Obstructive sleep apnea

Overview

Obstructive sleep apnea is a potentially serious sleep disorder in which breathing repeatedly stops and starts during sleep. Several types of sleep apnea exist, but the most common type is obstructive sleep apnea, which occurs when your throat muscles intermittently relax and block your airway during sleep. The most noticeable sign of obstructive sleep apnea is snoring. Anyone can develop obstructive sleep apnea, although it most commonly affects middle-aged and older adults and people who are overweight. Obstructive sleep apnea treatment may involve using a device to keep your airway open or using a mouthpiece to thrust your jaw forward during sleep. Some people undergo a procedure to change the structure of their nose, mouth or throat. Obstructive sleep apnea occurs when the muscles in the back of your throat relax too much to allow normal breathing. These muscles support structures including the soft palate, the uvula — a triangular piece of tissue hanging from the soft palate, the tonsils and the tongue. When the muscles relax, your airway narrows or closes as you breathe in and breathing may be inadequate for 10 to 20 seconds. This may lower the level of oxygen in your blood. Your brain senses this impaired breathing and briefly rouses you from sleep so that you can reopen your airway. This awakening is usually so brief that you don’t remember it. You can awaken with a transient shortness of breath that corrects itself quickly, within one or two deep breaths. You may make a snorting, choking or gasping sound. This pattern can repeat itself five to 30 times or more each hour, all night long. These disruptions impair your ability to reach the desired deep, restful phases of sleep, and you’ll probably feel sleepy during your waking hours. People with obstructive sleep apnea may not be aware that their sleep was interrupted. In fact, many people with this type of sleep apnea think they slept well all night.

Diagnosis

Treatment

For milder cases of obstructive sleep apnea, your doctor may recommend lifestyle changes:

Lose weight if you’re overweight.
Exercise regularly.
Drink alcohol moderately, if at all, and don’t drink several hours before bedtime.
Quit smoking.
Use a nasal decongestant.
Don’t sleep on your back.

If these measures don’t improve your sleep or if your apnea is moderate to severe, then your doctor may recommend other treatments. Certain devices can help open up a blocked airway. In other cases, surgery may be necessary.

Therapies: Positive airway pressure. If you have obstructive sleep apnea, you may benefit from positive airway pressure. In this treatment, a machine delivers air pressure through a piece that fits into the nose or is placed over the nose and mouth while you sleep. Positive airway pressure reduces the number of respiratory events that occur as you sleep, reduces daytime sleepiness and improves your quality of life.

The most common type is called continuous positive airway pressure, or CPAP (SEE-pap). With this treatment, the pressure of the air breathed is continuous, constant and somewhat greater than that of the surrounding air, which is just enough to keep your upper airway passages open. This air pressure prevents obstructive sleep apnea and snoring.

CPAP may be given at a continuous (fixed) pressure or varied (autotitrating) pressure. In fixed CPAP, the pressure stays constant. In autotitrating CPAP, the levels of pressure are adjusted if the device senses increased airway resistance.

Mouthpiece: Though positive airway pressure is often an effective treatment, oral appliances are an alternative for some people with mild or moderate obstructive sleep apnea. These devices may reduce your sleepiness and improve your quality of life. These devices are designed to keep your throat open. Some devices keep your airway open by bringing your jaw forward, which can sometimes relieve snoring and obstructive sleep apnea. Other devices hold your tongue in a different position.

Medications: If you continue to experience daytime sleepiness after treatment for your obstructive sleep apnea, your doctor may prescribe medications to reduce sleepiness.

Surgery or other procedures

The goal of surgery for obstructive sleep apnea is to prevent blockage of the upper airway during sleep. Surgery is usually considered only if other therapies haven’t been effective or haven’t been appropriate options for you. Surgical options may include: Surgical removal of tissue: Uvulo-palato-pharyngoplasty (UPPP) is a procedure in which your doctor removes tissue from the back of your mouth and top of your throat. Your tonsils and adenoids are commonly removed as well. UPPP usually is performed in a hospital and requires a general anesthetic.

Doctors sometimes remove tissue from the back of the throat with a laser (laser-assisted uvulo-palato-plasty or with radio-frequency energy (radio-frequency ablation) to treat snoring. These procedures don’t treat obstructive sleep apnea, but they may reduce snoring.

Jaw surgery: In this procedure the upper and lower parts of your jaw are moved forward from the rest of your facial bones. This enlarges the space behind the tongue and soft palate, making obstruction less likely.This procedure often requires an oral surgeon and possibly an orthodontist. Complications could include numbness of the mouth, bleeding, and infection, removal of hardware or temporomandibular joint problems.

Surgical opening in the neck: You may need this form of surgery if other treatments have failed and you have severe, life-threatening obstructive sleep apnea. In this procedure, called tracheostomy, your surgeon makes an opening in your neck and inserts a metal or plastic tube through which you breathe. Air passes in and out of your lungs, bypassing the blocked air passage in your throat.

Specialists