HomeHealth articlesobstructive sleep apneaWhat Are Sleep-Related Breathing Disorders?

Obstructive Sleep Apnea and Other Sleep-Related Breathing Disorders.

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Sleep-related breathing disorders include several sleep-related breathing disturbances. Read the article to know more.

Written by

Dr. Vidyasri. N

Medically reviewed by

Dr. Kaushal Bhavsar

Published At October 3, 2022
Reviewed AtFebruary 8, 2023

Introduction:

Sleep-related breathing disorders are abnormal conditions that cause difficulty in breathing during sleep. It includes snoring, obstructive sleep apnea or hypopnea syndrome (OSAHS), hypoventilation syndrome, and central sleep apnea. Complete or near-complete cessation in breathing refers to apnea, and decreased respiratory effect with oxygen desaturation or arousal refers to hypopnoea. These may last from a few seconds to a few minutes and occur about five times or more than an hour in adults.

What Are the Symptoms of Sleep Breathing Disorders?

The signs and symptoms of obstructive and central sleep apneas are commonly similar, making them difficult to diagnose. These signs and symptoms include:

  • Gasping for air during sleep.

  • Loud snoring.

  • Morning headache.

  • Difficulty staying asleep.

  • Hypersomnia (excessive daytime sleepiness).

  • Irritability.

  • Awakening with a dry mouth.

  • Difficulty in focusing.

What Is Obstructive Sleep Apnea?

  • Obstructive sleep apnea is one of the most common sleep-related breathing disorders.

  • This happens when the throat muscles intermittently relax and block the airway during sleep. The prominent sign of obstructive sleep apnea is snoring.

  • It occurs when the throat muscles relax too much to allow breathing. The muscles support the uvula (a triangular piece of tissue hanging from the soft palate), the tonsils, the back of the roof of the mouth, and the tongue.

  • When the muscles relax, the airway narrows and closes as inhaled, stopping the breath for ten seconds or longer. It will result in lowering oxygen in the blood and increased levels of carbon dioxide.

  • These signals are transferred to the brain and induced to awaken from sleep with shortness of breath and correct itself quickly with one or two deep breaths.

  • These patterns are repeated five to 30 times or more each hour throughout the night, which affects the deep, restful phases of sleep, and makes one feel sleepy during day time.

  • People with obstructive sleep apnea are mostly not aware of their interrupted sleep.

What Are the Symptoms of Obstructive Sleep Apnea?

The signs and symptoms of obstructive sleep apnea include:

  • Hypersomnia (excessive daytime sleep).

  • Observed episodes of stopped breathing during sleep.

  • Loud snoring.

  • Awakening with a dry mouth or sore throat.

  • Morning headache.

  • Depression or irritability.

  • Difficulty concentrating.

  • Decreased libido.

  • High blood pressure.

It is considered to be serious and recommended to consult a medical professional in the following situations:

  • Waking up choking or gasping.

  • Snoring loud enough to disturb others' sleep.

  • Pausing in breathing during sleep.

  • Excessive daytime sleepiness or drowsiness.

Risk Factors of Obstructive Sleep Apnea:

Various factors increase the risk of occurrence of obstructive sleep apnea. These include-

  • Chronic Nasal Congestion: The probability of obstructive sleep apnea is twice as often in those who have nasal congestion at night. This is mainly due to narrowed airways.

  • High Blood Pressure: Obstructive sleep apnea is found to be more susceptible in people with hypertension.

  • Narrowed Airway: The presence of naturally inherited narrow airways also increases the risk of obstructive sleep apnea. In addition, either tonsils or adenoids may become enlarged and block the airway.

  • Excess Weight: In obese people, the fat around the upper airway can obstruct breathing. Medical conditions associated with obesity, such as polycystic ovary syndrome and hypothyroidism, can result in obstructive sleep apnea.

  • Diabetes: Obstructive sleep apnea is more common in people with diabetes.

  • Gender: The frequency of this condition increases in women after menopause. However, men are more commonly seen with this condition than women.

  • Asthma: Asthmatic patients are more susceptible and are at higher risk of getting infected.

  • Older Age: The risk of this condition increases with an increase in age.

What Are the Complications of Obstructive Sleep Apnea?

  • Cardiovascular Problems: A sudden drop in blood oxygen levels during sleep increases blood pressure and impacts the cardiovascular system. The majority of the people with this condition develop high blood pressure, increasing the risk of heart disease. The risk of coronary artery disease, heart attacks, heart failure, and strokes increases with the severity of obstructive sleep apnea.

  • Eye Problems: Certain eye conditions, such as glaucoma, are associated with this sleeping disorder. However, these eye problems can be cured with the proper treatment.

  • Complications With Medications and Surgery: Certain medications such as narcotic analgesics, sedatives, and general anesthetics relax the upper airway and can worsen obstructive sleep apnea. People with obstructive sleep apnea are more prone to complications after major surgery.

  • Daytime Sleepiness and Fatigue: People with obstructive sleep apnea have severe drowsiness, irritability, and fatigue due to a lack of proper sleep at night. This may result in difficulty concentrating and induce sleeping at the workplace while driving and in other usual activities, which in turn increase the risk of work-related accidents.

What Is Central Sleep Apnea?

Central sleep apnea refers to the disorder where breathing repeatedly stops and starts during sleep. It occurs because the brain does not send the signals to the muscles that control breathing. This is different from obstructive sleep apnea, where breathing is stopped due to upper airway obstruction. This kind of disorder is less common than obstructive sleep apnea.

What Are the Symptoms of Central Sleep Apnea?

Certain signs and symptoms of central sleep apnea include:

  • Difficulty in staying asleep.

  • Difficulty concentrating.

  • Mood changes.

  • Morning headaches.

  • Snoring.

  • Episodes of not breathing or abnormal breathing patterns during sleep.

  • Abrupt awakening accompanied by shortness of breath.

What Causes Central Sleep Apnea?

Central sleep apnea is caused by various conditions that affect the ability of the brainstem- which links the brain to the spinal cord and controls many functions such as heart rate and breathing.

  • Cheyne-Stokes Breathing: This type of sleep apnea is mostly associated with congestive heart failure or stroke. It is characterized by a gradual increase and then a decrease in breathing effort and airflow. During minimal or weakest breathing effort, central sleep apnea can occur.

  • High Altitude Periodic Breathing: Cheyne stoke breathing can occur in high-altitude places. The change in the oxygen level can cause rapid breathing and under breathing.

  • Medical Condition-Induced Central Apnea: Certain medical conditions such as end-stage kidney disease and stroke may give rise to central sleep apnea of non-Cheyne stokes.

  • Idiopathic Central Sleep Apnea: The cause of this condition is usually unknown.

Tests to detect sleep-related breathing disorders include-

  • Polysomnography: In the case of both obstructive and central sleep apnea, this test is carried out by monitoring the heart, lung, and brain activity, breathing patterns, blood oxygen levels, and arm and leg movements while sleeping.

  • Home Sleep Apnea Testing: This test includes the measurement of airflow, blood oxygen levels, limb movements, breathing patterns, and snoring intensity.

What Are the Treatment Approaches of Sleep-Related Breathing Disorders?

  • Mouthpiece: It is used as an alternative therapy for people with mild to moderate sleep apnea disorders. It is also used in people with severe sleep apnea who are contraindicated to continuous positive airway pressure.

  • Positive Airway Pressure: In this treatment, a machine is used that delivers air pressure through a piece that fits into the nose or mouth while sleeping. It reduces the frequency and number of respiratory events that occur during sleep. It reduces daytime sleepiness and improves the quality of life.

  • Continous Positive Airway Pressure: The most common type is called continuous positive airway pressure (CPAP). In this method, the pressure of the air inhaled is constant, continuous, and greater than the surrounding air, which is maintained enough to keep upper airway passages open. This air pressure prevents snoring and obstructive sleep apnea. Though continuous positive airway pressure is the most consistent and successful method for treating obstructive sleep apnea, newer machines are introduced for the patient's comfort, which is smaller, less noisy than the older machines, and can be easily adjusted according to the individual's comfort. Several options are available such as nasal pillows, nasal masks, or face masks.

  • Bilevel positive airway pressure (BPAP): This is another type of positive airway pressure that delivers a preset amount of pressure during inhalation and a different amount of pressure when exhaled.

  • Medications: In the case of central sleep apnea, Acetazolamide is commonly used to stimulate breathing. This is used to help in breathing if positive airway pressure is not tolerated.

  • Surgical Procedure: Surgical Removal of the tissue. Uvulopalatopharyngoplasty is a procedure that refers to the removal of tissue from the back of the mouth and the top of the throat. Tonsils and adenoids are removed. It is performed under general anesthesia.

  • Jaw Surgery: In this surgery, a part of the upper and lower jaw is removed from the rest of the facial bones. This enlarges the space behind the areas of the tongue and soft palate, which prevents obstruction.

Conclusion:

Though sleep-related breathing disorders may result in various life-threatening complications, a timely approach and lifestyle modifications are necessary for a better prognosis of this condition. An interprofessional team approach is required for the positive outcome and well-being of the affected individuals.

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Dr. Kaushal Bhavsar
Dr. Kaushal Bhavsar

Pulmonology (Asthma Doctors)

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