Obstructive Sleep Apnea (OSA)

Posted by admin
March 14, 2008

Albert Lim Rafanan, MD
Pulmonary, Critical Care and Sleep Medicine
Chong Hua Hospital, Cebu City, Visayas, Philippines

WHAT IS OBSTRUCTIVE SLEEP APNEA(OSA)?
Loud snoring which is interrupted by respiratory arrest (apnea) of more than 10 secs in duration is obstructive sleep apnea. This is usually accompanied by a reduction in blood oxygen saturation followed by a microawakening to breath. In severe cases, hundreds of breathing pauses can occur every night.
In obstructive apnea, the throat closes during inhalation due to excessive relaxation of the pharynx muscles and the floor of the mouth, accompanied by increased tissue pressure from outside. This prevents air from entering the lungs, and the patient is threatened with suffocation.

IS OSA DANGEROUS? WHAT ARE THE EFFECTS?
OSA has been associated with an increased mortality ratio of 3.33. Sleep apnea has been associated with an up to 23-fold increased risk of heart attack. A number of studies have now documented sleep apnea in over two-thirds of male stroke victims. In the las JNC-7 Guidelines of hypertension, OSA was the most common etiology for secondary hypertension. In fact, in some series, almost half of subjects with hypertension demonstrated sleep apnea. In many patients, treating sleep apnea can bring blood pressure readings under control: often with less medication.

In some cases, OSA may be fatal. In many instances, the idea that someone died peacefully during sleep clearly must have amounted to wishful thinking, since instead, the deceased was probably fighting violently for breath up to the very end.

The most frequent symptom of sleep apnea is tiredness during the day. The continual lack of quality sleep can affect one’s life in many ways including depression, irritability, loss of memory, lack of energy, sexual dysfunction, a high risk of auto and workplace accidents, and many other problems.

Other common complications of sleep apnea include heart failure, cardiac arrhythmias, and increased levels of fasting blood glucose, insulin, and glycosylated hemoglobin, independent of body weight.

IS OSA COMMON?
Yes, extremely common! Sleep apneaoccurs in all age groups and both sexes but is more common in men. Four percent of middle-aged men and 2 percent of middle0aged women have sleep apnea.

WHO GETS OSA?
People most likely to have or develop sleep apnea include those who snore loudly and also are overweight, or have high blood pressure, or have some physical abnormality in the nose, throat, or other parts of the upper airway. Sleep apnea seems to run in some families, suggesting a possible genetic basis.

HOW WILL I KNOW IF MY PATIENT HAS OSA?
The only definite way to diagnose is to spend a night in a sleep laboratory to have a polysomnogram. The Chong Hua Hospital Center for Sleep Disorders is the first and only complete sleep laboratory outside Manila. During the sleep study, 16 recordings (including Electroencephalogram, EKG, Electromyogram, electrooculogram, sleep position, pulse oximetry, airflow measurements by oronasal thermistor and nasal pressure transducer, thoracic and abdominal efforts, real time video recording, snoriing sensors and limb movement monitor) will be analyzed to make a definitive diagnosis and initiate treatment. Diagnosis of sleep apnea is not simple because there can be many different reasons for disturbed sleep.

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Comments

Now I know why my brother snores so loud, and so irritable in the morning complaining of not having a good night sleep.

Now I can advise him to see a specialist for a consult. Thanks.

Comment by Lesley on February 20, 2009 @ 3:21 pm
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