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Snoring and Obstructive Sleep Apnea

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By Riddhi Patel, MD | Image – Antonio Guillem/Shutterstock.com |

Obstructive sleep apnea is the most common sleep-related breathing disorder, present in 20 to 30% of men and 10 to 15% of women. It is a disorder in which the upper airway collapses while sleeping resulting in reduced or complete cessation of airflow leading to problems in gas exchange and disturbed sleep.

Clinical Presentation

Patients with OSA are most commonly between the ages of 18 and 60 years old and have a BMI>30 kg/m2. They usually come to clinic complaining of daytime and nocturnal symptoms.

Nocturnal symptoms:

  • Snoring: 80 to 90% sensitivity for diagnosis
  • Witnessed apneas during sleep
  • Nocturia
  • Insomnia
  • Choking sensations that wake patient up

Daytime symptoms

  • Excessive daytime sleepiness is the hallmark of OSA
  • Morning headaches
  • Nonrestorative sleep (the subjective feeling that sleep has been insufficiently refreshing)

Risk Factors

  • Obesity: The strongest risk factor for OSA. Prevalence is directly related to body mass index and associated markers of weight such as neck circumference and waist-to-hip ratio
  • Age: Prevalence of OSA increases from the second to the seventh decade then plateaus
  • Gender: OSA is 2-3 times more common in males than females
  • upper airway abnormalities
  • Craniofacial abnormalities
  • Nasal congestion
  • Smoking
  • Menopausal and postpenopausal women

Diagnosis

Polysomnography is the gold standard diagnostic study for obstructive sleep apnea. The diagnosis is a combination of daytime symptoms of sleepiness and nighttime obstructive sleep apnea events while sleeping.

Diagnosis is defined by either:

  • 5 or more predominantly obstructive respiratory events per hour of sleep in a patient with one or more of the following: daytime symptoms of sleepiness, snoring/breathing interruptuions, or coexisting medical problems (such as hypertension, CAD, stroke, CHF, atrial fibrillation, diabetes mellitus type 2)
  • 15 or more predominantly obstructive respiratory events per hour of sleep without the presence of associated symptoms or coexisting medical problems

Complications

  • Cardiovascular morbidities: systemic hypertension, pulmonary hypertension, coronary artery disease, arrhythmias, stroke, heart failure
  • Excessive daytime sleepiness and inattention
  • Motor vehicle accidents due to drowsy driving
  • Type 2 Diabetes Mellitus
  • Metabolic syndrome
  • High blood pressure
  • Nonalcoholic fatty liver disease
  • Perioperative complications
  • Mortality: Patients with untreated OSA have a two to three-fold increased risk of mortality than individuals without OSA

 

Treatment

Because obesity is the biggest risk factor for obstructive sleep apnea, weight loss is one of the main treatments. Patients should be counseled on healthy eating and exercise to achieve weight loss.

Continuous positive airway pressure therapy is another treatment for OSA. CPAP devices should be used regularly by patients. This is often a problem due to noncompliance as patients report that the masks are uncomfortable and loud, making it hard for them to sleep. It is important to emphasize the importance of daily use of CPAP with patients.

Surgical intervetions such as uvulopalatopharyngoplasty, craniofacial reconstruction, and tracheostomy may be necessary in rare cases of OSA.

 

References

  1. Doney, R. Obstructive Sleep Apnea. Medscape, 2015.
  2. Epstein LJ, Kristo D, Strollo PJ Jr, et al. Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. J Clin Sleep Med 2009; 5:263.
  3. Sleep Apnea: Risk Factors, Mayo Clinic, June 29, 2010, Retrieved November 4, 2010
  4. Strohl, KP. Overview of obstructive sleep apnea in adults. Up to date. 2016.
  5. Victor, LD. Obstructive Sleep Apnea. Am Fam Physician. 1999; 60(8):2279-2286

3 COMMENTS

  1. In my opinion, this post couldn’t be written any better! Reading through this post reminds me of my previous room mate! He constantly kept snoring and concerning about this. I’ve forwarded this snoring article to him. Fairly confident he will have a great read. Thank you for great post!

    Yeh

  2. I have trouble falling asleep. I thought it was because of Paxil. Stopped taking for few weeks but it did not work. I felt so good with high energy level. I saw my doctor and she told me I have chronic depression and high risk to stop Paxil. So, I have to take Paxil. This is annoying 🙁

  3. I was just recently diagnoses with a mild case of Sleep Apnea. Instead of doing an intensive sleep study or surgery, my pulm dr told me that I will need to try the CPAP device. Thanks to the Cardiologytimes website. This article is overflowing with intelligent and informative data. And, there is no advertisement in this website.

    Ben

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