Sleep apnoea syndrome

What is apnoea?

The word apnoea means 'want of breath' and obstructive sleep apnoea syndrome refers to a clinical condition where obstruction in the upper airway leads to interruption of the breathing cycle on a frequent basis during sleep leading to various consequences as discussed below.

The obstruction sites are usually at more than one level and include within the nose, behind a bulky soft palate, behind a large base of tongue and due to fat deposition in side walls of the throat. In addition, gravity plays a role especially when the patient lies on their back. Muscles tend to be more relaxed during sleep including the tongue which increases likelihood of the airway closing or partially closing at this time.

What are symptoms of obstructive sleep apnoea syndrome (OSAS)?

During the night:

  • The main symptom is loud snoring which may be interrupted by snorting and or gasping.
  • Pauses in breathing (apnoeas) observed by bed partner often followed by loud snorting. These may last for as long as 100 seconds.
  • Restlessness during sleep.
  • Brief awakenings for no apparent reason or with sensation of throat being blocked.
  • Need to pass urine during the night. In men, this may be confused with prostatic symptoms but disappears with control of sleep apnoeas.
  • Excessive sweating.
  • Morning headache is occasionally experienced.

During the day:

  • The commonest and most important daytime consequence of OSAS is daytime sleepiness. The degree can vary from a mild tendency to sleep in front of the TV in evening to severe, overwhelming and disabling daytime sleepiness which affects work, social and family life.
  • Difficulty maintaining alertness and concentration while driving. This is a serious consequence of obstructive sleep apnoea and sleep apnoea patients have around five times the risk of general population of road traffic accidents. Sleepiness at the wheel is shown by drifting over the centre white line or into road margins, driving too close to the car in front, dozing at traffic lights and of course actual accidents, including head on collisions, may occur. If even minor incidents are occurring and patient drives for a living, a sleep recording and treatment are urgently required. Earlier signs of sleepiness include a need to open a window or to stop on long journeys. These symptoms may also occur in normal individuals if they are sleep deprived.
  • Lack of concentration and motivation.
  • Reduction in short-term memory.
  • Irritability and depression.
  • Sexual difficulties.

Management

The management of OSAS depends on severity of condition diagnosed on overnight sleep study. There are several hospitals offering this service in Ireland.

The treatment of mild cases is similar to that of simple snorers. In the case of moderate or severe sleep apnoea, the treatment will include life style changes and also the use of nasal CPAP

What is nasal CPAP?

Nasal CPAP (CPAP stands for Continuous Positive Airway Pressure) is a small, quiet, electrical pump which delivers air to the nose at pressure via a long hose and soft plastic mask. The pressure opens up the airway from the nose down, prevents it from closing even to a minor degree and thus eliminates snoring, apnoeas and returns sleep quality to normal. Pressures vary between individuals. The correct pressure is decided by medical team during a short hospital stay, during which the patient becomes accustomed to the device and learns how to use it.

Side effects from CPAP include air leaking from the mask, skin marking on the nose, sneezing /running nose during the day and finally swallowing a lot of air. These problems are usually managed by improving mask fit, humidifying air and altering pressure as necessary.

After an initial settling period the majority of patients use CPAP on a nightly basis with clear benefit to their general well being and that of their partner.

Long-term consequences of OSAS

The main effect of OSAS is on quality of life. Sleepiness can obviously be dangerous at the wheel.

Studies have also shown that OSAS is associated with high blood pressure. There are also associations noted between OSAS and heart disease and stroke. However, these associations may be indirect through other factors such as obesity, high blood pressure smoking and diabetes. Long-term studies are being carried out at present looking at this issue in detail.

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