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Obstructive Sleep Apnea

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Obstructive sleep apnea (OSA) is a common disorder characterized by repetitive narrowing or collapse of the pharyngeal airway during sleep. This leads to significantly reduced (hypopnea) or complete cessation (apnea) of airflow despite ongoing breathing efforts. The disorder is associated with major comorbidities including EDS, impaired cognition, poor quality of life, increased risk of motor vehicle accidents and increased risk of cardiovascular disease.9   Obstructive sleep apnea is more prevalent in men and in older individuals.

Symptoms of obstructive sleep apnea

Common symptoms of OSA include loud snoring, restless sleep and daytime sleepiness. Snoring is the hallmark symptom of sleep apnea, as it reflects the basic pathophysiology underlying the disorder, namely a critical narrowing of the upper airway. Many OSA patients are reported waking at night with a choking sensation, which invariably passes within a few seconds of wakening. Other associated features include symptoms such as fatigue, memory impairment, personality changes, morning headaches and depression.

Causes of obstructive sleep apnea

The underlying pathophysiology is multifactorial and may vary considerably between individuals. Important risk factors for OSA include obesity, male sex and aging. The physiological mechanisms underlying these risk factors are not clearly understood.

Cardiovascular Adverse Effects

Although the exact mechanism is unknown, OSA had been associated with a group of proinflammatory and prothrombic factors, which are also involved in the development of atherosclerosis. Autonomic abnormalities include an increased resting heart rate, decreased cardiac rhythm activity and increased blood pressure variability. Many studies have shown that patients with OSA have an increased incidence of daytime hypertension, and OSA is recognized as an independent risk factor for hypertension.10

Obstructive apnea is associated with myocardial ischemia (silent or symptomatic), acute coronary events, cardiac arrhythmia, transient ischemic attacks, stroke, pulmonary hypertension and heart failure.10

Treatment of obstructive sleep apnea

Several treatment options exist for OSA, which includes weight reduction, positional therapy, positive pressure therapy, surgical options and oral appliances such as mandibular advance devices and tongue-retaining devices.

The treatment of choice for moderate-to-severe OSA is the application of CPAP via a mask during sleep. Although CPAP is very effective at reversing the disordered breathing events and consequent daytime symptoms, maintaining patient adherence can be difficult. The role of surgery in the treatment of OSA remains controversial. The most appropriate indication is reversible causes of upper airway obstruction such as adenotonsillar hypertrophy or mass lesions. The available surgical procedures include uvulopalatopharyngeoplasty, geniotubercle advancement, hyoid myotomy and resuspension, midface advancement and tracheostomy.

Written by: healthplus24.com team

Date last updated: April 12, 2015

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