Dr Rajesh Swarnakar, one of the renowned pulmonologists in Nagpur from GetWell Hospital, Nagpur organized can awareness camp to discuss Obstructive Sleep Apnea (OSA) along with the benefits of early intervention of Continuous Positive Airway Pressure (CPAP) therapy.
OSA is one of the most undiagnosed and untreated condition, which people suffers on daily bases.
Lancet research 2019, shows that OSA is a serious, potentially life-threatening condition. It is far more common than previously thought.
Sleep apnea happens in all age groups and both genders, although it is more common in men.
Sleep apnea is a breathing disorder characterized by brief interruptions of breathing during sleep.
Sleep apnea is characterized by a number of involuntary breathing pauses or “apneic events” during a single night’s sleep. There may be as many as 20 to 30 or more events per hour. These events are usually accompanied by snoring between apnea episodes. But, not everyone who snores has sleep apnea. Sleep apnea may also be characterized by choking sensations. The frequent interruptions of deep, restorative sleep often lead to early morning headaches and excessive daytime sleepiness.
During the apneic event, you can’t breathe in oxygen or exhale carbon dioxide. This results in low levels of oxygen and increased levels of carbon dioxide in the blood. This alerts the brain to resume breathing and cause an arousal. With each arousal, a signal is sent from the brain to the upper airway muscles to open the airway. Breathing is resumed, often with a loud snort or gasp. Frequent arousals, although necessary for breathing to restart, prevent restorative, deep sleep.
Early recognition and treatment of sleep apnea is important, as it may be associated with:
- Irregular heartbeat
- High blood pressure
- Heart attack
- Stroke
- Daytime sleepiness
- Increased risk of motor vehicle accidents
Who is at risk for sleep apnea?
People most likely to have or develop sleep apnea include those who:
- Snore loudly
- Are overweight
- Have high blood pressure
- Have some physical abnormality in the nose, throat, or other parts of the upper airway
- narrowed airway – enlarged tonsils and adenoids in children
- thick neck circumference
Use of alcohol and sleeping pills increases the frequency and duration of breathing pauses in people with sleep apnea.
What are the symptoms of sleep apnea?
- Loud snoring, which is usually more prominent in obstructive sleep apnea
- Episodes of breathing cessation during sleep witnessed by another person
- Abrupt awakenings accompanied by shortness of breath, which more likely indicates central sleep apnea
- Awakening with a dry mouth or sore throat
- Morning headache
- Difficulty staying asleep (insomnia)
- Excessive daytime sleepiness (hypersomnia)
- Attention problems
- Irritability
When to see a doctor
Consult sleep expert or pulmonologists if you experience, or if your partner notices any of the following:
- Snoring loud enough to disturb the sleep of others or yourself
- choking or Shortness of breath that awakens you from sleep
- Intermittent pauses in your breathing during sleep
- Excessive daytime drowsiness, which may cause you to fall asleep while you’re working, watching television or even driving
Diagnosis –
Diagnosis of OSA is not simple because there can be many different causes. Primary healthcare providers, pulmonologists, neurologists, or other healthcare providers with specialty training in sleep disorders may be involved in making a diagnosis and starting treatment. Several tests are available for evaluating sleep apnea, including:
- Polysomnography: This test records a variety of body functions during sleep, such as the electrical activity of the brain, eye movement, muscle activity, heart rate, respiratory effort, air flow, and blood oxygen levels.
- Home Sleep Test: Wearable kit, that enables an individual to self-diagnose and get the final reports from Sleep Expert/ Sleep Technician.
What is Sleep?
Sleep is one of the key pillars of good health. It:
- is a naturally-occurring state, periodic and recurring
- involves both the mind and the body
- involves the temporary suspension of consciousness, and relaxation/inactivity of muscles
- is important to restore the body’s powers
Why sleep is important?
Sleep allows body to rest, and rejuvenate.
- Breathing slows down, becomes more regular.
- Heart rate and Blood pressure lower down.
- Digestion slows down, metabolism is regulated.
- Growth hormone is released – helps muscles repair and recover.
- Brain clears out toxins, memories are consolidated and stored, and, ability to concentrate is restored.
- Cytokines, which are essential components of immunity, are produced and released during sleep, to create an effective immune response.
- Sleep deprivation can severely impact productivity.
How much time should we sleep?
- Children: 10-16 hours
- Teenagers: 9-10 hours
- Adults: 7-9 hours
Sleep Hygeine techniques (Gettings a Good Night’s sleep):
1. Limit Media exposure
2. Make time to unwind
3. Take care of your body and mind
4. Connect with others
5. Reserve your bed predominantly for sleep
6. Keep a regular sleep-wake routine
7. Manage fatigue
What is Obstructive Sleep Apnea?
Obstructive sleep apnea (OSA) is the most common type of Sleep breathing disorder. It occurs when there are repeated episodes of complete or partial blockage of the upper airway during sleep. This leads to disturbed sleep and has association with a host of co-morbidities.
Symptoms of OSA that should concern you:
1. Daytime symptoms – Learning difficulties (especially in Children), Depression, Anxiety, Irritability, High Blood pressure, Concentration and memory problems, Diabetes, Early morning headaches, Lethargy and Fatigue, Excessive daytime sleepiness.
2. Night-time symptoms – Snoring, Increased frequency of urination, Irregular breathing during sleep, Night sweats, Increased cough and salivation at night, sexual dysfunction, palpitations.
Prevalence of OSA: (2019 Lancet study; Benjafield et al)
- 936 million globally – suffer mild to severe OSA
- 425 million globally – suffer moderate to severe OSA
- 28 million cases in India alone
- Number of affected individuals: China > USA > Brazil > India
Impact of OSA:
OSA has been known to occur in other comorbid conditions, and may severely impact the patient outcome as well as quality of life.
Prevalence as high as 52% with type 2 DM, 76% with Heart failure, 77% with Obesity, 83% with Drug resistant Hypertension and 63% with stroke.
How is Obstructive Sleep Apnea diagnosed?
Broadly, diagnostic tests classified into Sleep lab test (Polysomnography – Gold standard) and Home Sleep Tests (Type 2, Type 3 and Type 4 devices).
How is Obstructive Sleep Apnea treated?
Management includes:
1. Behavior/Lifestyle modifications
2. Corrective surgeries (if indicated)
3. CPAP therapy – Mainstay of the treatment, where positive pressure keeps the airway open by acting as a pneumatic splint.
