Classification and Symptoms
- Obstructive sleep apnea is classified as a sleep-related breathing disorder.
- It is divided into two categories: adult OSA and pediatric OSA.
- Obstructive sleep apnea is different from central sleep apnea.
- The respiratory effort is assessed to classify the apnea as obstructive.
- Obstructive sleep apnea-hypopnea syndrome is associated with daytime symptoms.
- Common symptoms of OSA syndrome include daytime sleepiness, restless sleep, and loud snoring.
- Less common symptoms include morning headaches, insomnia, and mood changes.
- OSA can be transient and caused by upper respiratory infections or drug use.
- Epstein-Barr virus can increase the size of lymphoid tissue and cause OSA.
- OSA can be underdiagnosed in individuals who sleep alone.
- Excessive daytime sleepiness is a hallmark symptom of OSA in adults.
- OSA can cause changes in the neurons of the hippocampus and frontal cortex.
- OSA is associated with problems in non-verbal information processing and memory.
- Diagnosis of OSA is more common among people in relationships.
- There is a stigma associated with loud snoring, particularly in females.
- Hypersomnolence is not typical in young children with sleep apnea.
- Children with severe OSA may appear over-tired or hyperactive.
- OSA in children is often caused by obstructive tonsils and adenoids.
- Excessive weight can also contribute to OSA in children.
- The prevalence and characteristics of pediatric OSA have changed due to obesity.
Risk Factors
- Obesity is a significant risk factor for OSA.
- Fatty infiltration and fat deposits in the neck region can narrow the upper airway.
- The severity of OSA is proportional to the degree of obesity.
- Adenotonsillar hypertrophy is a common cause of OSA in children.
- Changes in the prevalence and characteristics of pediatric OSA are linked to the obesity epidemic.
- People with normal body mass indices (BMIs) can also have OSA, possibly due to increased muscle mass or decreased muscle tone.
- Sleeping supine (on the back) and gravity can contribute to OSA development, confounded by neck obesity.
- Use of CPAP can expand a collapsed upper airway, indicating airway collapse as the cause of OSA.
- Throat lesions, especially enlarged tonsils, can aggravate OSA and their removal may provide relief.
- Old age is often accompanied by muscular and neurological loss of upper airway muscle tone.
- Decreased muscle tone can be caused by chemical depressants like alcohol and sedatives.
- Permanent premature muscular tonal loss can be caused by traumatic brain injury, neuromuscular disorders, or poor adherence to treatments.
- Age-related changes in muscle tone can increase the risk of OSA.
- Post-menopausal women have a prevalence of OSA similar to men in the same age range.
- Decreased muscle tone and increased soft tissue around the airway increase the risk of OSA.
- Men, with increased mass in the torso and neck, are at higher risk of developing sleep apnea.
- Women generally experience OSA less frequently and to a lesser degree due to physiology and possibly progesterone levels.
- Post-menopausal women have a higher risk of developing OSA.
- Medications and lifestyle factors can also contribute to OSA risk.
- OSA has a genetic component.
- Family history increases the likelihood of developing OSA.
- Genetic factors play a role in OSA development.
- Short lower jaws (neoteny) can cause OSA.
- Narrow upper jaw contributes to OSA.
- Small lower jaws can lead to crowded teeth and malocclusions.
- Craniofacial syndromes can involve unusual facial features.
- Down syndrome predisposes individuals to OSA.
- OSA can occur as a post-operative complication.
- Pharyngeal flap surgery is associated with post-operative OSA.
- Flap obstruction can hinder respiration during sleep.
- Healthcare professionals are becoming more aware of post-operative OSA.
- Concerns of OSA have increased following pharyngeal flap surgery.
Pathophysiology
- Transition from wakefulness to sleep is associated with reduced upper-airway muscle tone.
- During REM sleep, muscle tone of the throat and neck relax, potentially obstructing airflow.
- Neurological mechanisms can trigger sudden interruptions of sleep, causing gasping for air and awakening.
- Sleep interruptions can lead to sleep deprivation and negative effects on growth, healing, and immune response.
- Blocked upper airway, usually behind the tongue and epiglottis, is the fundamental cause of OSA.
- Spontaneous upper-airway blockage causes are debated.
- Pulmonologists and neurologists believe risk factors can be advanced age, brain injury, decreased muscle tone, long-term snoring, and increased soft tissue.
- Otorhinolaryngologists believe risk factors can be structural features like enlarged tonsils, enlarged posterior tongue, fat deposits, impaired nasal breathing, floppy soft palate, or collapsible epiglottis.
- Oral and maxillofacial surgeons believe risk factors can be primary forms of mandibular hypoplasia leading to glossoptosis.
- Orthognathic surgery is believed to offer superior guarantees of OSA cure by some maxillofacial surgeons.
Consequences
- OSA has physiological consequences such as hypoxia and sleep fragmentation.
- Intermediate consequences include inflammation and metabolic dysfunction.
- Clinical repercussions include pulmonary hypertension and heart diseases.
- OSA can lead to accidents and obesity.
- Increased risk of perioperative complications in patients with OSA.
- OSA is the most common Sleep-Disordered Breathing in children.
- Pre-term children are more likely to have OSA.
- Untreated OSA in children can lead to long-term consequences.
- OSA affects various domains of life, including organs and behavior.
- Nocturnal symptoms of OSA are associated with daytime symptoms and neuroc
Obstructive sleep apnea (OSA) is the most common sleep-related breathing disorder and is characterized by recurrent episodes of complete or partial obstruction of the upper airway leading to reduced or absent breathing during sleep. These episodes are termed "apneas" with complete or near-complete cessation of breathing, or "hypopneas" when the reduction in breathing is partial. In either case, a fall in blood oxygen saturation, a disruption in sleep, or both, may result. A high frequency of apneas or hypopneas during sleep may interfere with the quality of sleep, which – in combination with disturbances in blood oxygenation – is thought to contribute to negative consequences to health and quality of life. The terms obstructive sleep apnea syndrome (OSAS) or obstructive sleep apnea–hypopnea syndrome (OSAHS) may be used to refer to OSA when it is associated with symptoms during the daytime (e.g. excessive daytime sleepiness, decreased cognitive function).
| Obstructive sleep apnea | |
|---|---|
| Other names | Obstructive sleep apnoea |
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| Obstructive sleep apnea: As soft tissue falls to the back of the throat, it impedes the passage of air (blue arrows) through the trachea. | |
| Specialty | Sleep medicine |
Most individuals with obstructive sleep apnea are unaware of disturbances in breathing while sleeping, even after awakening. A bed partner or family member may observe a person snoring or appear to stop breathing, gasp, or choke while sleeping. People who live or sleep alone are often unaware of the condition. Symptoms may be present for years or even decades without identification, during which time the person may become conditioned to the daytime sleepiness, headaches and fatigue associated with significant levels of sleep disturbance. Obstructive sleep apnea has been associated with neurocognitive morbidity and there is a link between snoring and neurocognitive disorders.
