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By: AAST Associate Editor on April 7th, 2022

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Obstructive Sleep Apnea: Symptoms, Risk Factors, Concerns and Treatment

sleep apnea | obstructive sleep apnea | snoring

Obstructive sleep apnea (OSA), the most common type of sleep apnea, can be a serious sleep disorder, as breathing repeatedly stops and starts during sleep. Caused by throat muscles intermittently relaxing and blocking the airway, it can impair a patient's ability to reach desired deep and restful phases of sleep.

Symptoms of OSA1

Loud snoring is the most easily detectable symptom of OSA, but not all snorers suffer from OSA. Snoring can result from a number of factors, including the anatomy of the mouth and sinuses, alcohol use, allergies, a simple cold and even weight. However, loud and frequent snoring is one of the primary indicators of sleep apnea.

Another easily observable symptom of OSA is impaired breathing during sleep, often accompanied by abrupt, brief awakenings followed by gasping or choking and a dry mouth or sore throat. As a paper focused on the underlying mechanisms that contribute to sleep-related breathing disorders, including OSA, relates, "In some cases this likely represents the only way in which the airway can re-open and in this situation arousal is a life-saving event. However, when arousal does occur, it enhances the hyperventilation following termination of the respiratory event and thus the arousal can yield hypocapnia and further airway obstruction on return to sleep. However, cortical arousal does not always accompany termination of a respiratory event as at least some of the time patients are able to restore ventilation without arousal."

OSA has also been linked to several eye-related conditions. The American Academy of Ophthalmology details at least five that should flash a warning sign, including floppy eyelid syndrome, nonarthritic anterior ischemic optic neuropathy and papilledema.

Risk Factors1,2

Multiple factors can increase the risk of developing OSA. Some are hereditary, while others are related to physical factors and lifestyle. Common risk factors include:

  • Obesity
  • Post-menopausal state
  • Small lower jaw and certain other facial features
  • Large neck circumference
  • Large tonsils
  • Alcohol consumption at bedtime
  • Smoking
  • Hypertension
  • Hypothyroidism
  • Acromegaly
  • Diabetes
  • Asthma

Reasons to be Concerned3

The paper cited above on the underlying mechanisms that contribute to sleep-related breathing disorders also details how OSA can lead to "adverse cardiovascular outcomes." Other studies have shown a link between OSA and problems like type 2 diabetes, stroke and epigenetic age acceleration.

Jonathan Jun, MD, a sleep medicine specialist at the Johns Hopkins Sleep Disorders Center, explains the connection. He says that obesity is the link, noting that it is common in patients with sleep apnea and increases the risks of other severe medical conditions. “In most cases, obesity is the main culprit behind both conditions.”

OSA can also lead to excessive sleepiness during the day, morning headaches, difficulty in concentrating, mood changes and other impairments often accompanying sleep-related issues.

Another reason for concern comes from possible consequences for patients requiring anesthesia during surgery. Anesthesia relaxes a patient's upper airway and may worsen OSA. Alternatives to general anesthesia may be preferred. Further, the period of awakening from anesthesia can be problematic for patients with OSA. The lingering effects of an anesthetic upon awakening can cause difficulties, and many patients require postoperative intubation and mechanical ventilation until fully awake. A CPAP machine can be utilized for some patients postoperatively to support breathing.

OSA Treatment4

The first step in treating OSA is informing the patient about the condition and how it may be helped by specific lifestyle changes, such as dieting, regular exercise, cessation of smoking, limiting alcohol consumption or simply changing sleep positions. Mouth and throat exercises can also help.

The next step, should one be needed, is the use of a positive airway pressure (PAP) device, or CPAP. If a person is not able to use a CPAP device, dental devices can then be considered for treating mild or moderate OSA. There are two main types of dental devices for treating OSA —mandibular advancement devices (MADs), which keep the lower jaw pulled forward so that the jaw can’t constrict the airway, and tongue retaining devices (TRDs), which keep the tongue from sliding to the back of the mouth during asleep. A study comparing the two found them to have similar efficacy for sleep apnea, although patients in general preferred a MAD device and slept better with it.

Medications can also help with treatment but are rarely the main source of care, as their efficacy has not been proven in any major studies. As supportive care, stimulant medications may be prescribed for patients to treat daytime sleepiness, but these should only be used in the short-term until the underlying issue is addressed.

Surgery for adults should be considered only when a patient does not improve with other types of therapy. In children, however, an adenotonsillectomy is often the first form of treatment.

Conclusion

While OSA may be simple to diagnose, as some of the symptoms and other manifestations are easily observable, treatment is often less simple and requires that sleep technologists work closely with physicians and other health professionals to optimize therapy. Overall, impressing on patients the importance of treating OSA is important, as it may require a change in your patient’s life habits, therefore, stressing the potential long-term consequences of untreated OSA is crucial.

References:

  1. Obstructive Sleep Apnea. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/obstructive-sleep-apnea/symptoms-causes/syc-20352090
  2. Sleep Apnea-What Is OSA-Risk Factors. Harvard Medical School. https://healthysleep.med.harvard.edu/sleep-apnea/what-is-osa/risk-factors
  3. Obstructive Sleep Apnea (OSA). https://emedicine.medscape.com/article/295807-overview#a6
  4. Treatments for Obstructive Sleep Apnea. Sleep Foundation. https://www.sleepfoundation.org/sleep-apnea/obstructive-sleep-apnea/treatments