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Sleep Apnea

(Obstructive Apnea; Central Apnea; Mixed Apnea)

Definition

Sleep apnea occurs when breathing stops for brief periods of time while a person is sleeping. It can last for 10-30 seconds, and may occur up to 20-30 times per hour. During one night of sleep, this can cause up to 400 episodes of interrupted breathing.
Blocked Airway
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Causes

There are three types of respiratory events:
  • Obstructive apnea—caused by a temporary, partial, or complete blockage of the airway
  • Central apnea—caused by a temporary failure to make an effort to breathe
  • Mixed apnea—a combination of the first two types

Risk Factors

Factors that increase your chances of developing sleep apnea include:
  • Sex: male
  • Overweight
  • Large neck circumference
  • Age: middle to older age
  • Family history of apnea
  • Structural abnormalities of the nose, throat, or other part of the respiratory tract. Examples include:
  • Hypothyroidism
  • Medicines: sedatives and sleeping aids
  • Alcohol consumption
  • Smoking

Symptoms

Symptoms include:
  • Fatigue and sleepiness during waking hours
  • Loud snoring
  • Breathing that stops during the night that—as noticed by a bed partner
  • Repeated waking at night
  • Unrefreshing sleep
  • Morning headaches
  • Poor concentration or problems with memory
  • Irritability or short temper
People with chronic, untreated sleep apnea may be at risk for:

Diagnosis

An overnight sleep study is used to help diagnose sleep apnea.

Overnight Sleep Study (Polysomnography)

This test helps detect the presence and severity of sleep apnea. During sleep, it measures your:
  • Eye and muscle movements
  • Brain activity using an electroencephalogram
  • Heart rate
  • Breathing pattern and depth
  • The percent of your red blood cells that are saturated with oxygen

Other Studies

In addition to sleep studies, your doctor may order:

Treatment

There are a number of treatment options for sleep apnea, including:

Behavioral Therapy

  • Lose weight if you are overweight.
  • Avoid using sedatives, sleeping pills, alcohol, and nicotine, which can make the condition worse.
  • Try sleeping on your side instead of your back.
  • Use pillows to increase your level of comfort when sleeping.
  • For daytime sleepiness, practice safety measures, such as avoiding driving or operating potentially hazardous equipment.

Mechanical Therapy

Continuous positive airway pressure (CPAP) entails wearing a mask over your nose and/or mouth during sleep. An air blower forces enough constant and continuous air through your air passages to prevent the tissues from collapsing and blocking the airway. In some cases, dental appliances that help keep the tongue or jaw in a more forward position may help.

Surgery

In some cases, surgery may be recommended. It is most often beneficial in pediatric patients.
Types of surgery that may be done to treat severe cases of sleep apnea include:
  • Uvulopalatopharyngoplasty—Excess soft tissue is removed from the nose and/or throat.
  • Maxillomandibular advancement—The jawbone is repositioned forward.
  • Tracheotomy —For life-threatening cases of sleep apnea, an opening is made in the windpipe to allow for normal breathing.
  • Adenotonsillectomy—The adenoids and tonsils are removed.
Bariatric surgery may help with weight loss in some people who are obese . This surgery may reduce many of the complications that are related to obesity, including sleep apnea.

Medications

Only used in central apnea, acetazolamide may help improve the ability to regulate breathing. Overall, there is not a lot of evidence to support the use of medicines to treat sleep apnea.
Supplemental oxygen may be given if blood levels of oxygen fall too low during sleep, even after opening the airway.

Prevention

You may be able to prevent sleep apnea by maintaining a healthy weight . Avoid alcohol, nicotine, and sedatives, which may contribute to airway obstruction.

RESOURCES

American Sleep Apnea Association http://www.sleepapnea.org

National Sleep Foundation http://www.sleepfoundation.org

CANADIAN RESOURCES

Canadian Lung Association http://www.lung.ca

Canadian Sleep Society http://www.canadiansleepsociety.ca

References

American Academy of Sleep Medicine. The International Classification of Sleep Disorders. 2nd ed. Westchester, IL; American Academy of Sleep Medicine; 2005.

Kushida CA, Littner MR, Hirshkowitz M, et al. Practice parameters for the use of continuous and bilevel positive airway pressure devices to treat adults with sleep-related breathing disorders. Sleep. 2006;29:375-380.

Littner MR, Kushida C, Wise M, et al. Practice parameters for clinical use of the multiple sleep latency test and the maintenance of wakefulness test. Sleep. 2005;28:113-121.

Morgenthaler TI, Kapen S, Lee-Chiong T, et al. Practice parameters for the medical therapy of obstructive sleep apnea. Sleep. 2006;29:1031-1035.

Obstructive sleep apnea (OSA). EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated May 23, 2013. Accessed June 3, 2013.

Pack AI, Maislin G. Who should get treated for sleep apnea? Ann Intern Med . 2001;134:1065-1067.

Sleep apnea. American Sleep Apnea Association website. Available at: http://www.sleepapnea.org/learn/sleep-apnea.html . Accessed June 3, 2013.

Smith I, Lasserson TJ, Wright J. Drug therapy for obstructive sleep apnea. Cochrane Database Syst Rev . 2006;19:CD003002.

Revision Information

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

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