Sleep apnea is a condition characterized by repeated, involuntary pauses in breathing during sleep. These intervals are called apneic episodes, and they contribute to lowering blood oxygen levels and disrupting sleep. The result of this situation is to significantly affect the quality of sleep and the overall health of the affected person. A telltale sign of sleep disordered breathing episodes is snoring, which occurs when air is forced through the narrow space of the nasopharynx.
Types & etiology of sleep apnea
Sleep apnea is broadly categorized into three types, obstructive, central, and mixed sleep apnea. Obstructive sleep apnea is caused by a physical obstruction of the upper airway. Factors that contribute to this obstruction include obesity, which contributes to the accumulation of fat deposits around the airway, and certain anatomical issues. These anatomical issues include hypertrophy of the tonsils, adenoids, or sinuses, micrognathia or retrognathism of the lower jaw, and a large tongue or soft palate (the soft part of the palate at the back of the throat). Other anatomical issues that contribute to sleep apnoea are scoliosis of the nasal septum or the presence of nasal polyps.
Obstructive sleep apnoea can also occur due to relaxation of the breathing muscles from drinking too much alcohol or taking tranquilizers. Finally, it should be noted that certain habits or medical conditions, including smoking, which can increase inflammation and fluid retention in the airway, and nasal congestion, which prevents nasal breathing, can also contribute to increasing the chances of developing sleep apnea.
Central sleep apnoea on the other hand occurs when the brain fails to send proper signals to the respiratory muscles that regulate breathing, leading to periods when breathing activity is absent. The central type of sleep apnea is often linked to underlying health conditions, such as heart failure, stroke or kidney failure. Finally, mixed sleep apnea occurs when there is a combination of obstructive and central sleep apnea.
Symptoms
People with sleep disordered breathing snore loudly and experience pauses in breathing that last for more than ten seconds while they sleep. The result of this condition is the interrupted supply of oxygen to the brain and other bodily organs, which negatively affects not only the quality of sleep but also the overall health of the affected person. In fact, patients with sleep apnea are more likely to experience cardiovascular problems and strokes in the long term.
The symptoms with which sleep apnea manifests are the following:
- daytime sleepiness
- confusion on waking in the morning;
- persistent and more severe headaches
- problems with anger management and aggressive behavior
- tend to forget easily
- lack of concentration
- overexertion in childhood patients
- Increase in depressive symptoms
- Decreased performance at work or school
- Decreased sexual interest
Diagnosis of sleep apnea
The process of diagnosing sleep apnoea involves taking a detailed medical history and physical examination, especially in patients with daytime sleepiness and snoring. The next step is often imaging tests such as nasal endoscopy and laryngoscopy to identify anatomical issues. In addition, the sleep study, electrocardiography, and encephalogram help to accurately diagnose the condition.
Management options for apnea during sleep
Treatment focuses on facilitating the passage of air into the upper airway during sleep. Initially, in cases of obesity, weight loss is recommended. Quitting smoking and applying nasal decongestant sprays also work beneficially. At the same time, there are different treatment approaches depending on the cause of apnea, such as CPAP devices to maintain breathing during the night, aids for the correct positioning of the body during sleep, and special splints for the lower jaw.
Some anatomical issues, however, may require surgical repair. More specifically, surgery on the nose or throat may be needed to treat anatomical factors that contribute to apnea. Surgical options include:
- pharyngoperitonoplasty to resect part of the enlarged soft palate or hypertrophic vulvar
- tonsillectomy to remove hypertrophic tonsils
- removal of adenoids
- septoplasty
- shrinking of the nasal cavities in cases of hypertrophy
- removal of nasal polyps.
Sleep apnea is a complex disorder with multiple causes, requiring a tailored approach to management. In the first phase, an attempt is made to treat conservatively, however, if anatomical abnormalities are present, the solution is often surgical, as with their restoration, sleep apnea is also restored. Early diagnosis and comprehensive management are critical to mitigating the adverse health effects associated with this condition. ENT Surgeon in Athens Dr. Olga Papadopoulou surgically restores, in any cases deemed necessary, any anatomical issues that contribute to the occurrence of apnea episodes.