Definition

Obstructive sleep apnea, abbreviated as OSA, is a disorder caused by the repetitive collapse of the upper airway during sleep. OSA is the most common sleep-related breathing disorder.

This condition can occur at any age, including in children, but it most commonly affects older men. The incidence of OSA increases in women after menopause.

Causes

During normal breathing, air flows smoothly from the nose and mouth through the throat to the lungs. However, in individuals with OSA, the muscles that support the soft tissues around their throat relax. These muscles support the structures at the back of the roof of your mouth (palate), uvula, tonsils, and tongue.

When these muscles relax, your airway narrows or even closes while you're trying to breathe in. This can hinder your breathing for 10 seconds or more. Furthermore, it can lead to decreased oxygen levels in the blood and an accumulation of carbon dioxide in your body.

Your brain detects this breathing disturbance and quickly wakes you from sleep, reopening your airway. You may awaken gasping for air and quickly resolve the issue, returning to normal breathing.

Risk Factor

Anyone can experience OSA, but several factors increase the risk of developing it:

• Excess body weight. While not everyone with OSA is overweight, fat deposits around the upper airway can cause airway obstruction. Medical conditions associated with obesity, such as hypothyroidism and polycystic ovary syndrome (PCOS), can also cause OSA.
• Elderly. The risk of OSA increases in individuals aged 60-70 years and older.
• Narrowed airway. Some people have narrow airways that are genetically inherited. In addition to narrow airways, you may have enlarged tonsils that can block your airway.
• High blood pressure (hypertension). People with high blood pressure are at risk of OSA.
• Chronic nasal congestion. OSA is twice as common in individuals with consistent nighttime nasal congestion. This may be due to airway narrowing.
• Smoking. Smokers are more likely to have OSA.
• Diabetes. People with diabetes are more likely to have OSA.
• Gender. Generally, men are 2-3 times more likely to have OSA than women. The frequency of OSA in women increases after menopause.
• Family history. Several studies have shown that there is a relationship between asthma and the occurrence of OSA.

Symptoms

The most prominent symptom of OSA is loud snoring. In addition to snoring, other symptoms of OSA include:

• Excessive daytime sleepiness
• Episodes of breathing cessation during sleep
• Waking suddenly from sleep accompanied by choking or gasping
• Waking up with a dry mouth or sore throat
• Morning headaches
• Mood changes, such as depression or irritability
• High blood pressure
• Decreased libido or sexual desire

During an attack, you may make snorting, choking, or gasping sounds. This pattern can repeat five, thirty, or more times per hour, or throughout the night. This disruption may prevent you from entering a deep, restful sleep phase. Furthermore, it will make you feel extremely sleepy during the day or while engaging in activities. The majority of people with OSA are unaware of their sleep disorder.

Diagnosis

Diagnosing OSA begins with a thorough medical history and physical examination. During the medical history, your doctor will inquire about daytime sleepiness and snoring, both important signs for diagnosing OSA.

Your doctor will then examine your neck and head to identify physical factors contributing to OSA. You may be asked to fill out questionnaires related to daytime sleepiness, sleep habits, and sleep quality.

In addition to the medical history and physical examination, your doctor may perform additional tests as indicated. Polysomnography (PSG) is considered the gold standard test for diagnosing OSA. PSG requires an overnight stay in a hospital laboratory equipped with various devices to monitor your physiological variables.

If PSG is not available, your doctor may consider evaluating you using pulse oximetry and portable heart-lung monitoring devices at home.

Management

The management of OSA aims to ensure unobstructed breathing during sleep. Methods that can be employed include:

• Weight loss in individuals with obesity and lifestyle changes
• Sleeping in a lateral position may help manage OSA
• Continuous positive airway pressure (CPAP) therapy. CPAP is the primary treatment for OSA and is used during sleep. It is highly effective in managing OSA
• Bilevel positive airway pressure (BPAP). BPAP is used if CPAP treatment is ineffective
• Surgical procedures. These are considered if CPAP and BPAP usage do not yield results

Complications

• Daytime fatigue and sleepiness. Difficulty achieving deep sleep and frequent awakenings can cause fatigue, sleepiness, irritability, and difficulty concentrating during activities, including work and driving, leading to an increased risk of work-related accidents.
• Cardiovascular problems. Sudden drops in blood oxygen levels during OSA can lead to increased blood pressure and strain on the cardiovascular system. This can result in hypertension, increasing the risk of heart disease. More severe OSA increases the risk of coronary heart disease, heart attacks, heart failure, stroke, and arrhythmias (heart rhythm disturbances). Recurrent episodes of arrhythmia can cause sudden death.
• Complications of medication and surgery. If you have OSA and are undergoing major surgery, inform your doctor. General anesthesia or sedation is typically used during major surgery. Normally, you will lie on your back during surgery. However, in individuals with OSA, this can worsen breathing problems. Before surgery, your doctor will perform tests related to your OSA. If you are known to have OSA, your doctor will position you prone during the procedure to avoid obstructing your airway.
• Eye problems. Some studies have found a link between OSA and eye problems, such as glaucoma.
• Sleep disturbance for your partner. Your loud snoring may disrupt your partner's sleep.

Prevention

Maintain a healthy lifestyle by maintaining an ideal body weight, engaging in regular exercise, and not smoking. If you have conditions such as asthma, hypertension, diabetes, PCOS, or hypothyroidism, treat them effectively to prevent OSA in the future.

When to See a Doctor?

Consult a doctor if you or a close associate experience several symptoms, such as:

• Loud snoring that disturbs you or others
• Waking up from sleep due to choking or gasping
• Brief pauses in breathing during sleep
• Excessive daytime sleepiness leading to falling asleep while working, performing daily activities, or even while driving.

Remember that snoring doesn't always indicate something potentially serious, and not everyone who snores has OSA.