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Sleep Apnea by Jenna Hollenstein, MS, RD

En Español (Spanish Version) More InDepth Information on This Condition

Definition

Sleep apnea occurs when breathing stops for brief periods of time while a person is sleeping. It can last for 10-30 seconds, and may occur up to 20-30 times per hour. During one night of sleep, this can cause up to 400 episodes of interrupted breathing.

Blocked Airway

Causes

There are three types of respiratory events:

Obstructive apnea—caused by a temporary, partial, or complete blockage of the airway
Central apnea—caused by a temporary failure to make an effort to breathe
Mixed apnea—a combination of the first two types

Risk Factors

Factors that increase your chances of developing sleep apnea include:

Sex: male
Overweight
Large neck circumference
Age: middle to older age
Family history of apnea
Structural abnormalities of the nose, throat, or other part of the respiratory tract. Examples include:
- Polyps
- Severely enlarged tonsils
- Deviated nasal septum
Hypothyroidism
Medicines: sedatives and sleeping aids
Alcohol consumption
Smoking

Symptoms

Symptoms include:

Fatigue and sleepiness during waking hours
Loud snoring
Breathing that stops during the night that—as noticed by a bed partner
Repeated waking at night
Unrefreshing sleep
Morning headaches
Poor concentration or problems with memory
Irritability or short temper

People with chronic, untreated sleep apnea may be at risk for:

Motor vehicle accidents
Depression
Hypertension
Heart disease

Diagnosis

An overnight sleep study is used to help diagnose sleep apnea.

Overnight Sleep Study (Polysomnography)

This test helps detect the presence and severity of sleep apnea. During sleep, it measures your:

Eye and muscle movements
Brain activity using an electroencephalogram
Heart rate
Breathing pattern and depth
The percent of your red blood cells that are saturated with oxygen

Other Studies

In addition to sleep studies, your doctor may order:

Blood tests to check thyroid function
Electrocardiogram
Pulmonary function tests

Treatment

There are a number of treatment options for sleep apnea, including:

Behavioral Therapy

Lose weight if you are overweight.
Avoid using sedatives, sleeping pills, alcohol, and nicotine, which can make the condition worse.
Try sleeping on your side instead of your back.
Use pillows to increase your level of comfort when sleeping.
For daytime sleepiness, practice safety measures, such as avoiding driving or operating potentially hazardous equipment.

Mechanical Therapy

Continuous positive airway pressure (CPAP) entails wearing a mask over your nose and/or mouth during sleep. An air blower forces enough constant and continuous air through your air passages to prevent the tissues from collapsing and blocking the airway. In some cases, dental appliances that help keep the tongue or jaw in a more forward position may help.

Surgery

In some cases, surgery may be recommended. It is most often beneficial in pediatric patients.

Types of surgery that may be done to treat severe cases of sleep apnea include:

Uvulopalatopharyngoplasty—Excess soft tissue is removed from the nose and/or throat.
Maxillomandibular advancement—The jawbone is repositioned forward.
Tracheotomy —For life-threatening cases of sleep apnea, an opening is made in the windpipe to allow for normal breathing.
Adenotonsillectomy—The adenoids and tonsils are removed.

Bariatric surgery may help with weight loss in some people who are obese . This surgery may reduce many of the complications that are related to obesity, including sleep apnea.

Medications

Only used in central apnea, acetazolamide may help improve the ability to regulate breathing. Overall, there is not a lot of evidence to support the use of medicines to treat sleep apnea.

Supplemental oxygen may be given if blood levels of oxygen fall too low during sleep, even after opening the airway.

Prevention

You may be able to prevent sleep apnea by maintaining a healthy weight . Avoid alcohol, nicotine, and sedatives, which may contribute to airway obstruction.

RESOURCES:

American Sleep Apnea Association http://www.sleepapnea.org
National Sleep Foundation http://www.sleepfoundation.org

CANADIAN RESOURCES:

Canadian Lung Association http://www.lung.ca
Canadian Sleep Society http://www.canadiansleepsociety.ca

References:

American Academy of Sleep Medicine. The International Classification of Sleep Disorders. 2nd ed. Westchester, IL; American Academy of Sleep Medicine; 2005.
Kushida CA, Littner MR, Hirshkowitz M, et al. Practice parameters for the use of continuous and bilevel positive airway pressure devices to treat adults with sleep-related breathing disorders. Sleep. 2006;29:375-380.
Littner MR, Kushida C, Wise M, et al. Practice parameters for clinical use of the multiple sleep latency test and the maintenance of wakefulness test. Sleep. 2005;28:113-121.
Morgenthaler TI, Kapen S, Lee-Chiong T, et al. Practice parameters for the medical therapy of obstructive sleep apnea. Sleep. 2006;29:1031-1035.
Obstructive sleep apnea (OSA). EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated May 23, 2013. Accessed June 3, 2013.
Pack AI, Maislin G. Who should get treated for sleep apnea? Ann Intern Med . 2001;134:1065-1067.
Sleep apnea. American Sleep Apnea Association website. Available at: http://www.sleepapnea.org/learn/sleep-apnea.html . Accessed June 3, 2013.
Smith I, Lasserson TJ, Wright J. Drug therapy for obstructive sleep apnea. Cochrane Database Syst Rev . 2006;19:CD003002.

Last reviewed June 2013 by Rimas Lukas, MD; Michael Woods, MD

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