Obstructive sleep apnea

 

Alternative Names

Sleep apnea - obstructive; Apnea - obstructive sleep apnea syndrome; Sleep-disordered breathing; OSA

Definition

With obstructive sleep apnea, your breathing pauses while you are asleep because your airway has become narrowed or partly blocked.

Causes

When you sleep, all of the muscles in your body become more relaxed. This includes the muscles that help keep your throat open so air can flow into your lungs.

Normally, your throat remains open enough during sleep to let air pass by. However, some people have a narrow throat. When the muscles in their upper throat relax during sleep, the tissues close in and block the airway. This stop in breathing is called apnea.

Loud snoring is a telltale symptom of sleep apnea. Snoring is caused by air squeezing through the narrowed or blocked airway. However, not everyone who snores has sleep apnea.

Other factors also may increase your risk:

  • A lower jaw that is short compared to your upper jaw
  • Certain shapes of the roof of your mouth (palate) or airway that cause it to collapse more easily
  • Large neck or collar size (17 inches or more in men and 16 inches or more in women)
  • Large tongue, which may fall back and block the airway
  • Obesity
  • Large tonsils and adenoids in children that can block the airway

Sleeping on your back can also cause your airway to become blocked or narrowed.

Central sleep apnea is another sleep disorder during which breathing can stop. It occurs when the brain temporarily stops sending signals to the muscles that control breathing.

Symptoms

If you have obstructive sleep apnea, you usually begin snoring heavily soon after falling asleep.

  • The snoring often becomes very loud.
  • Snoring is interrupted by a long silent period while your breathing stops.
  • The silence is followed by a loud snort and gasp, as you attempt to breathe.
  • This pattern repeats throughout the night.

Most people with obstructive sleep apnea don’t know their breathing starts and stops during the night. Usually, a sleep partner or other family members hear the loud snoring, gasping, and snorting. Snoring can be loud enough to hear through walls.

People with sleep apnea may:

  • Wake up unrefreshed in the morning
  • Feel sleepy or drowsy throughout the day
  • Act grumpy, impatient, or irritable
  • Be forgetful
  • Fall asleep while working, reading, or watching TV
  • Feel sleepy while driving, or even fall asleep while driving
  • Have hard-to-treat headaches

Other problems that may occur include:

  • Depression
  • Hyperactive behavior, especially in children
  • Difficult to treat high blood pressure
  • Leg swelling (if severe)

Exams and Tests

The health care provider will take your medical history and do a physical exam.

  • Your provider will check your mouth, neck, and throat.
  • You may be asked about daytime sleepiness, how well you sleep, and bedtime habits.

You may be give a sleep study to confirm obstructive sleep apnea.

Other tests that may be performed include:

Treatment

Treatment helps keep your airway open while you sleep so your breathing doesn’t stop.

Lifestyle changes may help relieve symptoms in people with mild sleep apnea:

  • Avoid alcohol or medicines that make you sleepy before bedtime. They can make symptoms worse.
  • Avoid sleeping on your back
  • Lose excess weight

Continuous positive airway pressure (CPAP) devices work best to treat obstructive sleep apnea in most people.

  • You wear a mask over your nose while you sleep.
  • The mask is connected by a hose to a small machine that sits at the side of your bed.
  • The machine pumps air under pressure through the hose and mask and into your airway while you sleep. This helps keep your airway open.

It can take some time to get used to sleeping with CPAP therapy. Good follow-up and support from a sleep center can help you overcome any problems using CPAP. 

Dental devices may help some people. You insert them into your mouth while you sleep to keep your jaw forward and the airway open.

Other therapies may be available, but there's little evidence that they work. It's best to talk with a doctor who specializes in sleep problems before trying them.

Surgery may be an option for some people. Often it's a last resort if other treatments didn't work and you have severe symptoms. Surgery may be used to:

  • Remove extra tissue at the back of the throat.
  • Correct problems with the structures in the face.
  • Create an opening in the windpipe to bypass the blocked airway if there are physical problems.
  • Remove the tonsils and adenoids. This often cures the condition in children. It does not seem to help most adults.

Surgery may not completely cure obstructive sleep apnea and may have long-term side effects.

Outlook (Prognosis)

If not treated, sleep apnea can cause:

  • Anxiety and depression
  • Loss of interest in sex
  • Poor performance at work or school

Daytime sleepiness because of sleep apnea can increase the risk of:

  • Motor vehicle accidents from driving while sleepy
  • Industrial accidents from falling asleep on the job

In most cases, treatment completely relieves symptoms and problems from sleep apnea.

Possible Complications

Untreated obstructive sleep apnea may lead to or worsen heart disease, including:

When to Contact a Medical Professional

Call your health care provider if:

  • You feel very tired and sleepy during the day
  • You or your family notice symptoms of obstructive sleep apnea
  • Symptoms don't improve with treatment, or new symptoms develop

References

Aurora RN, Casey KR, Kristo D, et al. Practice parameters for the surgical modifications of the upper airway for obstructive sleep apnea in adults. Sleep. 2010;33:1408-1413.

Epstein LJ, Kristo D, Strollo PJ Jr., et al. Adult Obstructive Sleep Apnea Task Force of the American Academy of Sleep Medicine: Clinical guideline for the evaluation, management, and long-term care of obstructive sleep apnea in adults. J Clin Sleep Med. 2009;5:263-276.

Kasai T, Bradley TD. Obstructive sleep apnea and heart failure: pathophysiologic and therapeutic implications. J Am Coll Cardiol. 2011;57:119-127.

McArdle N, Singh B, Murphy M, et al. Continuous positive airway pressure titration for obstructive sleep apnoea: automatic versus manual titration. Thorax. 2010;65:606-611.

Patil SP, Schneider H, Schwartz AR, Smith PL. Adult obstructive sleep apnea: pathophysiology and diagnosis. Chest. 2007;132:325-337.

Qaseem A, Holty JE, Owens DK, Dallas P, Starkey M, Shekelle P; for the Clinical Guidelines Committee of the American College of Physicians. Management of Obstructive Sleep Apnea in Adults: A Clinical Practice Guideline From the American College of Physicians. Ann Intern Med. 2013 Sep 24.

Randerath WJ, Verbraecken J, Andreas S, Bettega G, Boudewyns A, Hamans E, et al. Non-CPAP therapy guidelines. Eur Respir J. 2011; 37: 1000–1028.

Tomfohr LM, Ancoli-Israel S, Loredo JS, Dimsdale JE. Effects of continuous positive airway pressure on fatigue and sleepiness in patients with obstructive sleep apnea: data from a randomized controlled trila. Sleep. 2011;34:121-126.

Review Date: 3/18/2014
Reviewed By: Allen J. Blaivas, DO, Clinical Assistant Professor of Medicine UMDNJ-NJMS, Attending Physician in the Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Veteran Affairs, VA New Jersey Health Care System, East Orange, NJ. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.