Obstructive sleep apnea is caused by the collapse of the upper airway during sleep. The muscles supporting soft tissues in the throat relax, narrowing or closing the airway and temporarily interrupting breathing.
Obstructive sleep apnea (OSA) is a common sleep-related breathing disorder.
Normally, air should flow smoothly from the mouth and nose into the lungs at all times, including during sleep.
Periods when breathing stops completely are called apnea or apneic episodes. In OSA, the normal flow of air is repeatedly stopped throughout the night. Events when breathing is partially obstructed are called hyponeas. In order for breathing to resume, the brain arouses.
Snoring is often associated with OSA, especially if the snoring is interrupted by periods of silence. Snoring is caused by airflow squeezing through the narrowed airway space.
It’s important to remember that snoring doesn’t necessarily indicate something potentially serious, and not everyone who snores has OSA.
People with OSA often report experiencing daytime sleepiness. In addition to having to arouse in order to restablish breathing, OSA causes episodes of decreased oxygen supply to the brain and other parts of the body, so sleep quality is poor. This causes daytime drowsiness and a lack of clarity in the morning.
Those who share beds with people with OSA may report the following about their partner:
- loud snoring
- gasping
- choking
- snorting
- interruptions in breathing while sleeping
These symptoms are also often detected when checking on another complaint or during health maintenance screening.
People with OSA may also experience the following
- morning headaches
- feeling disgruntled or grumpy
- forgetfulness
- drowsiness
- repetitive awakenings throughout the night
Other symptoms include:
- hyperactivity in children
- worsening depression
- poor job and school performance
- loss of interest in sex
Daytime drowsiness puts people with sleep apnea at risk for motor vehicle crashes and industrial accidents. Treatment can help to completely relieve daytime drowsiness.
The following are some conditions associated with OSA:
- obesity hypoventilation syndrome, a breathing disorder in people with obesity, who also underbreathe during the daytime
- endocrine conditions, such as hypothyroidism, acromegaly, and polycystic ovary syndrome, which may affect your breathing when you’re asleep
- chronic lung diseases, such as asthma, chronic obstructive pulmonary disease (COPD), and pulmonary fibrosis
- neuromuscular conditions, such as a stroke, which can interfere with brain signals to your chest muscles and airway
- heart or kidney failure, which may cause fluid to build up in your neck and obstruct the upper airway
- pregnancy
The risk for OSA increases if you have physical features that narrow your upper airway. Risk factors of OSA include:
- obesity
- large tonsils
- a large tongue, which can block the airway
- retrognathia, which is when your lower jaw is shorter than your upper jaw
- a narrow palate or airway that collapses more easily
- smoking
- drinking large quantities of alcohol
- family history of OSA
Untreated OSA can cause serious health problems, such as:
Proper diagnosis and treatment are essential for preventing complications.
People who suspect they may have OSA might go directly to their doctor, or some may use a wearable to
An accurate diagnosis of sleep apnea begins with a complete history and physical examination. A history of daytime sleepiness and snoring are important clues.
Your doctor will examine your head and neck to identify any physical factors that are associated with sleep apnea.
They may ask you questions about daytime drowsiness, sleep habits, and quality of sleep.
In some cases, the evaluation for OSA may be performed at home without a technician in attendance. However, home sleep apnea testing is only useful for the diagnosis of OSA in certain people. It’s not a substitute for other diagnostic tests if other sleep disorders and certain medical disorders like chronic obstructive pulmonary disease (COPD) or heart failure are suspected.
The following tests may be performed to diagnose OSA.
Polysomnography (PSG)
During a polysomnography, you sleep overnight in a hospital or sleep center while connected to a variety of monitoring devices that record physiologic data.
Patterns of abnormalities during sleep may indicate sleep-disordered breathing as well as many other sleep disorders.
While you sleep, the devices will measure the activity of different organ systems associated with sleep. It may include:
- electroencephalogram (EEG), which measures brain waves
- electrooculogram (EOM), which measures eye movement
- electromyography (EMG), which measures muscle activity
- electrocardiogram (ECG), which measures heart rate and rhythm
- pulse oximetry test, which measures changes in your oxygen levels in your blood
EEG and EOM
During an EEG, electrodes are attached to your scalp that will monitor brain waves before, during, and after sleep. The EOM records eye movement.
A small electrode is placed 1 centimeter above the outer upper corner of your right eye, and another is placed 1 centimeter below the outer lower corner of your left eye. When your eyes move away from the center, this movement is recorded.
Brain waves and eye movements tell doctors about the timing of the different phases of sleep. The two broad phases of sleep are non-REM (non-rapid eye movement) and REM (rapid eye movement).
Decreased muscle tone and paralysis occur during REM sleep.
EMG
To record the EMG, electrodes are placed on your chin: one above your jawline and the other below it. Other electrodes are placed on each shin.
The EMG electrodes pick up the electrical activity generated during muscle movements. Muscle relaxation should occur during sleep. The EMG picks up when your muscles relax and move while you’re sleeping.
ECG
A single lead ECG records the electrical signals from your heart during the sleep study to monitor your heart rate and rhythm.
Pulse oximetry
In this test, a device called a pulse oximeter is clipped onto a thin area of your body that has good blood flow, such as a fingertip or earlobe.
The pulse oximeter uses a tiny emitter with red and infrared LEDs to measure the oxygen saturation level of your blood. This level may decrease during episodes of apnea.
The goal for the treatment of OSA is to make sure airflow isn’t obstructed during sleep. Treatment methods include the following:
Weight loss
Weight management and exercise are usually recommended for people with OSA who also have obesity. The
Although it may not lead to complete remission, weight loss has been linked with a decrease the severity of OSA.
Losing weight, if your doctor has recommended it, could also reduce blood pressure, improve your quality of life, and decrease daytime sleepiness.
Continuous positive airway pressure (CPAP)
Continuous positive airway pressure (CPAP) therapy is the first line of treatment for OSA. It’s administered through a face mask worn at night.
The face mask gently delivers positive airflow to keep the airways open at night. The positive airflow props the airways open.
CPAP is a highly effective treatment for OSA.
For people with mild or moderate OSA who don’t benefit from CPAP therapy, an oral appliance is a reasonable alternative to positive airway pressure.
Bilevel positive airway pressure (BPAP)
Bilevel positive airway pressure (BPAP) machines are sometimes used for the treatment of OSA if CPAP therapy is not effective.
BPAP machines, sometimes called BiPAP machines, have settings that deliver two pressures in response to your breathing: inhaled pressure and exhaled pressure. This means the pressure changes during inhaling versus exhaling.
Sleeping on your side
Since sleeping on your back (supine position) can make OSA worse for some people, positional therapy is used to help you learn to sleep on your side.
Surgery
There is no consensus regarding the role of surgery in adults with OSA. In general, you may consider surgery when CPAP or BPAP machines or an oral appliance aren’t effective.
Surgical treatment may be the most effective for people who have OSA due to a severe, correctable, obstruction of the upper airway.
Being a surgical candidate depends on factors like:
- your desire to have surgery
- whether you have a surgically correctable problem
- your overall health to undergo surgery
Surgical evaluation begins with a physical exam to check on the anatomy of your upper airway.
Your doctor will insert a flexible laryngoscopy, a thin instrument inserted through your nose that lights and magnifies the upper airway, while you are awake or, if necessary, asleep.
You should always speak with a doctor if you’re experiencing daytime drowsiness or having consistent problems sleeping.
OSA has many treatment options to help you manage symptoms. A doctor will create a treatment plan that combines lifestyle changes and other therapies.