Greetings, Health Care Professional...
We’re glad you found your way to the American Sleep Apnea Association web site and to this page. Sleep apnea is finally becoming more widely recognized as the life-damaging and life-shortening disease that it is, but there’s still much to be done in getting out the word about its hazards, how to recognize it, and how to treat it.
A very short course on sleep apnea
On this page and its links we offer you a very short course on sleep apnea and suggest sources for more information.
Sleep disorders, including sleep apnea, have become a significant health issue in the United States. It is estimated that 22 million Americans suffer from sleep apnea, with 80 percent of the cases of moderate and severe obstructive sleep apnea undiagnosed. OSA, which represents the great preponderance of the cases,when left untreated can lead to high blood pressure, chronic heart failure, atrial fibrillation, stroke, and other cardiovascular problems; it is associated with type 2 diabetes and depression; and is a factor in many traffic accidents and accidents with heavy machinery, owing to the persistent drowsiness suffered by many OSA patients before the disease is recognized and treated. The public and the health community are generally aware of the increasing obesity of Americans, a phenomenon related to the increase in sleep apnea. Few outside the sleep medicine community, however, are aware that too little good sleep appears to be as much a factor in obesity as too much food and too little exercise.
OSA can strike people of any age, including infants and children, but it is most frequently seen in men over 40, especially those who are overweight or obese.
Meet the three sleep apneas
Obstructive sleep apnea is caused by a blockage of the airway, usually when the tongue collapses against the soft palate and the soft palate collapses against the back of the throat during sleep, and the airway is closed. In central sleep apnea, the airway is not blocked but the brain fails to signal the muscles to breathe. Complex sleep apnea, as the name implies, is a combination of the two conditions. With each apnea event, the brain rouses the sleeper, usually only partially, to signal breathing to resume. In those with severe sleep apnea this can happen hundreds of times a night, often most intensely late in the sleep cycle during rapid-eye-movement (REM) sleep. As a result, the patient’s sleep is extremely fragmented and of poor quality. Meanwhile the disorder continuously reduces the oxygenation of the blood, further stressing the sleeper’s physical system.
The sleep study: In the lab or at home?
The only definitive diagnostic tool for determining the presence of sleep apnea is a sleep study. A study conducted during a patient’s through-the-night visit to a sleep laboratory will include monitoring among other things blood oxygen levels, respiration rate, brain-wave activity, leg movements, and most significant, the apnea-hypopnea index, the number of apnea and hypopnea (partial inhalation) incidents the sleeper experiences per hour. Limited channel testing, or LCT, can now be considered for certain patients to use at home. The utility of the LCT must be evaluated by the clinician for the right patient.
Before deciding to recommend a sleep study, you may wish to gather a more comprehensive history by asking the patient to complete our online HistoryTaker questionnaire.
The most widely used and most successful treatment for moderate and severe OSA in adults is one or another of the various positive airway pressure machines. More detail on the types of PAP machines is available here. Other treatments include weight loss, avoiding sleeping on one’s back, nighttime dental devices that push the lower jaw or the tongue forward, and a variety of surgical procedures. The treatment options are described in greater detail and evaluated here.
Pediatric sleep apnea: A special case
Sleep apnea in both its obstructive and central forms is more common among children than is generally realized. It appears to affect between 1 and 4 percent of all children (including infants), and while particularly prevalent among those between 2 and 8 years old, occurs across the pediatric age spectrum. Untreated pediatric sleep apnea can lead to mood problems, cognitive dysfunction like inattentiveness, and behavior changes like hyperactivity and poor impulse control. These children are also believed to have an increased risk of later cardiovascular disease, especially if they are also obese. Since the majority of children with OSA snore, a general physical examination of children should always include the question, Does the child snore? In contrast to the management of adult OSA, pediatric OSA is usually and most effectively treated by surgical removal of the tonsils and adenoids. There’s more information about pediatric sleep apnea here
Anesthesia and pain medicine
The presence of sleep apnea presents special challenges to the administration of anesthesia and pain medications that may affect respiration or relax muscles. Since most people who have sleep apnea don’t know it, the anesthesiologist or pain clinician is well advised to screen the patient for OSA before proceeding. One useful screening tool is the STOP-BANG questionnaire, which is rapidly becoming the standard for a quick assessment. Should it be determined there is a likelihood that OSA is present, a sleep study should be considered. If not possible, the patient should be considered to have sleep apnea and treated with appropriate precautionary steps. These procedures are laid out in greater detail here.
As an organization committed to patient advocacy, we at the ASAA recommend to all clinicians that they continually seek to improve their communications with their patients. The AskMe3 organization offers helpful tips on how to pursue this. We also point you to a free two-hour interactive online course that will strengthen your ability to recognize and co-manage obstructive sleep apnea.