puri and a person suffering from significant OSA present with symptoms of snoring, gasping ,choking, silent gaps between snoring and frequent brief arousals which are typically witnessed by the bed partner
According to Dr. Puri, other problems related to sleep apnea include excessive daytime sleepiness, lethargy, irritability, mood swings, memory problems, inability to concentrate, depression, inability to cope up professionally and socially, heartburn, indigestion, erectile dysfunction, and even ultimately marital disharmony. “Additionally, significant OSA is a known risk factor for hypertension, irregular heartbeats known as cardiac arrhythmias, heart attacks, heart failure, strokes and major road traffic accidents,” he says and globally, OSA has a prevalence of five percent in the male population and about two percent in the female population.
OSA increases with age and obesity as obesity is a major risk factor for OSA; obesity being defined as a BMI of 30 or more. “Then the prevalence increases in females after menopause,” he says and in fact, children can be affected by OSA especially if they are obese and have some anatomical obstruction of upper airways like enlarged adenoids, tonsils, or nasal polyps. Other risk factors contributing to OSA include smoking, alcohol intake, and the use of sleeping pills, tells Dr. Puri and some hormonal disorders such as hypothyroidism and acromegaly can cause significant OSA. “Even facial deformities causing narrowing of upper airways can cause significant OSA,” he says.
With increasing awareness, Dr. Puri points out that more and more individuals with suspected OSA are seeking medical help for diagnosis and treatment. “OSA is diagnosed by sleep study known as polysomnography which is done overnight by recording of some or all of various parameters such as oro-nasal airflow, snoring, chest and abdominal movements, oxygen saturation, heartbeat, body position, muscle tone (EMG),brain electric activity(EEG), and heart electric activity(ECG),” he says and once diagnosed ,OSA is a treatable medical problem and potentially curable.
“Potentially curable causes of OSA include dealing with hypothyriodism by replacing thyroid hormone to achieve euthyriod state,” he says while another is dealing with acromegaly by surgical removal of pituitary macroadenoma or with medical treatment. “Also for enlarged tonsils/adenoids, the tonsils or adenoids are removed,” he says. Essentially the treatment of OSA is usually done by corrections of risk factors, tells Dr. Puri. “Since a major risk factor is obesity, the treatment of obesity is important factor in management of cases with OSA,” he says therefore regular exercise and diet control is advised with the aim to lose weight steadily until the ideal body weight is achieved. “This is easier said than done and needs focus and perseverance,” he says however the morbidly obese patient (BMI of 40 or more) can benefit from gastric bariatric surgery.
Besides weight reduction, Dr. Puri recommends other healthy lifestyle practices such as quitting smoking, avoid alcohol intake, consuming a light dinner at least two hours before bedtime, avoiding sleeping on the back, and avoid taking sleeping pills are all helpful in managing cases of OSA.
“Over time, there have been major advances in the management of OSA,” he says as a major breakthrough came with the use of Continous Positive Airway Pressure (CPAP) while sleeping. “CPAP is generated by a small portable appliance and is applied to upper airways with the help of comfortably placed face mask,” he says. “This mask is kept in place with the help of a headgear and CPAP acts as a pneumatic splint for the upper airways to keep upper airway open.” This leads to normal airflow during sleep, and minimal or no snoring/OSA, and no sleep fragmentation. Ultimately the individual feels rested, alert and energetic when awake and has improved quality of life, says Dr. Puri. “Also oral appliances such as Tongue protrusion devices and Mandibular advancement splint devices are also used with some success,” he says.”Some surgical procedures such as vulopalatopharygoplasty(UPPP),Orom axillofacial surgery, and Tracheostomy are sometimes used for selected cases of OSA.”
OSA is a sleep related breathing disorder and Dr. Puri urges should not be confused with other sleeping disorders such as Narcolepsy. “Narcolepsy is a neurological disorder characterized by excessive sleepiness,” he says. “Basically OSA is a major health problem and a risk factor for hypertension, heart attacks, cardiac arrhythmias, heart failure, and strokes and can also affect the quality of life.” However the good news is that it is easily diagnosed and treated.
Useful Tips that may indicate significant OSA:
Excessive daytime sleepiness (EDS) for example: falling asleep while watching TV, driving, waiting at traffic light, as a passenger in the car, in the cinema and during meetings.
- Poor performance at school especially in a child who is overweight or obese.
- Frequent work place or driving related accidents
- Increasing weight, irritability, mood swings, depression, memory problems, snoring at night and witnessed apnea by bed partner.
- Newly diagnosed case of hypertension or uncontrolled hypertension while on treatment.