''SLEEP APNOEA''. Review on Dealing with Sleep Apnea

Obstructive Sleep Apnoea(OSA) is characterized by frequent episodes of upper airway obstruction that occur during sleep. Sleep fragmentation and symptoms of snoring and excessive daytime sleepiness are observed.

RISK FACTORS

Disturbances in the free passage of air from nose to upper part of wind pipe called esophagus. These are increased by factors that reduce upper airway size or leads to upper airway obstruction.

1.Obesity:- Central obesity results in upper airway fat deposition and abdominal mass loading. Unless you lose extra weight this problem of Obstructive Sleep Apnoea cannot be corrected. In fact it is a vicious cycle, more you snore more you put on weight and more you put on weight more you snore. So you have to consult a doctor for losing weight.

*2.Male gender:, /b> - The androgenic pattern of the body fat deposition centrally is including the neck and face area. Tendency of OSA is strongest in middle-aged males.

3.Soft tissue factorsinclude enlarged small tongue(uvula), hardening of soft bones surrounding the tongue, nose and long soft palate and tonsillar enlargement.

4.Exposure to tobacco, alcohol and sedatives leads to upper airway muscle weakness and OSA. One must  quit smoking; alcohol; sedatives if one has to get rid off SNORING!

SYMPTOMS OF OSA

1. Most of time a person himself does not complain or he in not aware of it. His observes breathing disturbances during sleep by his bed partner, which include snoring, choking and apnoeas.

   
   




2. Frequent awakening and restless sleep are also one of the common symptoms.

   
   




3. Excessive daytime sleepiness is a prominent symptom in many patients wherein there is an irresistible desire to take short naps during the day particularly during routine activities such as watching television; reading newspapers; even during  SMOOTH DRIVING!

   
   




4. Person feels extreme tiredness.

   
   




5. Depression and irritability are observed often; and thereby lack of concentrations in the work.

   
   




6. Evidence  of  social interaction and sexual function.

   
   




7. Early morning headaches.

   
   




8. BED-WETTING—seen  in  even  elders!

   
   

PHYSICAL FINDINGS IN OSA

1. Obesity.(MOST OF TIME)

1. Increased neck circumference.

   
   




2. Enlarged  tonsils most of the time.

   
   




3. Nasal obstruction because of frequent cold.

   
   




4. High blood pressure.

   
   




5. Frequent swelling of the lower limbs.

   
   

WHY SHOULD WE TREAT   O S A?

1.HYPERTENSION: - This suggests that OSA is an independent risk factor for hypertension. Moreover, treatment of OSA is known to bring down the blood pressure to some extent.

2.Ischaemic Heart Disease(IHD): - Marked blood flow stresses during apnoeas are known to cause  HEART-DISEASES.(IHD).other MAYOCARDIAL damages.

3.Cerebrovascular disease: - There is an increased risk of paralysis in patients with OSA.

4.Mood, nervous and behavioral effect: - Depression, anxiety and irritability are seen in OSA.

5.Mortality: - Data suggests that an increase in mortality is likely in patients with severe OSA, which includes morbidities caused by vascular disease, vehicular and work related accidents.

TIPS ON RECOGNITION OF OSA BY THE FAMILY PHYSICIAN

Very few patients go to the doctor with snoring  as their primary complaints. In my clinic most of Male OBESE patients are having “SNORING” problem; they themselves do not tell; I have to ask leading questions to them!

*1.The family physician must ask the sleep history from the patient and the spouse, which should include symptoms of OSA described earlier in the text.

2.Obesity with hypertension should alert the family physician that there may be underlying OSA.

3.Simple examination of the throat with tongue depressor and torch highlights a large tongue and narrow space due to lax tissue and is an important examination finding.** Based on this clinical finding ask the patient if he snores or has EDS and often he would say ‘yes’.

Whenever OSA is suspected, the family physician should ask for an overnight sleep study to establish his diagnosis as treatment for his condition is effective and dramatically improves quality of life.

Whatever you say I have found LOSING WEIGHT is first to be treated; most of patients got rid of  snoring after losing 5 to 10 kilos of their weight!