Sleep Apnoea: Causes, Features, Ttreatment

Apnoea is a breathing pause of at least 10 second.
Hypoapnoea is a 10 second event where there is continuous breathing but ventilation is reduced by at least 50 % from the previous baseline during sleep.

Sleep apnoea is the most common cause of excessive day time sleepiness. Sleep apnoea or apnea is a disorder characterized by a reduction or cessation (pause of breathing, airflow) during sleep. It is common among adults but rare among children. There are two types of sleep apnea, obstructive sleep apnoea and the central sleep apnoea. Most Common of the two is obstructive sleep apnoea also called Obstructive Sleep Apnoea/ Hypoapnoea syndrome (OSAHS).

When there is no airflow but there is effort to breathe, the apnea is called “Obstructive”. When there is no airflow but no respiratory effort the apnea is called “Central”. Mixed apneas start with no effort but effort develops during the course of the apnea.

Factors predisposing to sleep apnoea are:

• Increasing age.
• Male gender.
• Obesity.
• Sedative drugs.
• Smoking and alcohol consumption.

Features of Obstructive Sleep Apnoea

• Excessive daytime sleepiness
• Impaired concentration
• Snoring
• Unrefreshing sleep
• Choking episodes during sleep
• Witnessed apnoeas
• Restless sleep
• Irritability / personality change
• Nocturia
• Decreased libido

The dominant symptoms of OSAHS are excessive sleepiness, impaired concentration and snoring.

Treatment of sleep apnoea

Treatment of sleep apnoea include three aspects that include:

1. Behavioral changes
2. Medical treatment
3. Surgical treatment

Behavioral change:

• Lose weight if you are overweight. But remember that sleep apnoea occurs in thin people as well; the airway can close during sleep for a number of reasons, not just excess weight.

• Sleep on your side and not your back.

• Change sleep positions to promote regular breathing.

• Avoid alcohol and medicines such as sedatives before bed.

• Stop smoking. Smoking can increase the swelling in the upper airway which may worsen both snoring and apnoea.

• If you have moderate to severe sleep apnea, you may be able to use a machine that helps you breathe while you sleep. Treatment is called continuous positive airway pressure. (CPAP).

Medical treatment:

CPAP

Continuous positive airway pressure (CPAP) is nearly always the first medical treatment for sleep apnea.

CPAP works by gently blowing pressurized room air through the airway at a pressure high enough to keep the throat open. This pressurized air acts as a "splint." The pressure is set according to the patient's needs at a level that eliminates the apnoeas and hypopnoeas that cause awakenings and sleep fragmentation. Pressure that is too low will not be as effective in eliminating the apneas and hypopnoeas.

Oral appliances:

Oral appliances, also called dental appliances, are intended to treat apnea by keeping the airway open in one of three ways:

• By pushing the lower jaw forward (a mandibular advancement device or MAD),

• By preventing the tongue from falling back over the airway (a tongue-retaining device)

• By combining both mechanisms.

Oral appliances are more effective in mild sleep apnea and for non-obese people but can, for some, be effective for moderate and severe sleep apnea.

The most common type of oral appliance, a MAD is often adjustable so that the dentist can move the jaw further or reduce the advancement as necessary. The goal is to find the most comfortable and effective position for the patient. On occasion oral appliances may worsen the apnea. Not all dentists have the necessary knowledge of sleep apnea, so if you wish to pursue this therapy, ask your sleep doctor to refer you to a dentist who is familiar with apnoea and who works with oral appliances.

Surgical Treatment:

Uvulopalatopharyngoplasty, by this surgery excess tissue in the throat is removed to make the airway wider. It is the most common surgery to treat sleep apnoea in adults.

Tonsillectomy and/or adenoidectomy, which removes the tonsils and/or the adenoids. It may be used if person has enlarged tonsils and/ or adenoids that are blocking the airway during sleep. This is often the first treatment option for children because enlarged tonsils and adenoids are usually the cause of their sleep apnoea.

Other surgical procedures, which are used to repair bone and tissue problems in the mouth and throat.

Tracheostomy, which creates a hole in the windpipe (trachea). A tube is then put in the hole to bring air in. this surgery is rarely used because of complications. But when other techniques have failed to cure sleep apnoea, almost all people who are treated with tracheostomy will be cured of their sleep apnoea.

Bariatric surgery is useful for extremely overweight patient and in whom the excess weight is making sleep apnea worse. Bariatric surgery can promote weight loss that improves sleep apnoea. This surgery is done only for people who cannot lose weight with diet and exercise.

Laser-assisted uvulopalatoplasty may be used to treat snoring. It is sometimes used to treat mild to moderate sleep apnea, though it does not benefit all people.

Newer Pillar Palatal Implant can reduce snoring and improve sleep for people suffering from snoring and sleep apnea. The implants work by reducing the movement or vibration of the soft palate with implants designed to stiffen it. Using a special needle, three pieces of polyester mesh are inserted into the soft palate near where it meets the hard palate. It is a out patient procedure and takes only about 10 minutes and is done under local anesthesia.

Somnoplasty is an unique surgical method for reducing habitual snoring by removing tissues of the uvula and soft palate. Unlike other approaches (such as the laser), somnoplasty uses very low levels of radiofrequency heat energy to create finely controlled localized burn-areas beneath the lining (mucosa) of the soft tissues of the throat. These burn- areas are eventually resorbed by the body, shrinking the tissue volume, opening the passage way for air, and thereby reducing symptoms of snoring. Somnoplasty is performed under local anesthesia in an outpatient setting and takes approximately 30 minutes.