Sleep Apnea
Obstructive Sleep Apnea-Hypopnea Syndrome (OSAHS) is characterized by snoring, apnea and daytime drowsiness, recurrent collapse, and upper airway obstruction.
Narrowing of the upper airway or limited ability to maintain open airways caused by various factors is the primary cause of OSAHS.
OSAHS individuals can develop hypoventilation, resulting in intermittent hypoxia, hypercapnia, and disruption of sleep patterns. In severe cases, it can cause multi-organ and multi-system damage or other diseases, such as hypertension, coronary artery disease, arrhythmia, cerebrovascular disease, cognitive dysfunction, and diabetes.
Definition
The most common type of apnea is obstructive sleep apnea. It is a condition in which individuals experience obstruction in breathing (apnea) during sleep. It occurs due to partial or complete throat closure (per airway). Complete closure can lead to apnea, while partial closure allows breathing but reduces the oxygen intake (hypopnea).
Classification
Individuals with obstructive sleep apnea may experience interruptions in sleep with frequent awakenings and loud snoring. Moreover, repeated pauses in breathing can lead to episodes of lower-than-normal oxygen levels (hypoxemia), resulting in a carbon dioxide buildup (hypercapnia) in the bloodstream. Interrupted and poor-quality sleep can lead to daytime drowsiness and fatigue. Besides, it may create impaired attention and memory, headaches, depression, and sexual dysfunction. Daytime drowsiness can lead to a higher risk of motor vehicle accidents in individuals with obstructive sleep apnea.
Epidemiology
OSAHS in adults is most frequent in obese middle-aged individuals. An epidemiological survey in 1993 in the US reported that the OSAHS prevalence was 4% in adult men and 2% in adult women. However, during the last two decades, OSAHS prevalence among American adults has increased by 1.5 to 2 times. Among them, approximately 80% of the sleep apnea individuals remain undiagnosed. According to a recent study, nearly one billion individuals globally are affected by OSAHS, with prevalence rates as high as 50% in some countries.
Causes
The causes of obstructive sleep apnea are often complicated. Moreover, the apnea and hypopnea symptoms can worsen after the apnea person falls asleep. This condition originates from a combination of genetic, health, and lifestyle factors, some of which require in-depth research. Obesity is a major risk factor for obstructive sleep apnea, as 60-70% of individuals with this condition are obese. Many studies reveal that excess fatty tissue in the head and neck constricts airways, causing apnea. Similarly, abdominal fat may prevent the chest and lungs from fully expanding and relaxing. Other risk factors for obstructive sleep apnea include alcohol consumption, frequent nasal congestion, airway blockages, and enlarged tonsils.
Symptoms
Sleep apnea is a common disorder causing the breathing to pause or become very shallow. These breathing pauses can last from a few seconds to minutes and might occur over 30 times an hour. The most common type of apnea is obstructive sleep apnea. It causes the airway to collapse or become congested during sleep. Normal breathing begins again with a snort or choking sound. Individuals with sleep apnea often snore loudly. However, not every snoring individual has sleep apnea.
Diagnosis
Physicians diagnose apnea by investigating the following factors:
Choking or gasping during sleep
Recurrent awakenings from sleep during the night
Unrefreshing sleep
Daytime fatigue and drowsiness
TImpaired concentration
Overnight monitoring by various studies demonstrates five or more obstructed breathing events per hour during sleep.
Treatment
Treatment helps keep snoring individual's airway open during sleep so their breathing does not stop. Lifestyle modifications may help relieve symptoms in people with mild sleep apnea. These changes include:
Avoiding alcohol or medicines that make apnea individual drowsy before bedtime or make symptoms worse.
Avoiding sleeping on an apnea individual's back.
Losing excess weight is vital to relieve apnea symptoms.
Continuous Positive Airway Pressure (CPAP) devices best treat obstructive sleep apnea in most individuals. It takes time to get used to sleeping with CPAP therapy. However, good follow-up and support from a sleep center can help apnea individual overcome any issues in using CPAP.
Dental devices may keep the mouth open during sleep by letting the jaws forward and the airways open. Likewise, surgery is an option for some individuals. However, it is often a last resort if other treatments do not work and an individual has severe symptoms. Surgery may not completely cure obstructive sleep apnea and may have long-term side effects.
Intervention
The apnea individuals can intervene by taking the following precautionary measures:
Behavior Management
Performing active control of inflammatory diseases of the upper airways
Doing moderate exercise
Maintaining a balanced diet to avoid obesity
Conducting weight loss therapy for obese apnea individuals
Avoiding smoking and alcohol
Avoiding taking sedative-hypnotic drugs before bedtime.
Sleep apnea individuals with postural OSAHS should sleep on one side
It is significant to treat underlying diseases like hypertension, diabetes, etc.
Monitoring Diary
Sleep apnea individuals treated with ventilators can use the ventilator parameter records to monitor their OSAHS disease.
Prevention
There is no direct method for preventing apnea. However, daily life management methods like weight control and active treatment of inflammatory diseases of the upper airway can help prevent its severity.
Prognosis
Several factors influence the occurrence and development of OSAHS. In daily life, quitting smoking, avoiding secondhand smoke, maintaining a balanced diet, and doing moderate exercises are imperative. Once the symptoms of OSAHS appear, seeking medical attention and receiving standard treatment promptly is essential. Sleep apnea may cause the following issues if an individual suffering from apnea does not treat it properly:
Anxiety and depression
Loss of interest in sex
Poor performance at work or studies
Moreover, daytime drowsiness due to sleep apnea can increase the risk of:
Motor vehicle accidents due to sudden drowsiness
Industrial accidents from falling asleep on the job
Complications
In most cases, the treatment completely relieves symptoms and complications from sleep apnea. In most cases, the treatment completely relieves symptoms and any complications from sleep apnea. However, untreated obstructive sleep apnea can lead to or worsen heart diseases, such as heart arrhythmias, heart failure, heart attack, high blood pressure, and stroke.
Many studies conclude that OSAHS is a significant risk factor for sudden death and traffic accidents. Recurrent apnea and hypopneas at night can cause chronic intermittent hypoxia and systemic inflammation, leading to cardiovascular and cerebrovascular diseases and metabolic disorders.
Similarly, OSAHS individuals can suffer from hypoventilation, resulting in intermittent hypoxia, hypercapnia, and disruption of sleep patterns. In severe cases, multi-organ and multi-system damage may occur.
Finally, OSAHS can create hypertension, coronary artery disease, arrhythmia, and cerebrovascular disease.
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