Obstructive Sleep Apnea

By Catherine M. Fascilla, D.D.S.

Apnea is a term that means without breath. Sleep apnea is a disorder characterized by abnormally low breathing while sleeping. The most common form of this disorder, 84%, is called obstructive sleep apnea (OSA). Breathing is interrupted by a physical block to airway flow, despite respiratory effort. Snoring is common. Another form of sleep apnea is called central sleep apnea (CSA). It is caused by an imbalance in the brain's respiratory centers, which leads to a reduction in the sleeper's effort to breath. Less than 1% of sleep apnea cases fall in this category. The rest of the cases are mixed sleep apnea, a combination of OSA and CSA.

Most patients are unaware of their apnea. Snoring is one of the key symptoms. Other symptoms include exhaustion, daytime drowsiness, lack of concentration, weight gain, headaches, emotional instability, forgetfulness, lack of motivation and delayed cognitive development in childhood sleep apnea.

Individuals with low muscle tone and soft tissue around the airway (because of obesity) and structural features that give rise to a narrowed airway (like enlarged tonsils, large tongue volume and small jaws) are at risk for OSA. The risk of OSA rises with increasing body weight (BMI>30), large neck circumference (16" in women and 17" in men), active smoking and age. Men are more likely to suffer from it than women and children. Patients with diabetes have up to three times the risk.

OSA is considered a serious medical condition. The sudden drops in blood oxygen levels that occur during sleep disorder increases blood pressure and strains the cardiovascular system, raising the risk of heart failure and stroke. Daytime fatigue can cause people to fall asleep at work and behind the wheel of a car. There is also a concern with medications and with general anesthesia. Undiagnosed OSA is especially risky for a patient undergoing surgery. Some research has connected this disorder with certain vision problems and also liver function impairment. Diagnosis of sleep apnea is made with the combination of symptoms (like excessive daytime drowsiness and fatigue) and the results of a formal sleep study done by spending a night in a sleep laboratory or through a home sleep testing device. The sleep study and therapy are covered by most medical insurance plans and Medicare.

Some treatments involve lifestyle changes like a reduction in alcohol consumption, avoidance of muscle relaxants, sleeping pills and other sedatives, losing weight and smoking cessation. Many people benefit from sleeping at a 30-degree angle or higher as if in a recliner. This prevents the gravitational collapse of the airway. Sleeping on a side instead of on the back is also recommended.

Another treatment option is the use of an oral appliance that is custom fitted and fabricated by a dentist. It is made to fit over the upper and lower teeth and keeps the airway open by shifting the lower jaw forward and separating the jaws slightly to prevent the tongue and soft tissue from collapsing. This device works well for patients with mild to moderate apnea.

CPAP (Continuous Positive Airway Pressure) is a more effective treatment for patients with a severe disorder. It is made up of a mask, tubing and a machine that forces air into the lungs. The problem is its low compliance. Many patients can not tolerate using it.

There are various surgical procedures available for patients who have severe conditions and who reject CPAP. The variations are due to anatomical differences causing the obstruction, for example, enlarged tonsils versus an obstructed nasal passage.

Anyone who suffers from chronic fatigue, daytime drowsiness or irritability, particularly if they have been told that they snore should consider having a medical evaluation for a sleep disorder. If it is caused by a breathing obstruction, your dentist may be able to help you if your doctor prescribes an oral appliance. Getting a good nights sleep will improve the quality of your life and may even save it.

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