Obstructive Sleep Apnea Syndrome: Basic Information on Causes, Symptoms, Diagnosis and Treatment

Obstructive sleep apnea syndrome is one of the most common forms of sleep apnea, a condition marked by repeated pauses in breathing during sleep. The flow of air either stops or slows down because the air passage is either blocked, narrowed or has become floppy.

The condition is associated with reduction in blood oxygen saturation because of reduced airflow through the air pipe. It happens when the muscles of the upper respiratory tract relaxes and collapses. The narrowing of the air passage can be due to obstructions created by excess tissues in the airway, enlarged tonsils, large tongue; defective anatomical structures of the jaw, etc. Other than the respiratory tract, the obstruction can also be located in the nasal passage.

What causes obstructive sleep apnea syndrome? 

During sleep all the muscles of the body become relaxed. This also includes muscles directly responsible for breathing and keeping the airway open for allowing air to flow through. While in a relaxed state these muscles may collapse and cause obstruction in the airway. There are various reasons for the muscle to become weak and flaccid. These include obesity, consumption of alcohol, wrong sleeping posture, etc.

Airway obstruction leading to snoring and subsequently obstructive sleep apnea syndrome can also be due to a lower jaw that is short compared to the upper jaw; large tonsils and adenoids in children; large neck or collar size, etc.

What are symptoms of obstructive sleep apnea syndrome? 

Most of the symptoms of this ailment remain unnoticed since they appear during sleep. It is usually the bed or room partner who first notices the distress that the patient is experiencing during sleep which includes:

–          Loud snoring

–          Gasping and choking during sleep

–          Intermittent pauses in breathing

Sooner than later, the patient also experiences some of the symptoms. Some of these include:

–          Excessive daytime sleepiness

–          Irrational weight gain

–          Headaches and dry mouth in the morning

–          Poor sleep quality

–          Depression, irritability, poor concentration

–          Rise in blood pressure

–          Heart burn

–          Reduced libido

How about diagnosis? 

After noting the medical history and physical examination, the mandatory diagnostic examination is called polysomnogram or overnight sleep study, where various physiological parameters are recorded during sleep including brain waves, muscle tension, eye movement, respiration, oxygen level in the blood and audio monitoring (for snoring, gasping, etc.). Other tests include arterial blood gases, Multiple Sleep Latency Test, Thyroid function test, etc.

Polysomnography results reveal the type of sleep disorder as well as severity of the condition.

How is obstructive sleep apnea syndrome treated? 

–          Mild conditions are treated with behavioral changes including weight loss, changing sleeping position, oral devices, quitting alcohol, etc.

–          Moderate conditions demand the use of CPAP (continuous positive airway pressure), a process of providing artificial ventilation to relieve breathing distress.

–          Severe conditions may demand the use of Bi-level (Bi-PAP) machine. The Bi-level machine blows air at two different pressures, unlike the CPAP that provides pressurized air on a continuous basis.

–           When none of the non-invasive treatment methods work, doctors are compelled to think of surgery as a means of treating severe sleep apnea. There are plenty of surgical options including tracheotomy, uvulopalatopharyngoplasty (UPPP), mandibular myotomy, laser assisted uvuloplasty (LAUP), radio frequency (RF) procedure or Somnoplasty, etc.

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