WHAT IS OBSTRUCTIVE SLEEP APNEA?
Obstructive Sleep Apnea (OSA) is a common syndrome but few people pay proper attention. It is estimated that there are nearly 1 billion people worldwide with sleep apnea syndrome, of which more than 400 million people have moderate-severe levels. In Vietnam, there are 4 million people who are infected but have not been diagnosed in time.
Sleep apnea is a pathological condition characterized by obstructive apnea and hypopnea caused by repeated collapse of the upper airway throughout the patient’s sleep. At that time, the amount of oxygen to the lungs will be limited and the brain will wake you up when you feel excessive lack of oxygen. This can happen several times a night, or more seriously, several hundred times a night.
This affects your health in the short term such as reducing the quality of life, increasing the risk of causing traffic accidents; and in the long term, it will contribute to chronic cardiovascular and metabolic diseases if not treated in time, and can even cause death while sleeping.
CLASSIFICATION OF SLEEP APNEA
OBSTRUCTIVE SLEEP APNEA
Obstructive Sleep Apnea (OSA): This is the most common type of apnea, accounting for more than 80%. The reason is that the respiratory tract muscles relax excessively during sleep and collapse, causing the airways to become blocked.
MIXED SLEEP APNEA
Mixed Sleep Apnea (MSA): It is a type of apnea that is both caused by problems with the respiratory control nervous system and relaxed respiratory muscles that compress the airway.
CENTRAL SLEEP APNEA
Central Sleep Apnea (CSA): This is a less common type of apnea. The reason is that the nervous system that controls breathing has problems, losing the interaction between the nervous system and the diaphragm, causing the diaphragm to become inactive.
OTHER TYPES OF APNEA
Each type of apnea will have a different treatment. But in this article, we will only focus on Sleep Obstructive Apnea Syndrome – the most common Apnea Syndrome.
TYPICAL SYMPTOMS
Up to 90% of people with obstructive sleep apnea syndrome are unaware of their medical condition. The reason is that the symptom only occurs during sleep, which means that the patient is not aware that this condition is occurring.
Sleep obstructive apnea syndrome is caused by the pharyngeal muscles relaxing and compressing the airway. At that time, the patient will make snoring sounds and then stop breathing. At that time, your body will warn you of a lack of oxygen and will wake you up. This is the most common symptom and also the easiest risk factor to diagnose.
The fact that your body is awakened several times during the night due to apnea will show typical symptoms in the following days, especially during the day.
WHO IS AT RISK OF OBSTRUCTIVE SLEEP APNEA
Sleep obstructive apnea can occur at any age, including in children. But it is more common in middle age, and more men than women. The main risk factors for sleep apnea are overweight – obesity. However, sleep apnea can also occur in thin people but at a lower rate.
Common risk factors for sleep apnea include:
🔹 Overweight – obesity: The risk of apnea increases up to 3 times compared to normal people
🔹 Large necklace circumference: The circumference is greater than 43cm for men and greater than 38cm for women. An enlarged neck has more soft tissue and increases the risk of blocking your airway
🔹 Mankind
🔹 Premenopausal women
🔹 Middle age
🔹Airway abnormalities: Enlarged tonsils, large tongue, small jawbone, deviated nasal septum, etc.
🔹 Tobacco and alcohol addicts with sleep apnea
🔹 Use of sedatives or addictive substances
🔹 Family history of sleep apnea: Some genetic traits such as obesity, large necklace, large tongue, etc. increases the risk of sleep apnea
🔹 People who are suffering from diseases such as Hypertension, Diabetes, Hypothyroidism, Cardiovascular, ...
SERIOUS BUT "SILENT" CONSEQUENCES
Sleep apnea may make you feel tired, have a headache, or be sleepy the next day. These may only be mild symptoms at first, and people often ignore it. But in the longer term, it will cause worse consequences due to the body's long-term lack of oxygen and having to wake up many times during the night because of apnea.
Simply explained, when you have sleep apnea, the oxygen in the blood will be low, and when the body realizes it, the heart will work more to provide enough oxygen to the body. When there is no longer enough oxygen to supply the body, the brain will wake us up. Over time, when the heart has to work continuously, it will affect cardiovascular function, which is a secondary cause of cardiovascular diseases such as secondary hypertension, heart failure, etc. And when we wake up many times in the middle of the night, other organs will also function normally like the kidneys and cause us to urinate at night many times.
DIAGNOSE
People with sleep apnea won’t be aware that they’re having trouble breathing, because apnea only appears when they’re already asleep. So, sleep apnea is usually not detected, although it can lead to serious consequences.
Before taking these in-depth sleep tests, you can assess your risk of sleep apnea through the test below:
Nowadays, with the development of science and technology, you can completely be diagnosed with modern equipment.
According to the American Association of Sleep Medicine (AASM), the gold standard for diagnosing sleep apnea syndrome is polysomnography. (Find out more)
The machine will record the following parameters:
Electroencephalogram – Electrocardiogram – Leg electromyography – Chin electromyography Breathing air flow – Respiratory movements – Blood oxygen saturation – Heart rate – Snoring
The software will then analyze and give the results:
Sleep indicators: Light sleep, deep sleep, sleep time, lying position Respiratory indicators: Apnea; decreased breathing; central apnea; obstructive apnea; … Blood Oxygen indicators – heart rate: SpO2, heart rate, … Other indicators: Frequency of snoring, leg movements, breathing rate, …
TREATMENT OF SLEEP APNEA
Sleep apnea is a serious sleep disorder. You need to have a treatment plan from a sleep specialist.
Depending on how severe you are, there are many methods to treat it. But according to the American Academy of Sleep Medicine, the gold standard in the treatment of Sleep Obstructive Apnea Syndrome is POSITIVE CPAP MECHANICAL VENTILATION
You can combine many methods together to increase the effectiveness of treatment:
A CPAP positive pressure ventilator
CPAP is a ventilator that uses a steady and gentle airflow that keeps your airways clear throughout the night. You will sleep with a mask attached to a machine placed at the head of the bed. Masks and machines can vary depending on your treatment needs and comfort. CPAP is the leading treatment for sleep apnea and is recommended for most patients.
Molar Instrument
A Molar instrument is an instrument that fits in your mouth on your teeth while you sleep. It can be similar to orthodontic retainers. The device prevents the airway from collapsing by keeping the tongue in place or sliding the jaw forward so that you can breathe while sleeping. Some patients prefer to sleep with molar appliances rather than a CPAP machine. Molar instruments are recommended for patients with mild to moderate apnea and are unable to use CPAP or simply want to try using an oral device instead of a CPAP device.
Oropharyngeal surgery
Surgery is applied when CPAP or molar instruments are not effective for you. The most common options reduce or remove excess tissue in the throat when it collapses and block your airway during sleep. More complex procedures can adjust your bone structure including jawbone, nose, and facial bones. Bariatric surgery may also be an option. Consult your sleep doctor about the type of surgery that is right for you.
Upper respiratory stimulation
It is a small device implanted into your chest wall, like a pacemaker. The machine will be connected directly to the nerve that stimulates the tongue. When in operation, the machine will stimulate your tongue to gently move forward while sleeping. The machine is remotely controlled so that it is more convenient for you to turn off – open. Before you can have this implant, your otolaryngologist will endoscope your airway with a flexible tube while you sleep to find out why you have sleep apnea. If it’s because your tongue is blocking your airway, you may want to use this method. If your airway is completely flattened, you should not use this method.
Weight control
Weight loss is an effective aid method that helps improve or eliminate sleep apnea symptoms if you are overweight or obese. Overweight people often have a thick neck with a lot of tissue in the throat that can block the airway. You should combine weight loss with other methods to increase the effectiveness of treatment.
Posture changes
Some people experience sleep apnea mainly when sleeping on their backs and breathing normally when they sleep on their sides. Posture therapy may involve wearing a special device around your waist or back that helps keep you asleep in a prone position. Another option is a small device that wears on the back of the neck. It gently vibrates when you start lying on your back while asleep and won’t wake you up. Posture therapy can be used alone or in conjunction with another sleep apnea treatment.
Lifestyle changes
There are many lifestyle changes that can help you reduce snoring and improve sleep apnea symptoms such as quitting smoking and not drinking alcohol,… Alcohol relaxes the throat muscles, which can cause you to snore or collapse your airways. If you have allergies, taking a decongestant before bed can help improve airflow through your nose.
References:
(1) Gottlieb DJ, Punjabi NM. Diagnosis and Management of Obstructive Sleep Apnea: A Review. JAMA. 2020 Apr 14;323(14):1389-1400. doi: 10.1001/jama.2020.3514. PMID: 32286648.
(2) Duong-Quy S, Dang Thi Mai K, et. Study about the prevalence of the obstructive sleep apnoea syndrome in Vietnam. Rev Mal Respir. 2018 Jan;35(1):14-24.
