About Sleep Apnea

Obstructive Sleep Apnea (OSA) or obstructive sleep apnea syndrome is the most common type of sleep apnea and is caused by obstruction of the upper airway. It is characterized by repetitive pauses in breathing during sleep, despite the effort to breathe, and is usually associated with a reduction in blood oxygen saturation. These pauses in breathing, called apneas (literally, "without breath"), typically last 20 to 40 seconds.

The individual with Obstructive Sleep Apnea is rarely aware of having difficulty breathing, even upon awakening. It is recognized as a problem by others witnessing the individual during episodes or is suspected because of its effects on the body (sequelae). Obstructive Sleep Apnea is commonly accompanied with snoring.

Symptoms may be present for years or even decades without identification, during which time the sufferer may become conditioned to the daytime sleepiness and fatigue associated with significant levels of sleep disturbance. Sufferers who generally sleep alone are often unaware of the condition, without a regular bed-partner to notice and make them aware of their symptoms.

As the muscle tone of the body ordinarily relaxes during sleep, and the airway at the throat is composed of walls of soft tissue, which can collapse, it is not surprising that breathing can be obstructed during sleep. Although a very minor degree of Obstructive Sleep Apnea is considered to be within the bounds of normal sleep, and many individuals experience episodes of Obstructive Sleep Apnea at some point in life, a small percentage of people are afflicted with chronic, severe Obstructive Sleep Apnea .

Many people experience episodes of Obstructive Sleep Apnea for only a short period of time. This can be the result of an upper respiratory infection that causes nasal congestion, along with swelling of the throat, or tonsillitis that temporarily produces very enlarged tonsils. The Epstein-Barr virus, for example, is known to be able to dramatically increase the size of lymphoid tissue during acute infection, and Obstructive Sleep Apnea is fairly common in acute cases of severe infectious mononucleosis. Temporary spells of Obstructive Sleep Apnea syndrome may also occur in individuals who are under the influence of a drug (such as alcohol) that may relax their body tone excessively and interfere with normal arousal from sleep mechanisms.

Signs and Symptoms of Sleep Apnea

Common signs of Obstructive Sleep Apnea include unexplained daytime sleepiness, restless sleep, and loud snoring (with periods of silence followed by gasps). Less common symptoms are morning headaches; insomnia; trouble concentrating; mood changes such as irritability, anxiety and depression; forgetfulness; increased heart rate and/or blood pressure; decreased sex drive; unexplained weight gain; increased urination and/or nocturia; frequent heartburn or gastroesophageal reflux disease; and heavy night sweats.

Adults

In adults, the most typical individual with Obstructive Sleep Apnea syndrome suffers from obesity, with particular heaviness at the face and neck. Obesity is not always present with Obstructive Sleep Apnea ; in fact, a significant number of adults with normal body mass indices (BMIs) have decreased muscle tone causing airway collapse and sleep apnea. The cause of this is not well understood. The hallmark symptom of Obstructive Sleep Apnea syndrome in adults is excessive daytime sleepiness. Typically, an adult or adolescent with severe long-standing Obstructive Sleep Apnea will fall asleep for very brief periods in the course of usual daytime activities if given any opportunity to sit or rest. This behavior may be quite dramatic, sometimes occurring during conversations with others at social gatherings.

The hypoxia (absence of oxygen supply) related to Obstructive Sleep Apnea may cause changes in the neurons of the hippocampus and the right frontal cortex. Research using neuro-imaging revealed evidence of hippocampal atrophy in people suffering from Obstructive Sleep Apnea . They found that some sufferers have problems in mentally manipulating non-verbal information and in executive function.

Common causes

Most cases of Obstructive Sleep Apnea are believed to be caused by:

  • old age (natural or premature),
  • brain injury (temporary or permanent),
  • decreased muscle tone,
  • increased soft tissue around the airway (sometimes due to obesity), and
  • structural features that give rise to a narrowed airway.

Decreased muscle tone can be caused by drugs or alcohol, or it can be caused by neurological problems or other disorders. Some people have more than one of these issues. There is also a theory that long-term snoring might induce local nerve lesions in the pharynx in the same way as long-term exposure to vibration might cause nerve lesions in other parts of the body. Snoring is a vibration of the soft tissues of the upper airways, and studies have shown electrophysiological findings in the nerves and muscles of the pharynx indicating local nerve lesions.

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