Obstructive Sleep Apnea (OSA) is a more severe form of upper airway collapse during sleep that results in sleep quality disruptions and physiologic stress on the body.  It's more than simply snoring and causing relationship problems.  OSA is a major cause of sleep related fatigue, memory problems, cardiovascular diseases. 

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OSA Symptoms and Complications

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OSA symptoms spectrum is extremely broad.  Sleep affects almost everything we do, so when it's compromised, there can be multitude of negative consequences.   Complications of untreated OSA can also be broad and can be severe.  

It's important that you speak with your doctor if you have any of these symptoms. 

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Symptoms and Complications of Untreated OSA can include

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• Daytime Sleepiness

• Concentration or memory problems

• Mood swings or irritability

• Depression

• Decreased libido

• Erectile dysfunction

• Morning headache

• Loud Snoring

• Visible pauses or choking episodes during sleep

• Abrupt awakenings with gasping/choking sensation

• Sore or dry throat in the morning.

 

Untreated OSA increases risk of

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• High Blood Pressure

• Heart Attack

• Irregular Heart Beat

• Stroke

• Car accidents

• Shortened life

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Causes

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The causes of OSA is similar to that of snoring. 

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Many things can be a factor in Obstructive Sleep Apnea (OSA) including

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• Nasal congestion

• Obesity

• Smoking

• Alcohol

• Presence of enlarged tonsils, adenoids. 

• Irregular sleep or sleep deprivation

• Unfavorable facial, mouth, throat anatomy

• Position of sleep.  Sleeping on your back can often worsen snoring and OSA

• Family History

• Asthma

• Diabetes

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Diagnosis

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Diagnosis of OSA requires a sleep study.  Sleep studies are noninvasive testing where multitude of physiologic data is collected during sleep.  The data may include; oxygen saturation, airflow, respiratory effort, pulse rate, ekg (heart monitor), eeg (brain monitor), emg (muscle activity), etc.

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There are currently two main ways that OSA is diagnosed.  PSG and HST.   Each method has their pros and cons.

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PSG (Polysomnography)

The gold standard sleep testing is called a Polysomnography (PSG), which literally means "many writings of sleep". 

PSG typically measures 16 channels (physiologic data points) during sleep and is performed in a sleep lab.  Sleep lab is usually housed in a sleep center or within a hospital.   It's not the Ritz Carlton (more like the Holiday Inn), but you are typically provided with a comfortable room.  A sleep technician will help setup the equipment, perform and monitor the study for you.   You wake up and go about your normal routine the next morning.  

Pro:  Treasure trove of data is collected during sleep that empowers a clinician to accurately diagnose a patient's sleep problems including but not just limited to OSA.

Con:  Cost is higher.  Sleep environment is different and sometimes that may affect results.  Scheduling maybe limited as it depends on availability of limited beds and location.  

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HST (Home Sleep Test)

Home Sleep Test (HST) is a more limited sleep study that is primarily for diagnosis of OSA and not any other sleep related problems.   There are number of different HST devices in the market.  The most commonly used devices usually include measurement of 4 channels such as oxygen saturation, respiratory effort, pulse rate, airflow. 

The study is performed at home.   A healthcare provider will provide a HST device for you with appropriate instructions on proper use.   You will take the device home and use it as directed during your sleep.  Once done, the device is returned for data download and analysis. 

This is the most common form of sleep testing for OSA. 

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Pro:   Cost.  Easier access and scheduling.  Sleep study is done at home in a person's natural sleep environment. 

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Con:  Collection of various sleep data is limited.  As such diagnosis maybe less accurate.   Unsuitable for people with significant heart or lung conditions. 

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Causes

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Many things can worsen or cause Obstructive Sleep Apnea (OSA) including

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• Nasal congestion

• Obesity

• Smoking

• Alcohol

• Presence of enlarged tonsils, adenoids. 

• Irregular sleep or sleep deprivation

• Constricted facial, mouth, throat anatomy

• Position of sleep.  Sleeping on your back can often worsen snoring and OSA.

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Treatment

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The main form of treatment for OSA can be divided into medical or surgical treatments.

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Medical Device Treatment

• CPAP

• Oral Appliance

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Surgical Treatment

• Nasal Surgery

• Minimally invasive techniques such as Pillar Implant and Radiofrequency treatment

• Modification or removal of tissue

• Modification of Jaw

• Upper airway stimulation

• Tracheostomy (surgical opening in the neck).  Highly effective but generally an option of last resort.

• Bariatric Surgery

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Treating exacerbating factors can also help and should be part of overall management plan. 

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• Nasal congestion.  You can try otc nasal steroid like fluticasone or nasal strips/cones.  Nasal surgery maybe appropriate.

• Obesity.  Weight loss.   Bariatric surgery maybe appropriate.

• Smoking.  Smoking causes increased nose and throat inflammation.  Quit smoking.

• Alcohol.  Alcohol worsens mouth/throat relaxation during sleep.  Avoid drinking alcohol 3-4 hrs before bed.

• Presence of enlarged tonsils, adenoids.  Surgical removal maybe necessary.

• Irregular sleep or sleep deprivation.  Maintain regular sleep schedule every day.  Excessive sleepiness or irregular sleep can worsen snoring.

• Facial, nose, mouth, throat anatomy.   Evaluation by a ENT airway specialist can locate the problem. 

• Position of sleep.  Elevating the head of the bed with an adjustable bed, wedge pillow.  Side sleeping, bumper belt. 
   

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