Obstructive sleep apnea (OSA) is the most prevalent type of sleep apnea disorder. It is defined by brief interruptions in breathing that can last anywhere from 10 to 40 seconds during sleep. These “apneas” lead to reduced oxygen levels in the blood, increased strain on the cardiovascular system, and irritation of the nose and throat. Additionally, they cause periodic awakenings throughout the night, resulting in fragmented sleep. An episode of apnea typically involves a cessation of breath, followed by a deep gasp for air, often accompanied by increased snoring and restless movements. Many individuals are unaware that this occurs, and it is common for a sleeping partner to be the first to notice these symptoms.
Obstructive sleep apnea can affect individuals of all ages and genders, but it is more frequently diagnosed in men, with a ratio of 2:1 compared to women. After menopause, this ratio equalizes to 1:1. The likelihood of developing OSA increases with age, with approximately 25% of seniors (aged 65 and older) diagnosed with the condition. Those at higher risk include individuals who snore loudly, have larger neck sizes, craniofacial abnormalities, are obese, or have conditions such as high blood pressure and diabetes. There appears to be a genetic component, as OSA can run in families. If left untreated, OSA can severely impact quality of life and may even lead to premature death.
While OSA is the most common form of sleep apnea, there are other types as well.
Common Symptoms of OSA
Individuals at higher risk tend to be those who are obese, have a thick neck, or consume alcohol regularly before bedtime. Alarmingly, only about 5% of those with OSA receive proper diagnosis and treatment. If you suspect that you or a loved one may be suffering from this potentially life-threatening condition, we encourage you to consult a doctor for an accurate diagnosis.
Health Risks and Complications
Untreated OSA can lead to several serious health issues, including:
Currently, there is no cure for sleep apnea; therefore, ongoing therapy is crucial, whether through CPAP, BiPAP, or oral appliances. OSA is a lifelong condition, and discontinuing treatment can lead to a return of symptoms. At Quality Sleep Philippines, we are dedicated to enhancing your CPAP therapy experience. We offer free public education seminars and cleaning clinics regularly to help you stay informed and healthy. Inquire about our WatchPAT Home Sleep Test.
Obstructive Sleep Apnea (OSA)
Obstructive sleep apnea (OSA) is the most prevalent form of sleep apnea, resulting from an obstruction in the upper airway. It is marked by intermittent pauses in breathing during sleep, despite the individual’s attempts to breathe, leading to decreased blood oxygen levels. These breathing interruptions, known as “apneas,” typically last between 10 to 40 seconds.
During sleep, the body’s muscle tone relaxes, and the throat’s soft tissue can collapse, obstructing airflow. While mild OSA may occur naturally and temporarily, many individuals experience episodes throughout their lives, with a small percentage suffering from chronic, severe cases.
Most people may only face short-lived OSA episodes, often triggered by conditions like upper respiratory infections or tonsillitis, which can cause throat swelling. Additionally, certain substances, particularly alcohol, can excessively relax the body’s muscle tone, complicating normal sleep arousal mechanisms.
Those with OSA may not be aware of their breathing difficulties, often relying on others to recognize the problem. Commonly associated with loud snoring, OSA may also present other symptoms that go unnoticed for years. Individuals who sleep alone are particularly at risk for undiagnosed cases.
Other frequent signs of OSA include excessive daytime sleepiness, restless sleep, and snoring characterized by pauses followed by gasping. Less common symptoms may include morning headaches, insomnia, difficulty concentrating, mood changes (irritability, anxiety, depression), forgetfulness, increased heart rate or blood pressure, decreased libido, unexplained weight gain, frequent urination at night, gastroesophageal reflux, and night sweats.
Central Sleep Apnea (CSA)
Central Sleep Apnea (CSA) occurs when the neurological control for breathing fails, preventing the brain from signaling the body to inhale. This can lead to missed breathing cycles, resulting in dangerously low oxygen levels (hypoxemia) and elevated carbon dioxide levels (hypercapnia). These conditions can trigger a cascade of effects on the body.
During episodes of central apnea, the respiratory drive is absent, and the brain does not respond to fluctuations in blood gases. The severity of the effects on the body correlates with the duration of the breathing stoppage. In severe cases, central sleep apnea can lead to sudden death. Additionally, drops in blood oxygen may provoke seizures, even in individuals without epilepsy. In those with epilepsy, hypoxia from apnea can destabilize previously controlled seizure disorders.
For adults with coronary artery disease, significant drops in oxygen levels can result in angina, arrhythmias, or heart attacks. Long-term recurrent apnea episodes may lead to an increase in carbon dioxide, altering the blood’s pH and causing metabolic acidosis.
Individuals with congestive heart failure may experience a form of CSA known as Cheyne-Stokes respiration, characterized by alternating periods of apnea and rapid breathing. Evidence suggests that heart transplants can effectively resolve central sleep apnea in these patients. Some respiratory stimulant medications may also alleviate the severity of symptoms.
There is a notable association between atrial fibrillation (AF) and central sleep apnea. Studies indicate that the prevalence of AF is significantly higher among patients with idiopathic CSA compared to those with obstructive sleep apnea or no apnea.
Mixed Sleep Apnea
Some individuals may experience a combination of both obstructive and central sleep apnea. In cases of severe and prolonged obstructive sleep apnea, episodes of central apnea can develop. The exact mechanism behind the loss of central respiratory drive in OSA remains unclear but is often linked to acid-base and carbon dioxide feedback malfunctions due to heart failure. A variety of diseases and symptoms related to body mass, cardiovascular health, respiratory function, and occasional neurological issues contribute to sleep-disordered breathing.
Excessive Daytime Sleepiness (EDS) is a potential consequence of chronic sleep deprivation, resulting in severe fatigue over time. Additionally, central sleep apnea can arise independently of obstructive components, commonly observed in individuals with chronic opiate use due to the respiratory depression effects of narcotics.
Complex Sleep Apnea
Recently, researchers have identified Complex Sleep Apnea, where patients exhibit OSA but continue to experience persistent central sleep apnea despite the application of positive airway pressure (CPAP). This phenomenon is often observed during CPAP therapy, once the obstructive element has been addressed. Historically, this condition has been managed with CPAP or bilevel therapy, and adaptive servo-ventilation (ASV) has emerged as a treatment option. While ASV has shown marginally improved outcomes for Cheyne-Stokes respiration, further longitudinal studies are needed to assess its effectiveness compared to standard CPAP therapy.
Upper Airway Resistance Syndrome (UARS)
Upper Airway Resistance Syndrome (UARS) is characterized by partial airway obstruction during sleep, making it a milder form of sleep-disordered breathing than OSA. Individuals with UARS may experience difficulties in breathing during sleep, leading to daytime fatigue.
UARS involves airway resistance that affects breathing but does not typically lead to significant drops in blood oxygen levels. Although it may not be as severe as OSA, UARS can disrupt sleep and harm overall health.
There is ongoing debate within the medical community regarding the recognition and significance of UARS, with some experts viewing it as a mild variant of sleep-disordered breathing. Many individuals with UARS are unaware of their condition, often snoring minimally or experiencing less pronounced daytime sleepiness compared to those with OSA.
A specialized sleep study is required for a definitive diagnosis of upper airway resistance. This polysomnography monitors various bodily functions, including respiratory rates, heart rates, and blood oxygen levels, alongside esophageal pressure (Pes) measurements. The Pes measurement is crucial for diagnosing UARS, as standard polysomnography may show minimal or absent apneas and hypopneas.
Evaluating Severity and Exploring Treatment Options
Addressing obstructive sleep apnea (OSA) is crucial, as untreated cases can lead to various health complications, including high blood pressure, diabetes, and cardiovascular issues. These conditions may escalate to more severe medical emergencies such as heart attacks, strokes, or even death.
When considering treatment for sleep apnea, it’s essential to consult with your physician to determine the most suitable approach for your specific situation. Here are several treatment options to consider:
CPAP Therapy
Continuous Positive Airway Pressure (CPAP) therapy is the most common and effective treatment for sleep apnea. Proven to work for all levels of severity, CPAP is regarded as the gold standard in sleep apnea treatment. The CPAP machine is a compact device that delivers a constant flow of air through a mask that fits over your nose or mouth, keeping your airway open during sleep. This ensures normal breathing and helps maintain a healthy sleep pattern. The continuous airflow prevents airway collapse during both inhalation and exhalation, effectively treating apneas without the need for surgery.
By successfully managing your sleep apnea, you can enhance heart function, reduce hypertension, alleviate daytime sleepiness, and improve your overall quality of life. Those suffering from sleep deprivation due to OSA are more susceptible to depression, memory issues, and heightened anxiety. We offer a wide range of products to support your treatment journey for obstructive sleep apnea. Contact us today for a sleep consultation.
Oral Appliances
There are two primary types of oral appliances for treating obstructive sleep apnea: Tongue Retaining Devices and Mandibular Repositioning Devices. For personalized guidance, please consult a dentist who specializes in sleep apnea treatment.
Surgical Treatments
Depending on the severity of your condition, surgical options may include nasal surgery, somnoplasty, reconstructive surgery, or tracheostomy. It’s advisable to explore CPAP therapy before considering surgical interventions. For more information on surgical treatments for obstructive sleep apnea, consult with an Ear, Nose, and Throat (ENT) specialist.
Behavioral Modifications
Behavioral modifications can significantly enhance the effectiveness of any of the aforementioned treatment methods for obstructive sleep apnea. Adopting a healthier lifestyle may lead to improved results, which can include following a weight loss program, reducing alcohol intake, or quitting smoking. Positional therapy, such as sleeping on your side, can also reduce the occurrence of apneas by minimizing airway collapse, allowing for more open airways during sleep.
The simultaneous presence of two chronic diseases or conditions in a patient. The presence of one disease often indicates a high likelihood of the presence of another disease.
Sleep apnea is a major comorbidity to most cardiovascular diseases and a significant risk factor for stroke, coronary artery disease, congestive heart failure and atrial fibrillation. Furthermore, the presence of sleep apnea can exacerbate the seriousness of many cardiovascular diseases. The following is a chart indicating sleep apnea comorbidities.
Despite evidence showing that sleep apnea management improves patient outcomes and reduces hospital readmission, millions of cardiac patients still remain undiagnosed and untreated for this serious condition.
Presently, 50% of all cardiovascular patients suffer from sleep apnea and 80% remain undiagnosed If you suffer from a cardiac related disease, insist your cardiologist test you for sleep apnea.
Alongside the popularity of telemedicine for cardiac patients lies the rising awareness of the link between Sleep apnea and heart disease. With concern growing for the effects of sleep apnea on patients’ cardiovascular risk and cardiac disease progression, home sleep apnea testing with a home sleep apnea test is the latest ambulatory tool in the health professional’s arsenal.
Cardiologists have always been early adopters of home-based and telemedicine applications and telehealth tools. For example, the Holter monitor that gathered data on the heart rhythms of cardiac patients over an extended period of time from their homes was one of the earliest instances of telehealth. Consequently, cardiologists are already accustomed to remotely monitoring their patients through implantable cardiac devices such as pacemakers and defibrillators that continuously collect and transmit data back to clinicians together with their main tasks of keeping the heart beating.
In-lab comprehensive sleep tests, also called polysomnography or PSG, was the first breakthrough in the diagnosis of sleep disorders. The first sleep clinic was set up at Stanford University in 1970; today, over 2,500 sleep centers are accredited by the American Academy of Sleep Medicine (AASM) to carry out sleep testing.
However PSG tests have their drawbacks:
In December 2007, an American Academy of Sleep Medicine (AASM) task force published guidelines on the use of unattended portable monitors (PMs) for the diagnosis of Obstructive Sleep Apnea (OSA) in adults. The shift to testing for sleep apnea at home began in full force in March 2008. In March 2017 in the wake of recent technological advances, the AASM revised guidelines and accepted home sleep tests (HST) which measure peripheral arterial tonometry (PAT) as well as oximetry and actigraphy as “technically adequate” for the diagnosis of Obstructive Sleep Apnea in patients. Currently, WatchPat is the leading sleep apnea diagnosis device in a market place that uses this unique PAT technology.
Besides overcoming the drawbacks of PSG, home sleep apnea testing has the following advantages:
For the physician, an HSAT can be administered quickly and at times even right at the point care in the cardiology office and delivers results within a day or two. In this way, a cardiac patient can be diagnosed with OSA and begin treatment immediately, rather than watching their heart disease get worse while they wait for an in-lab sleep test.
The PSG can still be conducted and used for more detailed information when it is needed as a secondary comprehensive investigation.
WatchPAT®️ home sleep apnea test is an ideal solution for cardiologists who focus on improving outcomes and their patients’ health-related quality of life, to expand their service portfolio to include the speedy diagnosis and treatment of sleep apnea. WatchPATTM combines the simplicity of pulse oximetry together with the accuracy of PSG and the cost-effectiveness of an at home sleep apnea test.
As Prof. Andrea Natale from Austin mentioned in the 2016 HRS symposium “In the past, I used to convince the patient to do a sleep study. Many of them did not do it. Now they come to our office, they see the flyer about sleep apnea, they ask me to take the test because the test is so easy. Clearly, there’s benefit in the ease of the device to reach diagnosis”.
Dr. Randy Lieberman from Detroit was quoted saying that “Once we explain to the patients that identification of the sleep apnea can lead to a better quality of life or potentially better management of their cardiovascular disease component, then the question is; What kind of a sleep study? Patients are very reluctant to accept the information from an overnight sleep study outside their house. They tell us, they do not believe the data because they were uncomfortable in their bed and they couldn’t sleep.
When they have a home sleep study done their own bed where it is minimally invasive, with a minimum amount of home sleep study equipment, then they much more open to accepting the diagnosis and the treatment”. As more medical tests are offered in the ambulatory settings, it’s easy for your patients to be tested more easily and keep on top of their health. Home sleep apnea tests empower patients and improve quality of care, while on a macroeconomic level telemedicine and home testing makes care more accessible while cutting operational costs and waiting times.
