Learning Center: OBSTRUCTIVE SLEEP APNEA and SNORING

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TYPES OF SLEEP APNEA (CENTRAL VS. OBSTRUCTIVE)

Sleep apnea may be either obstructive sleep apnea (OSA) in which breathing is interrupted by a blockage of air flow, central sleep apnea (CSA) in which regular unconscious breath simply stops. A given individual may have neither, either, or both types of sleep apnea.

EFFECTS OF UNTREATED OBSTRUCTIVE SLEEP APNEA

In general, the more severe the sleep apnea, the worse the consequences.

In children: Effects of obstructive sleep apnea include symptoms such as concentration and learning difficulties and irritability, neurocognitive development impairment, decreased school performance, excessive e daytime sleepiness, and behavior difficulties (such as hyperactivity), high blood pressure, bed wetting,

In adults: Effects of obstructive sleep apnea in adults include excessive daytime sleepiness, high blood pressure, heart attach (myocardial infarction) or other heart and vascular disease, impaired cognitive function (of attention, verbal and visual  long-term memory, visuospatial/constructional abilities and executive functions, such as mental flexibility), depression, impairments of social life and decreased effectiveness at work, social functioning, and a greatly increased risk of vehicle accidents.

EVALUATION FOR OBSTRUCTIVE SLEEP APNEA

How does one know if he or she has obstructive sleep apnea? Observations from a bed partner who has witnessed airway obstruction is a strong indicator, and snoring, obesity, excessive daytime sleepiness are among the softer signs that may raise one’s suspicion for OSA, A simple screening questionaire may help determine if OSA is likely, but a sleep study is the definitive way to make (or exclude) the diagnosis. Sleep studies performed in the sleep laboratory (a polysomnogram) are the most accurate and detailed type of sleep study. Home sleep studies have the advantage of ease of use, being able to sleep in one’s own bed, and costing less, but carry the disadvantage of having lower accuracy and yielding less information overall.

TREATMENT OF OBSTRUCTIVE SLEEP APNEA IN CHILDREN

For children with obstruction of their airway during sleep, tonsillectomy and adenoidectomy can be very helpful and is often curative. Some conditions, such as obesity, genetic disorders called mucopolysaccharidoses, Down syndrome, and neurological impairment require special consideration.

• Link to Tonsillectomy and Airway Obstruction During Sleep for parents at ENTHealth website.

TREATMENT OF OBSTRUCTIVE SLEEP APNEA IN ADULTS

Numerous treatment options are used in adult obstructive sleep apnea. Avoiding alcohol and smoking is recommended, as is avoiding medications that relax the central nervous system (for example, sedatives and muscle relaxants). Weight loss is recommended in those who are overweight. Continuous positive airway pressure (CPAP) and mandibular advancement devices are often used. Between these two, CPAP is more helpful when used, but is overall used less regularly than mandibular advancement devices. Physical training, even without weight loss, improves sleep apnea. A hypoglossal nerve stimulator (like Inspire) implant is effective among patients who meet selection criteria. There is insufficient evidence to support widespread use of medications for treatment of obstructive sleep apnea. In selected patients, e.g. with tonsillar hyperplasia tonsillectomy is recommended. In patients failing CPAP and oral appliances, surgical treatment with uvulopalatopharyngoplasty (UPPP) as salvage surgery is recommended for benefit in nocturnal respiration and excessive daytime sleepiness,

Treatment options for snoring

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