Obstructive Sleep Apnea(OSA)

Obstructive sleep apnea (OSA) is a sleep-related breathing disorder that occurs by recurrent episodes of breathing cessation and partial arousal from sleep. In essence, OSA is a periodic stop in one’s breathing due to partial or total collapse of the upper airway.

An episode is termed ‘apnea’ when the patient experiences total breathing cessation or ‘hypopnea’ when the breathing is partially compromised. OSA adversely affects the patient’s quality of sleep because the reduction in blood oxygen and difficulty in breathing often wakes up the patient.

What happens during an apnea or hypopnea?

A partial or total collapse of the upper airway causes reduced ventilation and a decrease in your blood oxygen level. There is also a concomitant increase in carbon dioxide level in the blood, which the brain senses, and you’re briefly roused from sleep for your airway to open again. The arousal is most times a transition from deep to light sleep and not a full awakening. Each episode of cessation of breathing and arousal is concluded by compensatory breathing or gasping for air, after which normal breathing resumes.

There is a higher prevalence of OSA in men than women, which becomes more evident with increasing age. However, anyone can be a potential OSA patient, and ignoring the severity of the disease’s impact on their life can lead to worse comorbidities down the road.

A partial or total collapse of the upper airway causes reduced ventilation and a decrease in your blood oxygen level. There is also a concomitant increase in Carbon dioxide level in the blood, which the brain senses, and you’re briefly roused from sleep for your airway to open again. The arousal is most times a transition from deep to light sleep and not a full awakening.

Each episode of cessation of breathing and arousal is concluded by compensatory breathing or gasping for air, after which normal breathing resumes.

Risk factors for Obstructive Sleep Apnea

While OSA can affect anyone, certain risk factors can increase the chances of suffering from it. The significant risk factors that are associated with OSA include the following;

  • Obesity (fat deposited in the soft tissues around the pharynx)
  • Aging (and associated partial compromise in muscle tone)
  • Adverse lifestyle and medications (e.g. smoking, alcohol consumption, sedatives)
  • Family history of OSA (Genetics)
  • Craniofacial syndromes (e.g. deformities associated with the shortening of the jaws, Down syndrome)
  • Post-surgery complications (e.g. with pharyngeal flap surgery)

What are the Symptoms of OSA?

While they differ in severity, the symptoms of OSA can include the following:

  • Excessive daytime sleepiness due to the fragmentation of your sleeping period
  • Loud snoring
  • Sudden awakening and choking
  • Inability to concentrate on a task
  • Tiredness
  • Early morning headache
  • Depression

Complications Associated with OSA

OSA is considered a severe medical condition that requires early diagnosis because of the associated life-threatening complications that can arise from it. If you’ve been diagnosed with OSA and you do not seek medical care, the following complications may arise:

  • Cardiovascular problems: Untreated OSA can be complicated by diseases of the heart and blood vessels. The sudden drop in blood oxygen level resulting from breathing in OSA can cause increased blood pressure (hypertension). Hypertension can progress to other cardiovascular diseases with worse outcomes. An example of such a condition is heart failure. OSA also increases the risk of abnormal heart rhythms, which can lead to sudden death.
  • Daytime fatigue and sleepiness
  • Depression
  • Depriving your partner or family of sleep
  • Stress levels
  • Complications can also arise when you take medications to relieve the symptoms of OSA. For example, using sedatives to achieve a sound sleep can worsen OSA because the sedatives are muscle relaxants

How is Obstructive Sleep Apnea Diagnosed?

Polysomnography, more commonly known as a sleep test, is the most reliable sleep study for the diagnosis of OSA. It involves the measurement of your sleep parameters, including:

  • your brain activity
  • the number of apneas and hypopneas per hour of sleep (Apnea-Hypopnea Index)
  • the electrical activity of your heart, your eyes and leg muscle activity
  • blood oxygen level during sleep.

The sleep test is typically performed at night at a sleep center or a sleep disorder unit in the hospital or your home.

OSA is diagnosed when the patient’s AHI is greater than five. However, a lower AHI accompanied by excessive daytime sleepiness can also result in an OSA diagnosis.

How Is OSA Treated?

Due to the diverse risk factors associated with OSA, treatment options wary case by case. These factors include your age, tolerance for medications and surgical procedures, and also personal preferences.

For OSA, the treatment modalities include:

  • Lifestyle modification (e.g. weight loss, quitting alcohol and smoking, a more active lifestyle)
  • Medical treatment options such as:
    • eXciteOSA®, which utilizes neuromuscular electrical stimulation to increase the endurance of your upper airway muscles through a daytime-only therapy
    • Continuous Positive Airway Pressure (CPAP) therapy, which is a night-time device that pumps air into your airway to keep it open
    • Mandibular Repositioning Devices (MRDs), which keep your jaw in a specific position to keep your airway open at night
  • Surgical treatment for severe OSA, such as:
    • Uvulopalatopharyngoplasty (UPPP): This is the most common surgical procedure for OSA. It involves the removal of excess tissues around your airway to increase patency.
    • Tracheostomy: It is done as a procedure of last resort. It involves surgically puncturing your trachea or windpipe to create an opening for air to pass through during breathing to bypass the obstruction at the upper airway
    • Shrinkage of excess tissue around the airway by ablation.

By Zia Rahim|11th January 2022

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