obstructive sleep apnoea

OBSTRUCTIVE SLEEP APNOEA

SLEEP (11)

Sleep is a routine of the daily life. In sleep, there is reduced or lack of conscious state. Voluntary muscles do not work during sleep.

There are 5 stages of sleep. Stage 1 to stage 4 are classified as NON RAPID EYE MOVEMENT (N-REM) stage of sleep. As the stages increase, the sleep gets deeper and consciousness decrease.

The last stage of sleep is the RAPID EYE MOVEMENT (REM) stage where there is paralysis (complete inactivation) of voluntary muscles. However, the eye muscles are still working and the eyes are moving (rolling) rapidly. The obstructive sleep apnoea mainly occurs in this stage when the paralysed muscles collapse onto the airways and cause blockage.

WHAT IS SLEEP APNOEA? (12)

Sleep apnoea is a disorder of sleep. The underlying cause is mostly stopping of breathing during the sleep, especially in the deep sleep.

When there is not enough oxygen in the body, it wakes up to re-initiate breathing. This results in interruptions to sleep and leads to lack of quality sleep. These episodes of awakening are very short moments and the patient may or may not even realise it.

SLEEPSLEEP

STOP BREATHING

STOP BREATHING

WAKE UPWAKE UP

RESTOREBREATHING

RESTOREBREATHING

TRIG GE

R

For managing sleep apnoea, it is very important to find the condition that triggers breathing to stop.

This lack of quality sleep causes SLEEPLESSNESS and TIREDNESS during the day.

TYPES OF SLEEP APNOEA (2)

Obstructive Sleep Apnoea (OSA):During sleep, mainly in the REM stage, the muscles of upper airway relax and BLOCK the airways. There can be complete blockage (apnoea) which stops breathing or half blockage (hypopnoea) which causes poorer breathing. The blocking can last for more than 10 seconds.

Central Sleep Apnoea (CSA):There is a respiratory centre in the brain which controls breathing during day and night. Central sleep apnoea occurs when this centre does not send appropriate signals to the muscles that facilitate breathing.

Complex Sleep Apnoea:Complex sleep apnoea is the condition when both obstructive sleep apnoea and central sleep apnoea are present. 

OSA - CAUSES (2) (3)

 Palate shape and micrognathism (small jaw)

Large tonsils or tongue

Large neck

Being overweight

Narrow upper airway

OSA - RISK FACTORS (2) (3)

 Male gender

Old age

Family history

Smoking

Alcohol or addictive drug consumption

High blood pressure

Obesity

SIGNSAND

SYMPTOMS

SNORING

GASPS IN SLEEP

FEELING OFSLEEPLESSNESS AND

FALLING ASLEEP DURING DAYTIME

DRY MOUTH IN THE MORNING

SUSPENSION OF BREATHING

WAKING UP FREQUENTLY IN THE NIGHT

FORGETFULLNESS

HEADACHE

OSA - SIGNS AND SYMPTOMS (3)

CLINICAL EXAMINATION

OVERNIGHT PULSEOXIMETER

ELECTROENCEPHALOGRAM

ELECTROMYOGRAM ELECTRO-OCULOGRAM

ELECTROCARDIOGRAM

NASAL AIRFLOW SENSOR/SNORE MICROPHONE

Pulseoximeter: record pulse and oxygen saturation during sleep

Electroencephalogram: Measure brain activity

Electromyogram: Measure muscle activity

Electro-occulogram: Measure eye movements

Electrocardiogram: Measure heart rhythm

OSA - DIAGNOSING CRITERIA (4)

OSA - TREATMENT OPTIONS (4) (6) (8)

OSA is a condition which can be treated very successfully. If the symptoms are mild, simple lifestyle changes can help. However, if the condition remains, a sleep specialist must be seen.

1. Continuous Positive Airflow Pressure (CPAP):

The main treatment for obstructive sleep apnoea is the CPAP treatment. A mask is positioned on the face and secured in a way that it is not very loose to move or it is not very tight to give pain. The mask is connected to a small machine which blows out air with a steady force. This prevents the obstruction of airways and ensures the inflation of lungs with air is satisfactory during inhalation phase of breathing.

2. Oral Appliance Therapy (OAT):

OAT ARE specially designed mouthpieces such as mandibular repositioning device, mandibular responding splint or tongue retaining device, which are commended by dental specialists. The aim is to bring the jaw (chin) or tongue to front and prevent airway blockage.

3. Surgery:

Surgery is the last choice of OSA treatment and it is mainly performed in the presence of tonsiliar enlargement, small jaw, or nose injury.

Tonsillectomy: Removal of tonsils

Adenoidectomy: Removal of adenoids

Uvulopalatopharyngoplasty: Removal of surplus neck tissue

Soft palate implants: Adding a tool into the mouth to prevent airway obstruction

OSA - LIFESTYLE CHANGES (6)

Certain lifestyle changes are beneficial in treatment of OSA. Little changes to daily routines and habits can noticeably improve the quality of life. These changes can result in the prevention of airway blockage, and help to restore normal breathing in due course.

SMOKING CESSATION

WEIGHT LOSS

NO ALCOHOL BEFORE BEDTIME

NO ADDICTIVE DRUG USE

DECREASED CAFFEINE BEFORE BEDTIME

MAINTAINING REGULAR SLEEP ROUTINE

AVOID SLEEPING ON THE BACK

USING A PILLOW IN BED - KEEP HEAD ELEVATED

* AFTER BEING DIAGNOSED WITH SLEEP * APNOEA, DVLA NEEDS TO BE INFORMED

OSA - OUTCOME (9) 

OSA is mainly seen in middle aged and elderly people.

Middle Aged Men

4 in 100

Elderly Over 65

6 in 10

Middle Aged

Women2 in 100

OSA is a treatable condition with good prognosis. With appropriate treatment, patients can continue their daily lives with no obvious problems. However, untreated OSA can lead to serious complications.

OSA - COMPLICATIONS (9)

Complications are mainly caused by the increase of CO2 and decrease of O2 during apnoea.

UNTREATEDOBSTRUCTIVE

SLEEPAPNOEA

HYPERTENSION

HEART ATTACK/ STROKE HEART FAILURE

TYPE 2 DIABETES

Hypertension: Blood pressure above 140/90

Heart failure: Condition when heart cannot pump enough blood

Heart attack: Damaging of a vessel in heart

Stroke: Damaging of a vessel in brain

Type 2 diabetes: Condition when body cannot produce enough insulin

OSA - RESEARCH & FUTURE MANAGEMENT (10)  

-There are various research programs going on in order to improve diagnosis and treatment of OSA.

-Exercises for throat and tongue to decrease OSA are developed.

-A study in New York is working on developing new technology chips to be placed in the chest for OSA treatment.

-American thoracic society is working on portable monitor testing.

-Da Vinci Surgical System is being implanted into medicine for robotic surgery operations. It will also be used in surgeries for OSA.

-Cognitive behavioural therapy for psychologically accepting CPAP usage is in clinical trials.

BIBLIOGRAPHY  

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