Obstructive Sleep Apnea, Snoring’s disturbing relative

While snoring and obstructive sleep apnea (OSA) are not synonymous, they often go hand-in-hand. Approximately 87% of those who snore have OSA, while up to 95% of those who have OSA snore.

About 10% of adults suffer from OSA, however, it is undiagnosed and untreated in up to 90% of sufferers. Persons whose OSA is not attended to are three times more likely to die prematurely.

Snoring is the noise that emanates from the throat as a result of the vibration of the relaxed tissue in the pharynx on inhalation. Most people snore occasionally, however, in some it is a long-term issue. OSA on the other hand is as a result of the obstruction of the upper airway while asleep causing one’s breathing to be cut off for 10 seconds or more. OSA may be associated with numerous and significant health issues.

OSA accounts for up to 99% of sleep apnea cases, while central sleep apnea accounts for 1%.

OSA is often challenging to diagnose if it’s not witnessed. However, any of these associated symptoms should raise one’s index of suspicion that OSA may be lurking:

• Bed partner reporting loud snoring and or temporary cessation of breathing
• May awaken snorting, choking, spluttering, or gasping
• Extreme daytime tiredness
• Dry mouth and or throat
• Frequent yawning
• Challenges concentrating
• Morning headaches
• Chest pains at night
• Insomnia
• High blood pressure
• Daytime and work-related accidents/ mistakes
• Forgetfulness
• Mood swings, irritability, depression
• Dizzyness
• Nightmares
• Frequently getting up at night to urinate
• Heartburn
• Reduced interest in sex
• Erectile dysfunction
• Restless during sleep
• Night sweats

Predisposing factors to OSA

• Being overweight
• Large neck circumference – 43.2cm/ 17 inches for men, 40.6 cm/ 16 inches for women
• Other anatomical variations – include a narrow upper airway, a short jaw, an elevated tongue, a long soft palate, enlarged tonsils/ adenoids, nasal polyps, and a deviated nasal septum.
• Men over 40
• Women over 50
• Males are twice as likely to suffer from OSA
• Smoking
• Alcohol
• Chronic nasal congestion
• Asthma
• High blood pressure
• Postmenopause
• Hypothyroidism
• Prior stroke
• Polycystic Ovarian Syndrome
• Congestive heart failure
• Excessive growth hormone levels
• Family history
• Upper respiratory tract allergies and infections
• Medications – sleeping tablets, tranquilizers
• Down Syndrome

Potential complications from (untreated) OSA

• Hypertension
• Type 2 diabetes
• Strokes
• Heart attacks
• Irregular heartbeat (arrhythmia)
• Depression, anxiety
• Reduced life expectancy

Degrees of severity of OSA

The severity of OSA is determined by the number of breathing pauses experienced while sleeping within an hour. Typically these pauses last 10-20 seconds.

• Mild OSA – five to 15 pauses within an hour
• Moderate OSA – 16 to 29 pauses within an hour
• Severe OSA – 30 or more pauses within an hour

Persons with severe OSA who are “sleeping” for 8 hours will cease to breathe on 240 or more occasions.

How OSA is diagnosed

If OSA is suspected the following test should be carried out, where available:

A laboratory or home conducted polysomnogram is the gold-standard for diagnosing OSA. The data collected from this test is analysed by a sleep specialist in order to determine if OSA is present.

Other tests that may be ordered include:

• Electroencephalogram (EEG) measures and records the brain’s electrical activity
• Electromyogram (EMG) is used to detect the body’s muscular activity.
• Electrooculogram (EOG) records the eye’s movements.
• Electrocardiogram (ECG) monitors and records the electrical activity of the heart.
• The nasal airflow sensor is used to monitor the airflow
• The snore microphone records the snore’s decibels.

Treating OSA

The following are highly recommended:

• Loss of weight
• Smoking cessation
• No alcohol before bedtime
• Avoid sleeping tablets
• Sleeping on your sides as opposed to back
• Using a continuous positive airway pressure (CPAP) machine
• At bedtime wearing a mandibular advancement device (MAD)
• Treating underlying conditions such as heart failure and asthma
• Surgery may be used to correct or remove, respectively, a deviated septum, nasal polyps, tonsils, and or adenoids

Types of doctors who manage OSA

It is highly recommend, to get the most out of the visit when visiting any of the below listed doctors, that the sleeping parner accompany the patient and video footage of the concerning events be shared with the doctor.

• Sleep Medicine Physician
• Primary Care Physician
• Dentists
• Ear, Nose and Throat (ENT) Doctors (Otolaryngologists)
• Pulmonologists (Lung Doctors)
• Neurologists

Author: Dr. C. Malcolm Grant – Family Physician, c/o Family Care Clinic, Arnos Vale, www.familycaresvg.com, clinic@familycaresvg.com, 1(784)570-9300 (Office), 1(784)455-0376 (WhatsApp)
Disclaimer: The information provided in the above article is for educational purposes only and does not substitute for professional medical advice. Please consult a medical professional or healthcare provider if you are seeking medical advice, diagnoses, or treatment. Dr. C. Malcolm Grant, Family Care Clinic or The Searchlight Newspaper or their associates, respectively, are not liable for risks or issues associated with using or acting upon the information provided above.