Sleep Apnea

Sleep Apnea is a sleep disorder that involved stoppage or significant decrease in airflow in the presence of breathing effort during sleep.  Each pause can last for a few seconds to several minutes and can happen several times throughout a night.  Commonly, this follows loud snoring.  There are three forms: obstructive (OSA), central (CSA), and a combination of the two called “mixed;” however OSA remains to most common.  

OSA is the most common sleep-related breathing disorder, with an estimated prevalence of 20-30 percent in males and 10-15 percent in females in North America.  OSA is more prevalent in African Americans who are younger than 35 years old compared with Caucasians of the same age group, independent of body weight.

The strongest risk factor for OSA is obestiy.  OSA is caused by recurrent soft tissue collapse in the pharynx during sleep, causing substantially reduced airflow despite breathing efforts.  This leads to intermittent disturbances in gas exchange (hypercapnia and hypoxemia).

Snoring and daytime sleepines are common presenting complaints of OSA.  They are sensitive, but lack specificity for diagnosis.  Additional symptoms include restless sleep, periods of silence terminated by loud snoring, fatigue, poor concentration, nocturnal angina, nocturia, and morning headache.

Common findings on exam include obesity, a large neck, hypertension, and a crowded oropharyngeal airway.  

A sleep study is the first-line diagnostic study when OSA is suspected.  In home sleep testing may also be done in patients strongly suspected of having OSA without any other comorbidities.

OSA is a chronic disease that requires long term management.  Weight loss and CPAP are the cornerstones of therapy, with both having been shown to improve outcomes in randomized trials.  Other alternative therapies that have shown benefit are oral appliances, upper airway surgery, and hypoglossal nerve stimulation,