Sleep Apnea

 In summary, sleep apnea refers to the frequent obstruction or partial blockage of breathing during sleep.

It can range from mild to severe, depending on how often the lungs fail to receive enough air. This condition may occur between 5 and 50 times per hour.

The most common type is obstructive sleep apnea.

The type known as central sleep apnea is less common. It is typically observed in individuals who have had a stroke, heart failure, brain tumors, or infections.

Causes of Sleep Apnea

Obstructive sleep apnea is usually caused when the muscles of the tongue and throat relax during sleep and block the airway.

When your breathing is blocked in this way during sleep, insufficient oxygen reaches your lungs, causing a decrease in the oxygen level in your blood.

Bone deformities and enlarged tissues in the nose, mouth, or throat can also contribute to obstructive sleep apnea.

For example, if your tonsils are larger than normal, this may not cause any issues while standing during the day. However, when you lie down at night, your enlarged tonsils press downward, narrowing or blocking the airway and causing sleep apnea.

In children, the primary cause of sleep apnea is enlarged tonsils and adenoids.

Other Causes of Sleep Apnea:

Several other factors can contribute to sleep apnea.

Drinking alcohol can affect the breathing center in the brain. Alcohol can relax the muscles used for breathing, leading to blockage or narrowing of the airway, which can result in sleep apnea.

Obesity, particularly excess fat in the neck area, can cause the tissue around the airways to press downward, affecting the airway. Seven out of 10 people with sleep apnea are obese.

Certain medications, such as narcotics, antihistamines (used for allergies), long-term painkillers, sleeping pills, and medications for anxiety, can cause sleep apnea by relaxing the muscles in the airway.

What Causes Sleep Apnea?

Obstructive sleep apnea causes your airway to become blocked or narrowed, leading to periods of halted breathing during sleep. 

When breathing stops, you may wheeze, breathe loudly, snore, or make restless body movements. As soon as breathing ceases, loud snoring begins. This can happen repeatedly throughout the night.

The more frequently this occurs, the more severe the sleep apnea. Sleep apnea can be classified as mild, moderate, or severe.

When breathing stops, the oxygen level in the blood decreases, and the carbon dioxide level increases. This forces your heart, blood vessels, and nervous system to work harder. When these systems or organs are overworked:

• It can lead to high blood pressure and heart disease.
• It can result in other conditions that are difficult to treat.
• Your risk of having a stroke increases.
• Due to the lack of quality sleep caused by sleep apnea, you may feel tired and drowsy during the day.

Therefore, if you have sleep apnea:

• Your risk of having a traffic accident increases.
• Your productivity at school and work decreases, and you may experience concentration problems.
• It can cause memory problems.
• It may lead to personality issues, such as anxiety and depression.
• It can decrease your sex drive.

Sleep Apnea Diagnosis

Your doctor will ask you and, if applicable, your bed partner some questions about your daily life and sleep behavior. These questions might include: Do you snore? What is your sleep behavior like? Do you feel tired during the day? This questioning is known as medical history.

Your doctor may give you a questionnaire to help make a diagnosis (Epworth Sleep Questionnaire). If your doctor suspects you have sleep apnea, they may recommend a sleep study or other tests.

Sleep studies are a series of tests that examine what happens in your body during sleep. The most important sleep test is polysomnography (PSG). This test measures electrical activity in the brain, eye movements, muscle activity, heart rate, airflow through the mouth and nose, and the amount of oxygen in the blood.

Polysomnography is the most accurate method for diagnosing sleep apnea.

Other Tests for the Diagnosis of Sleep Apnea

• Blood test: Hypothyroidism (TSH test) and red blood cell count
• Electrocardiogram and echocardiogram (ECG, ECHO): To assess whether sleep apnea is affecting the heart

Diagnosis of Sleep Apnea in Children

Most doctors follow the guidelines of the American Academy of Pediatrics.

During the routine examination, your doctor will ask you and your child several questions. Be sure to mention whether your child snores. A comprehensive sleep study will help determine if your child has sleep apnea.

Your child may have sleep apnea if they have:

• Genetic disorder
• Lung disease
• Sickle cell anemia
• Facial and head deformities
• Down syndrome
• Cerebral palsy
• If there are severe heart and lung problems, doctors from other specialties should also be consulted.

Testing After Initial Treatment

You may need additional tests after the first treatment to assess its effectiveness.

If your sleep apnea has not improved after the first treatment and the cause is related to advanced tissue in the mouth and throat, your doctor may recommend one or more additional tests before considering surgery. These tests include:

• Fiber-optic pharyngoscopy: To identify what is obstructing your airway and making it difficult to breathe
• Computed Tomography (CT) of the head area: To assess the size of the tongue, scan for other soft tissues obstructing the airway, and locate the narrowest part of the airway
• X-ray: Bone deformities in the head are examined using a method called cephalometric X-ray

When Should You See a Doctor for Sleep Apnea?

• If you snore loudly and feel sleepy during the day
• If your breathing stops during sleep and you make wheezing sounds
• If you fall asleep at inappropriate times (e.g., while talking or eating)
• If your child snores during sleep, has trouble breathing, seems uncomfortable, wakes frequently, and feels sleepy during the day

“Wait and See” Approach in Sleep Apnea

• If the symptoms of sleep apnea gradually disappear on their own, no treatment is needed. However, if the condition worsens, you should see a doctor immediately and decide on the next steps.
• For example, if you snore loudly at night but are not sleepy during the day, you can adopt a “wait and see” approach. If the symptoms resolve, no treatment is necessary.
• However, if you have multiple symptoms of sleep apnea, such as loud snoring, restlessness during sleep, daytime fatigue, or breathing cessation during sleep, it would be unwise to follow a “wait and see” approach. The best course of action is to consult a physician as soon as possible.

Sleep Apnea Surgery

Surgery is recommended when other treatments for sleep apnea fail or are ineffective.

Techniques Used in Sleep Apnea Surgery

• Uvulopalatopharyngoplasty (UPPP): The most commonly preferred surgery for adults.
• Tonsillectomy or adenoidectomy: The first choice for children, as enlarged tonsils and adenoids are the leading cause of sleep apnea in children.
• Tracheostomy: One of the most effective treatments for sleep apnea, but only used if other treatments fail.
• Maxillomandibular advancement (MMA): Moving the upper and lower jawbones forward to widen the airway.
• Radiofrequency ablation (RFA): Reduces the size of the tongue and other soft tissues that block airflow to the lungs.
• Palatal implants: Small plastic rods placed in the palate to stiffen the soft palate, preventing the soft tissue from obstructing the airway.
• Other surgical procedures: Address bone and tissue issues in the mouth and throat.
• Obesity surgery: Promotes weight loss, which indirectly improves sleep apnea.