Obstructive Sleep Apnea

Obstructive Sleep Apnea is a sleep-related breathing disorder that involves a decrease or complete halt in airflow despite an ongoing effort to breathe. It occurs when the muscles relax during sleep, causing soft tissue in the back of the throat to collapse and block the upper airway.

Most people with OSA snore loudly and frequently, with periods of silence when airflow is reduced or blocked. They then make choking, snorting or gasping sounds when their airway reopens.

People that suffer from sleep apnea experience excessive daytime sleepiness, depression, and loss of concentration. In addition, decreased oxygenation can lead to very serious cardiovascular problems.

Prevalence

• OSA can occur in any ager group, but prevalence increases between middle and older age.
• OSA with resulting daytime sleepiness occurs in at least four percent of men and two percent of women
• About 24 percent of men and nine percent of women have the breathing symptoms of OSA with or without daytime sleepiness.
• About 80 percent to 90 percent of adults with OSA remain undiagnosed.
• OSA occurs in about two percent of children and is most common at preschool ages.

Types

• Mild OSA:  Involuntary sleepiness during activities that require little attention, such as watching TV or reading
• Moderate OSA: Involuntary sleepiness during activities that require some attention, such as meetings or presentations
• Severe OSA: Involuntary sleepiness during activities that require more active attention, such as talking or driving

Risk groups

• People who are overweight (Body Mass Index of 25 to 29.9) and obese (Body Mass Index of 30 and above)
• Men and women with large neck sizes: 17 inches or more for men, 16 inches or more for women • Middle-aged and older men, and post-menopausal women
• Ethnic minorities
• People with abnormalities of the bony and soft tissue structure of the head and neck
• Adults and children with Down Syndrome
• Children with large tonsils and adenoids
• Anyone who has a family member with OSA
• People with endocrine disorders such as Acromegaly and Hypothyroidism
• Smokers
• Those suffering from nocturnal nasal congestion due to abnormal morphology, rhinitis or both.

Treatments

Continuous positive airway pressure (CPAP): CPAP is the standard treatment option for moderate to severe cases of OSA and a good option for mild sleep apnea. First introduced for the treatment of sleep apnea in 1981, CPAP provides a steady stream of pressurized air to patients through a mask that they wear during sleep. This airflow keeps the airway open, preventing pauses in breathing and restoring normal oxygen levels.

Oral appliances: These are an effective treatment option for people with mild to moderate OSA who either prefer it to CPAP or are unable to successfully comply with CPAP therapy. Oral appliances look much like sports mouth guards, and they help maintain an open and unobstructed airway by repositioning or stabilizing the lower jaw, tongue, soft palate or uvula. Some are designed specifically for snoring, and others are intended to treat both snoring and sleep apnea.

Surgery: Surgery is a treatment option for OSA when noninvasive treatments such as CPAP or oral appliances have been unsuccessful. It is most effective when there is an obvious anatomic deformity that can be corrected to alleviate the breathing problem. surgical options most often address the problem by reducing or removing tissue from the soft palate, uvula, tonsils, adenoids or tongue.  Jaw surgery – known as maxillomandibular advancement (MMA) is a form of facial skeletal surgery that advances the jaws to expand the airway. All incisions are performed inside the oral cavity.  This is effective to treat severe OSA, according to the study in the January issue of the Journal of Oral and Maxillofacial Surgery, the official journal of the American Association of Oral and Maxillofacial Surgeons (AAOMS).

info obtained from American Academy of Sleep Medicine https://aasm.org/