Obstructive Sleep Apnoea

Obstructive sleep apnoea

sleep apnea
Obstructive sleep apnoea (OSA) is a disorder in which breathing is repeatedly interrupted during sleep. OSA is on a spectrum of sleep breathing disorders, with snoring on one end and OSA on the other. OSA is present in about 5% of individuals and it is more common in middle-aged males and women after menopause.

OSA is caused by collapse of the airway tissues. The collapsibility of the airway in any individual is based on a number of factors. There may be anatomic reasons such as a blocked nose, large tonsils or a small jaw. Physiologic reasons relate to the way the airway functions. Some people cannot tolerate the normal changes in airflow during sleep as well as others. Other factors may include an unhealthy weight, use of alcohol or medications, and other medical conditions.

Your brain senses disruption to airflow during sleep and causes you to wake up briefly. Everyone experiences a few of these during the night. You are not normally aware of these interruptions to sleep, but may be aware of symptoms such as excessive sleepiness which may affect daytime function such as driving or memory, tiredness, morning headaches or a dry mouth. Partners may report snoring or pauses during your sleep. Research shows that some forms of OSA are linked to health problems in the long term, such as increased risk of high blood pressure, heart disease, diabetes or strokes.
The diagnosis of OSA is based on a comprehensive discussion about your symptoms and medical history, an examination to determine which anatomic factors may be associated with airway collapse and a sleep test, the polysomnogram. This test involves monitoring specific measures while you sleep. The test categorises the severity of sleep apnoea into mild, moderate or severe.

Treatment of OSA is based on what the main issue is for the patient, how severe the disease is based on the sleep test and what factors can be altered with treatment. Some treatments are designed to address snoring, some for sleepiness and some to minimize the long term health problems which can be associated with OSA.

Treatment firstly addresses weight loss, which may include weight loss surgery, improving bedtime behaviours and managing other medical problems including other sleep disorders and allergic rhinitis. After that, most patients are recommended for continuous positive airway pressure (CPAP). This is device worn over or in the nose or mouth, which splints the airway open when you breath during sleep. Because this is so effective at controlling the symptoms and consequences of OSA, a great deal of emphasis is placed on getting the right CPAP set up for you.

For patients that are unable to tolerate CPAP, other treatments become options. These include jaw splints to hold the jaw and tongue forward, positional devices to move you off your back, and surgery. The type of surgery depends on where the airway tissue is collapsing or obstructing. Typical surgeries include straightening the nose, removing tonsils, repositioning the soft palate, advancing the hard palate, reducing tongue volume and moving the position of the jaws. In children the first line of treatment is removal of tonsils and adenoids. This is effective in curing sleep apnoea in 80-85% of children.