Obstructive Sleep Apnea

CHAPTER 5

  

Obstructive Sleep Apnea

PART 1

What Is Sleep Apnea?

A sleep apnea is the temporary stoppage of breathing when you sleep. (Apnea is a Greek word that means “without breathing.”) By far the most common type of sleep apnea is obstructive sleep apnea (OSA), in which the apnea is caused by obstruction of the windpipe, or upper airway. By definition, breathing stops for at least 10 seconds during an episode of OSA. It can remain cut off for up to a minute or more. Someone with OSA may have literally hundreds of these episodes each night. READ MORE

It’s not unusual to have temporary episodes of sleep apnea during your lifetime. They could be the result of an upper respiratory infection that causes nasal congestion, tonsillitis, or swelling of the throat due, for example, to infectious mononucleosis. However, some individuals suffer from severe, chronic OSA, and may go for years without knowing they have the disorder. LESS
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PART 2

How Does Air Flow Get Blocked?

OSA frequently occurs due to the buildup of fat or the loss of muscle tone that accompanies aging. Most people with sleep apnea generally have no problem breathing during the day. The typical apnea sufferer is an overweight, middle-aged male—but anyone can have the disorder, male or female, young or old. The primary physical abnormality in people with sleep apnea is a small upper airway due to obesity, the structure of the bones or soft tissues, or, in children, enlarged tonsils and adenoids. READ MORE

At night, when you sleep (and especially if you sleep on your back), it’s more likely that your pharynx or upper airway, behind your tongue and soft palate, will collapse. This portion of your airway has little support from bones or cartilage and mostly relies on muscles to keep it open. Normally the muscles surrounding the airway remain constricted enough to keep the airway taut. But if you have sleep apnea, when you sleep your throat muscles relax and allow your windpipe to collapse. LESS
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PART 3

When You Have to Struggle for Breath

While you struggle to breathe, your blood vessels constrict and your blood oxygen level falls. You may snort or gasp for air as the low oxygen level signals your brain to wake you up just enough to cause your throat muscles to tighten, stiffening and opening up your windpipe, allowing air to rush in. As you inhale you may snore, but the snoring itself is not dangerous: it’s a sign that air is getting in. Then you fall back into a deeper level of sleep, your windpipe collapses again, and the cycle repeats itself. This can happen hundreds of times a night. You don’t go through the normal, complete sleep cycles that you need to be fully rested. READ MORE

Typically, people with sleep apnea don’t regain full consciousness when they wake during a sleep apnea episode, so they are unaware they have the disorder. LESS
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PART 4

Can People Who Aren’t Overweight Have Sleep Apnea?

Although about 70% of people who have sleep apnea are obese, it can occur in people who are of normal weight or even people who are underweight. Causes of OSA in normal-weight people may include chronic nasal congestion or having very large tonsils, an oversized uvula, or a small, receding jaw.
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PART 5

Central and Complex Sleep Apnea

Not all sleep apnea is caused by obstruction.

  • Central sleep apnea (CSA) refers to a number of different sleep-related breathing disorders. In CSA, as in OSA, air flow stops for at least 10 seconds. In CSA, however, the person doesn’t make a visible effort to inhale. In the general population, the prevalence of CSA is less than 1%, but CSA occurs in 25-40% of people with heart failure.

  • Complex sleep apnea combines features of both OSA and CSA. At first, complex sleep apnea appears to be OSA. However, when continuous positive air pressure (CPAP) is applied, central sleep apnea appears.

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PART 6

Sleep Apnea in Children

Because sleep apnea is associated with obesity, the epidemic of obesity among children has caused rates of sleep apnea to soar as well. In a 20-year CDC review of obesity-associated diseases among children aged 6 to 17, discharges for sleep apnea were found to have increased 436%. Sleep apnea has serious consequences for children and adolescents. It’s been associated with memory and behavioral problems, ADHD, and growth and developmental problems.
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