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Sleep Apnea
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.
Other problems
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.
Risk Factors
According to Dr. Puri, prevalence for
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
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
axillofacial surgery, and Tracheostomy
are sometimes used for selected cases of
Final Words
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:
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
• 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
Jan/Feb 2014