Chủ Nhật, 12 tháng 1, 2014

Obstructive Sleep Apnea

Obstructive Sleep Apnea Obstructive sleep apnea OSA is a sleeping disorder in which the regular air-flow stops for few seconds while the person is asleep. It is often caused due to narrow airway or block in the path of airway. A pause while breathing is known as one apnea episode. Reduction of airflow while sleeping is called hypopnea episode. This is not like a routine break or pause that occurs for almost everyone while asleep, but is a serious disorder breathing episodes are disrupted while sleeping. Visible symptom of sleep apnea is the loud snoring. The throat muscles of the person relax continuously thus blocking the path of airway while sleeping. It occurs commonly in middle aged and old age people who are overweight. Obstructive sleep apnea can be treated using sleep device or by surgery of nose or throat to clear the blockage in the muscles.


Symptoms :


Obviously the first symptom of obstructive sleep apnea is snoring. The affected person will snore loudly as soon as he falls asleep. There will be pause or break in the breathing session while sleeping. It can cause daytime sleepiness in such persons and many people will have morning headache. The person may awake abruptly due to shortness of breath or chest pain while staying asleep. He may develop irritation, depression and hypertension and poor concentration during daytime.


The affected person will not be aware of the pause in his sleeping sessions. Only his partner or other family members should observe and report to family GP. Once the snoring gets louder it is interrupted by silent period for few seconds followed by loud gasp for breathe. The snoring process will continue and the cycle repeats several times during sleep.


When to consult your doctor?


If any of your family members are snoring loudly with intermittent pauses during sleep with excessive daytime drowsiness then it is time to consult your doctor. Not everyone who snores will have obstructive sleep apnea. Only if the snoring episodes have brief lapse of breathing it is indicative of OSA.


Causes :


The main cause for obstructive sleep apnea is the continuous relaxation of the throat muscles that blocks normal breathing pattern. The throat muscles include muscles of soft palate, uvula, tongue and the tonsils. When the muscles relax when you start sleeping, it narrows down the airway path so that breathing can become insufficient for 10-20 seconds. This in turn lowers the oxygen level in your blood. Your brain senses this problem and briefly arouses you so that you can re-open the blocked airway. You will awaken with shortness of breath making a gasping or choking sound.


This pattern repeats for several times each hour when you are asleep and will prevent you from having good night’s sleep making you drowsy all through the daytime. Certain abnormal size and shape of palate or oral cavity can cause block in the airway leading to collapsing of normal breathe. Presence of large tonsils can create disruption in the airway. Even abnormal size of the neck or collar size can cause this problem. For some people large tongue may fall back causing block in the airway.


Risk Factors :


Anyone can have obstructive sleep apnea. But certain factors like obesity, having large sized neck, having narrowed airway, having diabetes and/or blood pressure, being male, being middle aged or old aged, and smoking/drinking habit can increase the risk of OSA.


Complications :


Obstructive sleep apnea and snoring is considered as a sleep disorder. It can cause potential problems like cardiovascular diseases like heart attack, stroke and heart failure. You are likely to have daytime fatigue due to repeated awakenings during the night and will have difficulty in concentrating. People with OSA are likely to fall asleep while driving or watching television. Children with this problem can perform poor in school and may suffer from attention deficit problems. Lastly individuals with OSA will develop more complications after any surgery that requires putting him under anesthesia.


Tests and Diagnoses :


Your doctor will conduct physical examination checking your oral cavity, neck and throat region. He may order for polysomnogram (sleep study) test to record the sleeping pattern during the entire night. During the process of sleep study testing, the person will be connected with equipments that monitor the activity of heart, lungs and brain. It will give report of breathing patterns, arm/leg movements and blood oxygen levels while sleeping. Often it involves testing the person during full night asleep and for some it is enough to have split night study.


Oximetry test is done for recording the blood oxygen level when you are asleep. Having obstructive sleep apnea is confirmed if the results show drop in blood oxygen level while asleep (during apnea episodes). Hence this is used as a screening test for OSA.


Treatment :


Treatment for obstructive sleep apnea involves providing combined approach of therapy and lifestyle changes. Positive airway pressure therapy is given for repairing the airway block for affected persons. A machine delivers air from external source through a piece of tubing that is inserted into the nose and mouth while the person is asleep. This pressure therapy decreases the number of respiratory block and events that occur repeatedly while you are asleep. This will gradually provide you sound sleep during night thus reducing daytime drowsiness.


CPAP device (Continuous Positive Airway Pressure) is the most common device used for preventing OSA. By using this device, the person will receive continuous free airflow during his sleep and this will keep his upper airway path widely open. This instrument is used for treating snoring as well as OSA. But this device is somewhat larger and uncomfortable. Now smaller machines that produce less noise are available.


Nasal pillows, nasal masks and face masks can also be used for preventing awakening episode during sleep. Alternatively you can also use a humidifier to have additional air pressure for giving more comfort. BPAP is yet another device that gives positive airway pressure in predetermined amounts facilitating easy breathing. While using any of these instruments if you snore again or put on excess pounds, you should consult your doctor.


Oral devices are available for treating people with mild problems of obstructive sleep apnea. All these devices are designed for producing quality sleep to improve your life quality. You can discuss with your doctor for finding out suitable device that matches your requirements. In addition to the above machines, medications are also available for reducing daytime drowsiness and for improving sleep quality.


Surgery :


Surgical procedures are the best solution for removal of tissue that blocks the throat and narrows the airway. Surgery is considered as last option for OSA and if no other treatment is effective. This procedure is called uvulo palatopharyngoplasty in which your surgeon removes tissue from the top of your mouth. Snoring will be reduced considerably after this surgery.


Jaw surgery is done for enlarging the existing space available inside the oral cavity so that airway path is blocked. In rare cases, an opening or perforation is created in the neck through which a metal tube is inserted for breathing easily. In this procedure the airway passes directly in and out of lungs instead of usual route through your throat. For some people, nasal surgery is done for clearing the polyps or for straightening crooked portion in your nose.


Lifestyle Changes :


If you are obese, you should take steps to reduce your weight. Practice exercise regularly. Restrict the alcohol consumption and quit smoking. Try sleeping on your sides and don’t lie on your back which will worsen the symptoms. You can also use nasal congestion device like nasal spray for keeping the passages open. Once you reduce your weight, sleep apnea episodes will decrease naturally.


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