Lets talk : Sleep Apnoea

If you snore or if someone you know snores, you should surely read this.

    Sleep Apnoea, also known as Obstructive Sleep Apnoea (OSA), is believed to affect a large number of people in the world and also our country, India. And that too 90% of people affected remain undiagnosed for various reasons. Certain researches claim that around 4 in 100 middle-aged men, and 2 in 100 middle-aged women have OSA. Studies have also shown that around 60% of people over 65 years of age have some form of OSA.

    A layman’s definition of Sleep Apnoea is ‘the cessation of breathing during sleep’. It is a Respiratory Sleep Disorder, not a disease. It is Respiratory in nature (as we stop breathing), but it only happens when we sleep or nap.

    These periods of ‘stopping breathing’ only become clinically significant if the cessation lasts for more than 10 seconds each time and occur more than 5 times every hour.

    Obstructive sleep apnoea is caused by the obstruction and/or collapse of the upper airway (back of throat), usually accompanied by a reduction in blood oxygen saturation, and then an awakening (arousal) to activate breathing again. This is called an apnoea event.

    When breathing stops the levels of oxygen in the blood begin to drop. After a short time, the lack of oxygen causes a reflex response. This response forces open the airway with a loud snort, maybe gasping breaths and loud snoring. There may also be kicking and flailing of the arms.

    Often the symptoms when mild are first noticed by the partner (spouse) of the patient and hence early detection may actually be a lot more helpful.

There are two types of breathing interruptions which have been defined as follows:

 

Apnoea – the muscles and soft tissues in the throat relax and collapse sufficiently to cause a total blockage of the airway; it is called an apnoea when the airflow is blocked for 10 seconds or more

 

Hypopnoea – is a partial blockage of the airway that results in an air flow reduction of greater than 50% for 10 seconds or more. Whilst Hypopnoea doesn’t seem as dangerous as an Apnoea, it does create its own problems and should not be disregarded or ignored.

 

Episodes of hypopnoea are sometimes referred to as ‘obstructive sleep apnoea-hypopnoea syndrome’. The term ‘obstructive’ distinguishes OSA from rarer forms of sleep apnoea, such as central sleep apnoea, which is caused by the brain ‘forgetting’ to breathe during sleep. Instances of central sleep apnoea are rare.

                              

 Causes:

Obstructive sleep apnoea is caused by the muscles and soft tissue in the back of your throat collapsing inwards during sleep. These muscles support your tongue, tonsils and soft palate (a muscle at the back of the throat that is used in speech).

Once the muscles relax, the airway in your throat can narrow or become totally blocked. This interrupts the oxygen supply to your body, which triggers your brain to pull you out of deep sleep so that your airway reopens, and you can breathe normally.

There is no definitive cause for sleep apnoea but there are several risk factors, such as:

•     Being overweight is a major risk factor because excessive body fat increases the bulk of soft tissue in the neck, which can place a strain on the throat muscles and can obstruct your breathing. Excess stomach fat can also lead to breathing difficulties, which can make OSA worse.
•    Being male – it is not known why OSA is more common in men than in women, but it may be related to different patterns of body fat distribution.
• Being 40 years of age or older – although OSA can occur at any age, it is more common in people who are over 40 years old.
• Having a large neck – a man of average height (1.7m or 5ft 8in) with a collar size that is greater than 45cm (18 inches) is classed as obese and has an increased risk of developing OSA. People with thicker necks might have narrower airways.
• Taking medicines that have a sedative effect, such a sleeping tablets or tranquillisers.
• Having an unusual inner-neck structure, such as an unusually narrow airway, unusually large tonsils or tongue, or having a small lower jaw that pushes the tongue backwards.
• Having excess folds in the inner lining of the mouth (mucous membrane).
• Alcohol – drinking alcohol can make snoring and sleep apnoea worse.
• Smoking – you are three times more likely to develop sleep apnoea if you smoke. Smoking can increase the amount of inflammation and fluid retention in the upper airway.
• Being menopausal – the changes in hormone levels during the menopause may cause the throat muscles to relax.
• Having a family history of OSA – there may be genes inherited from your parents that can make you more susceptible to OSA.
• Diabetes – OSA is three times more common in people with diabetes.
• Nasal congestion – OSA occurs twice as often in people with nasal congestion, which may be due to the airways being narrowed. If you have difficulty breathing through your nose — whether from an anatomical problem or allergies — you’re more likely to develop obstructive sleep apnoea.

Dangers or Risks:

    Sudden drops in blood oxygen levels that occur during sleep apnoea increase blood pressure and strain the cardiovascular system. Having obstructive sleep apnoea increases your risk of high blood pressure (hypertension).

    Obstructive sleep apnoea might also increase your risk of recurrent heart attack, stroke and abnormal heartbeats such as atrial fibrillation (arrhythmia). If you have heart disease, multiple episodes of low blood oxygen (hypoxia or hypoxemia) can lead to sudden death from an irregular heartbeat.

    Having sleep apnoea increases your risk of developing insulin resistance and type 2 diabetes. It also increases the risk of developing Metabolic syndrome, a disorder which includes high blood pressure, abnormal cholesterol levels, high blood sugar and an increased waist circumference. Metabolic syndrome is linked to a higher risk of heart disease.

    Obstructive sleep apnoea is also a concern with certain medications and general anaesthesia. People with sleep apnoea might be more likely to have complications after major surgery because they’re prone to breathing problems, especially when sedated and lying on their backs. If you have been diagnosed with sleep apnoea and require surgery, tell your doctor about your condition and how it’s being treated before the operation.

    People with sleep apnoea are more likely to have abnormal results on liver function tests, and their livers are more likely to show signs of scarring (non-alcoholic fatty liver disease).

    Loud snoring can keep anyone who sleeps near you from getting good rest. It’s not uncommon for a partner to have to go to another room, or even to another floor of the house, to be able to sleep.

    As someone with sleep apnoea can suffer a lack of refreshing sleep, they run an increased risk of being involved in a life-threatening accident, such as a car crash. Their risk of having a work-related accident also increases significantly. Research has shown that someone who has been deprived of sleep due to OSA has the same impaired judgement and reaction time as someone who is over the drink-drive limit, in fact Drivers with OSA are three times more likely to have a road traffic crash than the general population.

Diagnosis & Solution:

    If you have symptoms of excessive daytime sleepiness, such as feeling drowsy, a lack of energy and poor memory, ask a partner, friend or relative to observe you while you are asleep. They may be able to spot episodes of breathlessness that could help to confirm a diagnosis of obstructive sleep apnoea (OSA).

    Next step that is always advisable is to visit a specialist doctor for the same before it is too late and look for alternatives of treatment depending on your current clinical status.

Do I have Sleep Apnoea?

    People with sleep apnoea may complain of excessive daytime sleepiness often with irritability or restlessness. But it is normally the bed partner, family or friends who notice the symptoms first.

    Most people with sleep apnoea snore loudly. Their breathing may be noisy and laboured, and it is often interrupted by gasping and snorting with each episode of apnoea.

    If you have sleep apnoea, you may have no memory of your interrupted breathing during the night. However, when you wake up you are likely to feel as though you have not had a good night’s sleep.

Common Symptoms of sleep apnoea include:

• Extremely loud heavy snoring, often interrupted by pauses and gasps
• Excessive daytime sleepiness, e.g., falling asleep at work, whilst driving, during conversation or when watching TV. (This should not be confused with excessive tiredness with which we all suffer from time to time)
• Waking up with a sore or dry throat
• Forgetfulness, poor memory and concentration
• Headaches (particularly in the morning)
• Irritability and a short temper
• Anxiety
• Depression
• Lack of interest in sex
• Impotence in men (inability to get or maintain an erection)
• Some people with OSA may also wake up frequently during the night to urinate.

    Remember, not everyone who has these symptoms will necessarily have sleep apnoea. Most people will suffer from these symptoms from time to time but people with sleep apnoea demonstrate some or all of these symptoms all the time.