Sleep apnea is a potentially serious disorder in which breathing repeatedly stops and starts. It is due to repetitive collapse of the upper airway during sleep. Sleep apnea is generally under reported and under diagnosed. Prevalence is general adult population varies between 15-30 per cent.
WHY SLEEP APNEA MUST BE TREATED
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Untreated sleep apnea has many potential consequences and adverse clinical associations, including excessive daytime sleepiness, impaired daytime function, metabolic dysfunction and increased risk of cardiovascular and cerebrovascular disease.
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Adverse outcomes include drowsy driving and accidents, neuropsychiatric dysfunction, pulmonary hypertension, Type-2 diabetes and non-alcoholic fatty liver disease.
RISK FACTORS
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Well defined risk factors include older age, male sex, obesity, facial and upper airway abnormalities.
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Potential risk factors include smoking, family history of sleep apnea or snoring and nasal congestion.
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Sleep apnea is associated with certain medical conditions like obesity hypoventilation syndrome, pregnancy and end stage kidney disease, congestive heart failure, chronic lung disease and diabetes mellitus.
SYMPTOMS
The most common signs and symptoms include:
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Loud snoring
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Gasping for air during sleep
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Waking up with a dry mouth
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Morning headache
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Difficulty staying asleep (insomnia)
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Excessive daytime sleepiness (hypersomnia)
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Difficulty paying attention while awake
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Irritability
CONDITIONS THAT MIMIC SLEEP APNEA
Conditions which mimic sleep apnea are restless leg syndrome, narcolepsy, sedative drugs, gastroesophageal reflex disorder, swallowing disorders, nocturnal seizures, nocturnal asthma, insomnia and panic attack.
DIAGNOSIS
Recommendations for testing patients who have excessive daytime sleepiness and 2 out of 3 of the following:
Habitual snoring
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Witnessed apnea
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Gasping or choking during sleep
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Diagnosed hypertension
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Many evaluation tools and questionnaires like ESS, Berlin, stop-bang questionnaires are not typically used for diagnostic testing since they are inaccurate and not superior to good history and physical examination.
TESTS
Diagnosis is confirmed with sleep study or polysomnography (PSG). This is a single non-invasive test which can be done at home or in lab/hospital. The diagnosis of sleep apnea is based upon the presence or absence of related symptoms as well as the frequency of absence of respiratory events during sleep (i.e., apneas, hypopnea and RERAs (respiratory effort related arousals)
TREATMENT
The management of a patient with sleep apnea begins by firmly establishing the diagnosis and its severity. The patient should be educated about the risk factors, natural history and consequences of sleep apnea. Importantly, all patients should be warned about the increased risk of motor vehicle accidents associated with untreated. Treatment options are:
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Behaviour modifications
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Weight loss and exercise
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Sleep positions
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Alcohol avoidance
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Medications
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Upper airway surgery
MYTHS
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Sleep apnea is not a disease, it's a disorder
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Sleep apnea is not only seen in obese patients
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Prevalence is not rare as it is underdiagnosed
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Establishing the diagnosis and understanding the disorder is the key
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Just breaking the sleep cycle variations, many illnesses and death can be prevented
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No invasive testing is required
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Beneficial treatment option is by use of CPAP/BIPAP without medications.
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It’s not a lifetime disease, behavioural modifications can reverse the disease and use of CPAP/BIPAP
(The writer is head & senior consultant, department of intensive care & critical care, Kauvery Hospitals Electronic City)
