Alternate Names: Sleep apnea - obstructive

Causes and Risks: During sleep, relaxation of the muscles at the base of the throat cause obstruction of the airway, with extremely loud snoring and labored breathing. When complete blockage of the airway occurs, breathing stops. The obstruction to breathing prevents a person from reaching deeper stages of sleep, causing the symptoms of daytime drowsiness. Obstructive sleep apnea occurs most frequently in obese middle-aged men. Contributing factors may include use of alcohol or sedatives before sleep, anatomically narrowed airways, and massively enlarged tonsils and adenoids. Hypertension or pulmonary hypertension with enlarged right ventricle may be present. The incidence is 6 out of 100,000 people.

The classical presentation of obstructive sleep apnea in the adult is the appearance of snoring shortly after going to sleep. The snoring proceeds at a regular pace for a period of time, often becoming louder, but is then interrupted by a long silent period during which no breathing is taking place (apnea). The apnea is then interrupted by a loud snort and gasp and the snoring returns to its regular pace. This behavior may recur repetitively and frequently throughout the night. During the apneic periods the oxygen level in the blood falls dramatically. Persistent low levels of oxygen (hypoxia) causes the daytime symptoms. If the condition is severe enough, pulmonary hypertension develops and the patient may develop right sided heart failure (cor pulmonale) or myocarditis.

Prevention: Weight reduction and avoidance of alcohol use and sedatives may help some individuals risk. Children with massive adenoid and tonsillar hypertrophy can develop obstructive sleep apnea and its associated problems and should have a tonsillectomy and adenoidectomy (T and A surgery).

Symptoms:

• loud snoring
• snoring interrupted by periods of not breathing (apnea)
• breath cessation during sleep
• frequent night awakening
• awakening not rested in the morning
• abnormal daytime sleepiness
• headaches
• recent weight gain
• limited attention
• memory loss
• poor judgment
• personality changes
• lethargy

• swelling, overall (edema)
• hallucinations
• consciousness, decreased
• confusion
• blood pressure, high

Signs and Tests: A physical examination of the mouth and throat (oropharynx) is given to detect abnormalities.

Tests may include:

• sleep studies
• an ECG to show arrhythmias during sleep
• an arterial blood gases to show low oxygen during sleep

Treatment: The objective of treatment is to keep the airway open to prevent apneic episodes during sleep.

Weight management (or intentional weight loss) and the avoidance of alcohol and sedatives at bedtime may achieve the desired results in some individuals. If these measures are unsuccessful in stopping sleep apnea, continuous positive airway pressure (nasal CPAP), involving the use of a specially designed mask worn over the nose and mouth at night, may be prescribed. Mechanical devices inserted into the mouth at night to keep the jaw forward are being studied as a form of treatment. Oxygen therapy in select cases may achieve the desired results.

Surgery to remove excess tissue at the back of the throat (called a uvulopalatopharyngoplasty or UPPP), to remove enlarged tonsils or adenoids (see tonsillectomy, T and A), or to create an opening in the trachea to bypass the obstructed airway during sleep (tracheostomy) may be indicated if anatomical causes are present.

Prognosis: Treatment is not always successful. Frequently, people are unable to lose weight and are not always compliant with therapy.

Complications:

• sleep deprivation

Call for an appointment with your health care provider if symptoms of obstructive sleep apnea are present. If you have this condition, call for an appointment if symptoms do not improve with treatment, or if new symptoms develop.

Decreased consciousness, extreme somnolence, hallucinations, personality changes, and persistent confusion can indicate an urgent or emergency situation.