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Weekend Doctor: Obstructive Sleep Apnea

By Tom Zhou, MD
Otolaryngology
ENT Specialists of Northwest Ohio

Snoring is a loud, harsh sound that occurs when the movement of air in the throat causes the throat tissues to vibrate, specifically during sleep when muscles relax and the throat narrows. While snoring itself does not typically cause medical problems, snoring is often associated with obstructive sleep apnea, which is a serious medical condition and is considered a "silent" killer.

Obstructive sleep apnea, or OSA, is a chronic medical condition characterized by pauses in breathing or shallow breathing during sleep. Individuals with OSA can stop breathing for 10 seconds or more, even up to 1-2 minutes. This causes the oxygen level to fall, which then briefly awakens one so they can breathe. Most of the time, the person falls back asleep quickly and does not remember the event. Others will awaken with the sensation of gasping or choking or will turn in bed. In severe OSA, this can happen once every other minute throughout their night's sleep.

You may think, "I have OSA, but what is the big deal?" A poor night's sleep can lead to many short-term consequences, but it can also lead to long-term problems. This includes difficulty concentrating, which leads to an increased risk of accidents. This includes driving, and those with OSA are three times more likely to be involved in a major car accident. In addition, those with OSA have an increased risk for heart attack, high blood pressure, abnormal heart rhythm, stroke, lung disease, diabetes and high cholesterol. These medical conditions represent 5 of the top 7 leading causes of death in the United States. Due to its indirect effects, OSA is referred to as the "silent" killer. Fortunately, these risks typically occur from years of untreated OSA, and therefore it is important to get treatment as soon as possible to reduce those risks.

The main symptoms of OSA are loud snoring, fatigue, and daytime tiredness. Other symptoms may include low energy, difficulty concentrating, memory impairment, feeling unrested, and morning headaches. However, some individuals have no symptoms. Particularly, those without a bed partner often are not aware of their snoring.

So, how do you get diagnosed with OSA? The diagnosis of OSA is made with a sleep study. There are two main types of sleep studies: home sleep study and in-center sleep study. Over the last decade, home sleep studies have made it much easier for many to get diagnosed with sleep apnea while sleeping in the comfort of one's own bed.

The goal of the treatment for OSA is to open the airway during sleep. This can be accomplished using a mechanical device called continuous positive airway pressure, or CPAP, which keeps the airway open by applying air pressure. This is like a Flexi Hose - the hose is normally collapsed, but when there is pressure like water or air, the hose opens. With CPAP, a mask is worn over the nose or mouth or both when sleeping. In addition to CPAP, sleep position and weight loss can be helpful. Avoiding alcohol and sedatives can also reduce the severity of OSA.

If one does not tolerate CPAP, which means that one is using CPAP fewer than 4 hours per night or using fewer than five days per week, then there may be surgical options. Depending on where the airway is narrowed, it may be possible to be addressed with surgery. Surgery can include surgery to improve nasal breathing, surgery on the palate, throat, or tongue, or surgery on the neck. Another option is a dental appliance that fits on the teeth like a retainer but shifts the jaw forward, which pulls the tongue.

For those who do not tolerate CPAP, Inspire hypoglossal nerve stimulator may be an option. This is like a pacemaker that sends out a small electrical stimulus to the tongue nerve. This causes the tongue to stiffen, which opens the back of the throat. The amount of stimulus is adjusted accordingly, so it relieves the airway obstruction to provide good sleep but does not awaken the individual. This device is turned on immediately before bed, and then after a full night's sleep, this device is turned off, and then one goes on with their normal, well-rested day. 94% of patients are satisfied with Inspire and would recommend it.

If you think you may have OSA or do not tolerate CPAP, discuss with your family doctor to see if you should be referred to see a sleep specialist. If you do not tolerate CPAP, consult your family doctor or sleep specialist to see if there is anything else that can be done to help. If you do not tolerate CPAP and are interested in surgical options, see your local ENT doctor.

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