Recognizing sleep apnea syndrome

An increasing incidence of obesity in the United States is causing the rise of other associated health problems, one of which leads to heart disease and premature death. This condition is called sleep apnea syndrome (SAS), and it can occur in both children and adults.

The first description in medical literature of what is now called sleep apnea dates only from 1965. However, this condition has long been recognized as a trait of obese people. The term “Pickwickian syndrome” is sometimes used and was coined by the famous early-20th-century physician, William Osler, who must have read Charles Dickens’s “The Pickwick Papers.”

For the affected person, episodes of not breathing (apnea) are usually noticed by family and bed partners and may occur five to more than 50 times an hour. There is loud snoring, restlessness and nighttime choking or gasping spells. Generally, the person with sleep apnea does not wake-up after an episode. It is important to point out that almost all people who have sleep apnea snore, but not all people who snore have sleep apnea.



The three forms of sleep apnea are central, obstructive and mixed.

In the central form, breathing stops because the body does not try to take in breath. The person experiences a drop in oxygen levels and a rise of carbon dioxide. The sleeper stops breathing with no chest movements or struggling, followed by a period of faster breathing. Central apnea is present in about one to two percent of persons with sleep apnea syndrome. This form is not associated with obesity.

The most common form of sleep apnea is from airway obstruction. In obstructive SAS, breathing is interrupted by a partial blockage of the upper airway when the person is taking in a breath, causing snoring. The obstruction is caused by a relaxation of the soft tissue of the upper airway or narrowing of the throat from excessive weight. For children with sleep apnea, most cases result from obstruction from enlarged tonsils or abnormal airway passages.

Mixed obstructive sleep apnea is a combination of central and obstructive causes.

The symptoms of sleepapnea are:

  • Excessive daytime sleepiness so pronounced that it can cause falling asleep while driving or inappropriately drifting off while doing something that requires concentration
  • Waking up tired and un-refreshed
  • Problems with memory, difficulty with concentration, feeling tired and irritable
  • Morning or night headaches
  • Heartburn or a sour taste in the mouth at night
  • Leg swelling
  • Change in sleeping pattern with having to get up during the night to urinate
  • Sweating and chest pain at night


Long term condition

Symptoms may be present for years without being recognized, during which time the sufferer becomes conditioned to the daytime sleepiness and fatigue associated with significant levels of sleep disturbance.

Sleep apnea syndrome is a major threat to health. Evidence shows that this condition is involved in the premature deaths of people in their 40s and 50s. During the apneic period, blood pressure shoots up and then falls when the person takes a breath. The repetitive stress on the circulatory system can lead to heart enlargement, because these pressure spikes occur hundreds of times per night over many years, which can also lead to congestive heart failure. People with severe coronary artery disease whose blood oxygen drops during each episode may also be at risk of irregular and potentially fatal ventricular contractions.

Sleep apnea is diagnosed by undergoing a sleep study in which the person is monitored while sleeping. Oxygen levels are measured, along with heart rate and the number of episodes per hour.



How is this condition treated?

Changing behavior is an important part of the treatment program. The individual should avoid the use of alcohol, tobacco and sleeping pills, which make the airway more likely to collapse during sleep and make the apneic periods longer. Overweight persons benefit from losing weight. Even a small amount of weight loss can reduce the number of episodes. In some people with mild sleep apnea, breathing pauses occur only when they sleep on their backs; in such cases, using pillows and other devices will help them sleep in a side position.

For more severe cases there are mechanical therapies. Nasal continuous positive airway pressure (CPAP) is the most common effective treatment for sleep apnea. The patient wears a mask over the nose during sleep, and continuous pressure from a blower forces air through the nasal passages to prevent the throat from collapsing. Nasal CPAP is not a permanent cure, and apnea episodes return when CPAP is stopped or not properly used.

Dental appliances are also sometimes prescribed to reposition the lower jaw and the tongue and have been helpful to some patients with mild sleep apnea or who snore but do not have SAS. Most often, a dentist or orthodontist will fit the patient with such a device. For more severe cases, there are also surgical procedures that attempt to open the air passages to reduce obstruction.

If you or someone you know who may have sleep apnea, it is important to discuss this concern with a physician so that a sleep study can be ordered.

 

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