Sleep Apnoea
What is obstructive sleep apnoea?
Obstructive Sleep Apnoea is a serious, potentially life-threatening condition that is far more common than is generally understood. Obstructive Sleep Apnoea is a breathing disorder characterised by brief interruptions of breathing during sleep. It owes its name to a Greek word, apnea, meaning “without breath”.
The effects of OSA is that a person can stop breathing for periods when asleep. These interruptions (apnoeas), which last for 10 seconds or more, occur when the airway narrows so much that it closes. This stops breathing, and the brain reacts by briefly waking the subject, causing the airways to re-open and breathing to restart. The individual is usually unaware of this awakening and this process can be repeated up to several hundred times during the night.
Proper restful sleep becomes impossible, resulting in sleepiness and impairment of daytime function. Early recognition and treatment of OSA is important. The excessive sleepiness associated with OSA impairs quality of life and places people at increased risk of road traffic and other accidents. It may also be associated with irregular heartbeat, high blood pressure, heart attack and stroke.
- “Apnoea” is a Greek word meaning “without breath.” An apnea is clinically defined as a cessation of breath that lasts at least ten seconds.
- “Hypopnea” also comes from Greek: “hypo” meaning “beneath” or “less than normal” and “pnoea” meaning “breath.” A hypopnoea is not a complete cessation of breath but can be defined as a perceptible reduction in airflow that leads to sleep fragmentation or to a decrease in the oxygen level in the bloodstream.
- The apnea-hypopnea index (AHI) or respiratory disturbance index (RDI) refers to the total number of apneas and hypopneas divided by the total sleep study in a patient’s sleep study. The AHI gives one measure of the severity of the sleep apnoea.
- Typically the soft tissue in the rear of the throat collapses and closes the airway, forcing sufferers to stop breathing repeatedly during sleep, sometimes hundreds of times a night.
- Although the typical Obstructive Sleep Apnoea patent is overweight, male, and over the age of forty, sleep apnoea affects both males and females of all ages and those of ideal weight.
The most common symptoms of Obstructive Sleep Apnoea are loud snoring and excessive sleepiness (i.e., falling asleep easily and sometimes often inappropriately). Untreated Obstructive Sleep Apnoea can be life threatening; consequences may include high blood pressure and other cardiovascular complications
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FAQ
Who suffers from obstructive sleep apnoea?
Obstructive Sleep Apnoea occurs in all age groups and in both sexes although it is more common in middle aged men. Obstructive Sleep Apnoea, which causes symptoms of excessive sleepiness affects an estimated 4% of the male and 2% of the female middle age population.
Sleepiness is a global epidemic, and Obstructive Sleep Apnoea syndrome is a major threat to nightly rest. People most likely to have or develop Obstructive Sleep Apnoea include those who snore loudly, are overweight, have high blood pressure, or with physical abnormality in the nose, throat, or other parts of the upper airway. If left untreated or undiagnosed the results can be tragic.
Stimulants (like coffee) taken to counter the effects of tiredness are not a substitute for sleep. The regular use of stimulants by individuals may be a clue to the existence of an underlying sleep disorder.
What are the symptoms of obstructive sleep apnoea?
If you, or someone you know, snores nightly and has one or more of the following signs or symptoms, Obstructive Sleep Apnoea may be the cause. Common signs and symptoms of Obstructive Sleep Apnea include:
- Excessive daytime sleepiness
- Nightly snoring interrupted by pauses in breathing
- Falling asleep when you shouldn’t – at work, while driving, etc.
- Loss of energy, fatigue
- Choking and gasping during sleep
- Restless sleep
- High blood pressure
- Neck size greater than 42cm in men, 40cm in women
- Overweight
- Depression
- Trouble concentrating
- Irritability
- Forgetfulness
- Morning headaches
- Sexual dysfunction
What causes obstructive sleep apnoea?
As we go to sleep, the muscles of the throat relax as a normal part of the sleep process. In individuals with Obstructive Sleep Apnoea (OSA), this relaxation progresses to the point where the passage for air is partially or completely blocked, dramatically reducing or stopping airflow into the lungs.
This causes an increase in Carbon Dioxide levels and the brain responds by waking up the individual for a short while to open the air passage. Breathing begins again, but the natural sleep cycle is interrupted. Ingestion of alcohol, sleeping pills, anti-depressants or smoking increases the frequency and risk of breathing pauses in people with Obstructive Sleep Apnoea.
Consequences of untreated Obstructive Sleep Apnoea include Excessive sleepiness during the day, frequently “nodding off”; Impairment of cognitive function i.e. thinking, memory problems; Mood and personality changes; Reduction in quality of life; Heart Disease and possibly an increase in the risk of Stroke.
Treatments for obstructive sleep apnoea?
The treatment of OSA should be multifactorial and include the following:
- Lifestyle changes: the most important factor in the genesis of OSA is weight and therefore weight reduction and lifestyle interventions such as a reduction of alcohol consumption, increase in daily exercise and other pro-health interventions are strongly recommended as the core intervention strategy. However, lifestyle measures alone cannot effectively treat the underlying problem and this is where effective treatments have been developed. These include oral appliances (also known as mandibular advancement splints); Continuous Positive Airways Pressure (CPAP) therapy and Surgical Interventions.
- Oral appliances (Mandibular Advancement Splints): work by virtue of the simple fact that moving your jaw forward a short distance stops you snoring (this is true for a very large percentage of snorers).Mandibular advancement can provide immediate relief from snoring. Mandibular advancers are an alternative to CPAP, laser treatment and various surgical procedures and have been shown to be effective at treating snoring and low level upper airway obstructions associated with Obstructive Sleep Apnoea (OSA) and other sleep disorders. Custom-made splints are normally fitted by a dentist or dental technician. Head & neck surgeons, thoracic consultants, consultant physicians, maxillofacial surgeons, sleep specialists and general practitioners may also be involved in the process.
- Surgery for OSA: In a small percentage of patients with OSA, surgical and laser interventions have been found to be useful where an anatomical cause such as enlarged tonsils or an elongated soft palate have been shown to be causing obstruction to the airway.
- Continuous Positive Airway Pressure (CPAP) Therapy is the most common and effective treatment for Obstructive Sleep Apnoea. The CPAP machine adds gentle pressure to the air as it is breathed in. This prevents the airway from collapsing and stops obstruction during sleep. Continuous Positive Airway Pressure (CPAP) is a proven and reliable treatment for Obstructive Sleep Apnoea and other breathing related sleep disorders. At the Sleep Medicine group of sleep centres we have a team of experienced doctors and medical technologists who are leaders in the field of CPAP therapy. We provide the full range of CPAP assessment, treatment and follow up services to our patients and to fellow professionals who require access to this gold standard service. Our services involve patient education, domiciliary support and regular follow up to monitor compliance.
The risk of OSA
Many people including drivers have OSA and don’t realise it. Obstructive Sleep apnoea is more common in men aged 30 – 65 years, though it can occur in all age groups. It affects an estimated 4% of males and 2% of females worldwide.
In South Africa it is thought to be considerably higher in specific groups and occupations were the consequences can be fatal or lead to serious injury if left undiagnosed and treated.
Sigma Sleep Diagnostics is currently screening freight company drivers to determine the prevalence of OSA amongst professional drivers companies. A number of the largest South African freight companies have commissioned these studies. If you would like more information or details on how to take part in the screening programme, to reduce your personal or corporate risk please contact us.
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