Obstructive Sleep Apnea (OSA)

Obstructive Sleep Apnea (OSA): Overview

Alternative Names: Sleep apnoea

Obstructive Sleep Apnea Syndrome (OSA) is the most prevalent of the hypersomnolence disorders and affects some 4% of adult males and 2% of adult females.  It is characterized by heavy snoring and the recurrent collapse of the throat airway during sleep which generally requires arousal to re-establish an open airway and resume breathing.  Patients suffer from both sleep fragmentation (frequent arousal) and the recurrent lack of oxygen with possible cardiovascular complications.  It is therefore important to recognize this condition and treat it.

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Incidence; Causes and Development; Contributing Risk Factors

It is thought that up to 10% of adults are affected by OSA.

OSA occurs when part of the airway is closed off (usually at the back of the throat) while a person is trying to inhale during sleep, and breathing stops for more than 10 seconds before resuming again.  These breathless episodes can occur as many as several hundred times per night.

Obesity, especially obesity in the neck, can increase the risk of developing OSA, because the fat tissue tends to narrow the airway.  One of the best predictors of whether there are upper airway problems during sleep is neck circumference.  More than 16" – could be a snorer, more than 17" – could have sleep apnea.  One can still have sleep apnea with smaller necks but it is less common.

Age and ethnicity are also risk factors.

Signs and Symptoms

The common symptoms are:

  • Loud snoring
  • Frequent pauses in breathing while asleep
  • Waking up tired and/or suffer from sleepiness during the day
  • Waking up with headaches, or dry mouth
  • Waking up during the night with a choking sensation
  • Waking up gasping for air
  • Perspiring excessively during the night
  • Depression
  • Heartburn
  • Reduced libido
  • Insomnia
  • Restless sleep, tossing and turning

Treatment and Prevention

Supportive treatment of obstructive sleep apnea includes maximizing nasal breathing, and more intensive approaches such as dental appliances and upper airway surgery.  There are several different styles of devices available over-the-counter to enhance nasal breathing.  Some remain on the outside of the nose, sticking to the skin and supplying a lifting action.  Others insert into the nostrils, forcing them to remain open.

Treatment of OSA has been shown to improve both quality of life and may reduce medical complications.  Strychnine has been tried to cure sleep apnea – it works to a certain extent, but there are worries that spouses might be tempted to give an overdose when the snoring is particularly bad!

Prognosis

The bad news is that sleep apnea is a serious, potentially life-threatening condition that can cause many health problems if left untreated (particularly increasing risk of heart disease).  But the good news is that it can be very easily managed.  If suspected, it is wise to go to a doctor and order a "sleep study."

Signs, symptoms & indicators of Obstructive Sleep Apnea (OSA):

Symptoms - Metabolic

Waking up with a headache

Waking up with a headache or dry mouth is a symptom of OSA.

Symptoms - Reproductive - General

Symptoms - Sleep

Occasional/regular/frequent drowsiness

Some patients suffering from OSA fall asleep in a nonstimulating environment, such as while reading something uninteresting or in a quiet room.  Others may fall asleep in a stimulating environment, such as during business meetings, while eating, and even while having sex.

So-called "drowsy driver syndrome", which some believe is responsible for many automobile accidents, may result from OSA.  Drivers may fall asleep at the wheel or suffer from a lack of alertness because of sleep deprivation.  Decreased alertness places the person at risk in a variety of potentially hazardous situations.

(Somewhat) disturbed sleep

Patients rarely complain about frequent awakenings due to obstruction, but it does occur.

Conditions that suggest Obstructive Sleep Apnea (OSA):

Circulation

Coronary Disease / Heart Attack

Obstructive sleep apnea increases a person's risk of having a heart attack or dying by 30% over a period of four to five years, according to a Yale University study presented at the American Thoracic Society 2007 International Conference in May of 2007.  Sleep apnea is associated with many physiological changes that increase the risk of both heart attack and stroke.

Hypertension (High Blood Pressure)

Hypertension is prevalent in patients with OSA, and it has been shown that treating OSA can modestly lower blood pressure.

OSA and other forms of Sleep-Disordered Breathing can cause temporary elevations in blood pressure as well as lowered blood-oxygen levels; it may also cause elevated blood pressure during daytime and, eventually, sustained high blood pressure.

A study from the University of Wisconsin School of Medicine suggests that sleep apnea is a risk factor for chronic hypertension and heart disease.  [New England Journal of Medicine, May 2000]

Stroke

Obstructive sleep apnea (OSA) significantly increases the risk of stroke or death from any cause, and the increase is independent of other risk factors, including hypertension.  [N Engl J Med 2005; 353: pp.2034-2041]

Another study published April of 2010 in the American Journal of Respiratory and Critical Care Medicine followed 5,422 people aged 40+ who had no history of stroke for 9 years.  It was found that even mild OSA led to elevated risk of stroke, and this risk increased with more severe OSA.  Men with moderate to severe OSA had 3 times the stroke risk than men with mild or no OSA.  The risk in women was also increased, but only in cases of severe OSA.

Arrhythmias/Dysrhythmias

Sleep apnea can also result in cardiac arrhythmias.  Most often, the heart slows while the person stops breathing, and increases when the apneic episode ends.  In 90% of those patients studied with nocturnal bradyarrythmia (slowed heart rate), there was no sign of heart rhythm abnormalities while awake.  Bradyarrhythmias occurred only during sleep and varied considerably in frequency and severity.  [American Heart Journal 2000; 139: pp.142-8]

Digestion

General

Excessive Fatigue

In individuals with sleep apnea, the brain detects that they are not getting rid of enough CO₂, so it wakes up briefly in an alarmed state.  This happens repeatedly during the night, without the subject noticing, and results in an inability to achieve or maintain the deep stages of sleep.  This can lead to unexplained daytime sleepiness and nonrestorative sleep.  Patients often complain of waking up feeling like they had not slept at all, and often feel worse after taking a nap than before napping.

Mental

Metabolic

Musculo-Skeletal

Respiratory

Problems Associated With Snoring

Sleep apnea manifests itself in most people as loud snoring interrupted by periods of obstructed breathing or breath holding.  If you snore, it may be a symptom of a more serious disorder called obstructed sleep apnea (OSA).  People with OSA almost always snore heavily, because the same narrowing of the airway that causes snoring can also cause OSA.  Snoring may actually attribute to OSA as well, because the vibration of the throat tissues which occurs in snoring can cause the tissue to swell.

Skin-Hair-Nails

Symptoms - Sleep

Uro-Genital

Risk factors for Obstructive Sleep Apnea (OSA):

Hormones

Hypothyroidism

Hypothyroidism can present itself as obstructive sleep apnea and snoring.

Metabolic

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Obstructive Sleep Apnea (OSA) suggests the following may be present:

Metabolic

Obstructive Sleep Apnea (OSA) can lead to:

Circulation

Arrhythmias/Dysrhythmias

Sleep apnea can also result in cardiac arrhythmias.  Most often, the heart slows while the person stops breathing, and increases when the apneic episode ends.  In 90% of those patients studied with nocturnal bradyarrythmia (slowed heart rate), there was no sign of heart rhythm abnormalities while awake.  Bradyarrhythmias occurred only during sleep and varied considerably in frequency and severity.  [American Heart Journal 2000; 139: pp.142-8]

General

Excessive Fatigue

In individuals with sleep apnea, the brain detects that they are not getting rid of enough CO₂, so it wakes up briefly in an alarmed state.  This happens repeatedly during the night, without the subject noticing, and results in an inability to achieve or maintain the deep stages of sleep.  This can lead to unexplained daytime sleepiness and nonrestorative sleep.  Patients often complain of waking up feeling like they had not slept at all, and often feel worse after taking a nap than before napping.

Tumors, Malignant

Cancer, General

May, 2012: According to research to be published in the American Journal of Respiratory and Critical Care Medicine, those affected by severe sleep disordered breathing (SDB) are 4.8 times more likely to develop cancer than those who are not.  Those with moderate SDB are at double the risk, and those with only slight SDB have a 10% increased risk of developing cancer.

The researchers from the University of Wisconsin-Madison looked at cancer rates in more than 1,500 people, in a study of sleep problems that has spanned 22 years.

Recommendations for Obstructive Sleep Apnea (OSA):

Diet

Alcohol Avoidance

Alcohol is useful for relaxation but unfortunately it also relaxes the throat muscles and provokes snoring and obstructive apneas.  Alcohol or sedative use near bedtime may thus further depress breathing mechanisms.

Hormone

Not recommended
Testosterone

More serious complications arising from testosterone supplementation include exacerbation of sleep apnea.

Physical Medicine

Physical Supports and Devices

Although every patient is treated individually, continuous positive airway pressure (CPAP) is the most common treatment.  It is simple, safe, effective, and non-invasive.  CPAP treats Obstructive Sleep Apnea by providing a gentle flow of positive-pressure air through a mask to help keep the airway open during sleep.  It stops the snoring, restores restful sleep, improves the quality of life, and reduces risk of heart complications.

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