The Physiology of OSA | Risk Factors | OSA Symptoms | What Should You Do? |
What are the Treatment Options?
Overview
Obstructive Sleep Apnea (OSA) is a common health concern for many people. This manageable breathing-related sleep disorder can significantly impact an individual’s physical and mental health.
However, it is generally underreported and goes undiagnosed and untreated very often. When you combine this with OSA’s potential to increase the risk of several disorders, such as hypertension, depression, and even heart attacks, it’s easy to see why OSA is sometimes dubbed “the silent killer.”
Further complicating things is that many of the symptoms of OSA overlap with those of other disease processes, so it is difficult to ascertain without appropriate tests whether it is conclusively something to be concerned about.
With OSA, knowing the symptoms and when to get tested could dramatically affect health outcomes.
The Physiology of OSA
OSA happens as a result of throat muscles relaxing intermittently during sleep. This physiological reaction leads to a collapse in the structures they support, such as the roof of the mouth (soft palate), the uvula (the small, triangular tissue hanging from the palate), the tongue, and the tonsils.
When repeated throughout sleep, this relaxation and collapse cause the tongue to fall back into the air passage, causing airflow blockage.
With this blockage, the affected person cannot get sufficient oxygen into their system, and as the blood oxygen levels drop, carbon dioxide levels increase. This reaction triggers the brain to sense this breathing impairment and rouse the person awake just enough to start breathing again normally.[1]
Often, the person doesn’t remember waking up to do this because it’s momentary. Still, the frequent awakening at night (which can repeat 30 times or more every hour) prevents them from attaining REM sleep, the most restorative sleep segment.[2]
Risk Factors
1) Male Sex: OSA is more prevalent in men than women
2) Obesity: Excess fat around air passages and in the chest area can obstruct breathing
3) Neck Size: A neck circumference of more than 17″ in men and more than 16″ in women[3,4]
4) Genetics: OSA is more prevalent amongst first-degree relatives (parent to child)
5) Glands: Enlarged tonsils or adenoids can cause narrow airways
6) High Blood Pressure
7) Smoking[5]
Furthermore, OSA is commonly seen alongside other conditions,[6] such as:
1) Asthma
2) Diabetes
3) Tonsilitis
4) Hypertension
5) Chronic nasal congestion (sinusitis)
OSA Symptoms
1) Snoring[7]
2) Nocturia (waking up two times or more at night to void the bladder)[7]
3) Sporadic gasping and choking during sleep
4) Daytime drowsiness
5) Reduced alertness
6) Morning headaches or frequent headaches throughout the day
7) Irritability
8) Forgetfulness
9) Hyperactivity, especially in children
10) Poor job and academic performance[6]
11) Swelling in the legs
12) Loss of interest in sex
What Should You Do?
If you have any of the risk factors for OSA and are exhibiting one or more of the above symptoms, it is strongly recommended that you speak with your doctor or sleep specialist.
If your healthcare practitioner suspects OSA or simply wants to rule it out, you will probably be advised to undergo polysomnography (an overnight sleep study at a sleep center).
If, for whatever reason, you cannot get a sleep study done at a sleep center, you may qualify for the prescription of an at-home sleep test through companies like MHSleepTesting.com.
A home OSA test is a simplified breathing monitor that tracks breathing effort and oxygen levels, but not sleep, while worn.
While at-home OSA tests can be cost-effective, overnight sleep studies in a sleep center provide a far more thorough assessment of any possible sleep disorder that the at-home kit cannot detect.
Left untreated, your risk of hypertension, heart attacks, cardiac failure, and stroke increase. Cognitive issues like depression and other mental health issues can happen due to sleep deprivation and its effect on daytime productivity and the overall quality of life.[8]
What are the Treatment Options?
If you are diagnosed with OSA, know there are effective treatments for the disorder, with the current gold standard CPAP (continuous positive airway pressure) machine leading the way.
A CPAP unit has a mask that the patient wears on their mouth, nose, or both. Oxygen is pumped into the airways through the mask, improving oxygen flow and allowing the airways to remain open while asleep.
Oral appliances such as a mouthguard that a dentist can fit can also help in some instances in that it keeps the airways open during sleep.
Surgery may be an option in more severe cases of OSA where CPAP or oral appliances cannot provide relief. The type of surgery depends on the root cause of the OSA. Upper or lower pharyngeal procedures involving the tongue, mandible, or tonsils can be an effective and permanent treatment.
Another surgical option is upper airway stimulation by placing a medical device in your body as an outpatient procedure, keeping airways open with a click of a remote-controlled button.
If you feel that you may be at risk or are experiencing symptoms of OSA, it’s essential to speak to your healthcare practitioner. The sooner you access treatment, the better your outcome.
References:
- Pham, L. V., & Schwartz, A. R. (2015). The pathogenesis of obstructive sleep apnea. Journal of thoracic disease, 7(8), 1358–1372. https://doi.org/10.3978/j.issn.2072-1439.2015.07.28
- Slowik JM, Collen JF. Obstructive Sleep Apnea. [Updated 2020 Nov 20]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459252/
- Millman, R. P., Carlisle, C. C., McGarvey, S. T., Eveloff, S. E., & Levinson, P. D. (1995). Body fat distribution and sleep apnea severity in women. Chest, 107(2), 362–366. https://doi.org/10.1378/chest.107.2.362
- Davies, R. J., & Stradling, J. R. (1990). The relationship between neck circumference, radiographic pharyngeal anatomy, and the obstructive sleep apnoea syndrome. The European respiratory journal, 3(5), 509–514.
- Krishnan, V., Dixon-Williams, S., & Thornton, J. D. (2014). Where there is smoke…there is sleep apnea: exploring the relationship between smoking and sleep apnea. Chest, 146(6), 1673–1680. https://doi.org/10.1378/chest.14-0772
- Hoffstein, V., & Szalai, J. P. (1993). Predictive value of clinical features in diagnosing obstructive sleep apnea. Sleep, 16(2), 118–122.
- Romero, E., Krakow, B., Haynes, P., & Ulibarri, V. (2010). Nocturia and snoring: predictive symptoms for obstructive sleep apnea. Sleep & breathing = Schlaf & Atmung, 14(4), 337–343. https://doi.org/10.1007/s11325-009-0310-2
- Jehan, S., Auguste, E., Pandi-Perumal, S. R., Kalinowski, J., Myers, A. K., Zizi, F., Rajanna, M. G., Jean-Louis, G., & McFarlane, S. I. (2017). Depression, Obstructive Sleep Apnea and Psychosocial Health. Sleep medicine and disorders : international journal, 1(3), 00012.
