So, you’ve been told you snore.

Although snoring is a common symptom in people with obstructive sleep apnea (OSA), there is a lot more to the disorder than just the whistling, snorting and rumbling that so annoys the person lying next to you in bed. Just because you snore doesn’t automatically mean you have OSA. However, it is worthwhile considering because OSA, should you have it, can significantly impact your life.

What is Obstructive Sleep Apnea (OSA)?

OSA is a sleep disorder resulting in abnormal breathing during sleep. It is caused by repetitive closure or narrowing of the throat (the upper airway). This causes a decrease in the normal airflow in and out of the lungs. Episodes of airway narrowing that cause a partial decrease in airflow are called hypopneas. Episodes of airway narrowing or collapse that cause a complete pause in airflow for at least 10 seconds are called apneas.1

Frequent apneas and hypopneas disrupt normal sleep patterns. This can lead to symptoms of daytime sleepiness and safety concerns and are associated with depression and poorer health outcomes.2,3 People with severe OSA are more than twice as likely to be involved in a car accident compared to people without OSA.3 Untreated OSA is also associated with an increased risk for high blood pressure, heart attack, abnormal heart rhythms and stroke.4 Reduced testosterone levels and erectile dysfunction are also more common in men with untreated OSA.5

OSA is common in North America. In the United States, OSA exists in about 15 percent of males. Rates also appear to be increasing, likely due to rising rates of obesity.3,6

What Causes Sleep Apnea?

Normally air flows in and out of the throat to reach the lungs, or lower airway. During sleep, the muscles surrounding the throat normally relax causing narrowing (or collapse) of the throat. Usually this small degree of narrowing does not cause problems. However, in some people it can cause snoring and if airflow is reduced sufficiently it can cause obstructive apneas or hypopneas. These episodes of apneas and hypopneas cause a person to awaken in order to stimulate the muscles surrounding the throat. People may wake with a sensation of gasping or choking. However, many with the disorder are unaware of these sleep interruptions.

Since OSA is caused by a narrowing or collapse of the upper airway or throat, it makes sense that factors leading to a smaller upper airway, such as small mouth and lower face, increase the risk for OSA. Other important risk factors are:

  • Obesity
  • Male sex (twice the risk for OSA)
  • Large neck circumference — greater than 17 inches in men
  • Older age 7

When to Suspect OSA

In addition to the above risk factors, it is also important to consider OSA if you have any of the following symptoms:

  • Awakening with gasping or choking
  • Snoring
  • Observed episodes of pauses in breathing (apneas)
  • Sleepiness during the day (feeling the need to have regular naps or dozing off after meals, while watching TV, during conversations or while driving
  • Restless, non-refreshing sleep
  • Poor concentration and memory
  • Morning headaches

Diagnosis

Historically, OSA was diagnosed by a sleep medicine specialist, usually a respirologist. Today, many family physicians now diagnose and manage uncomplicated OSA. In order to receive an OSA diagnosis you need to undergo a sleep study. In most cases the diagnosis is made during a home study and a specialized in-hospital sleep study where a polysomnogram (PSG) is used isn’t required. During a home sleep study, snoring, oxygen levels and chest movement are all recorded and used to estimate the number of apneas and hypopneas occurring during every hour of sleep.

OSA is diagnosed if there are either:

  • Five or more respiratory obstructive events per hour of sleep in addition to symptoms of OSA. •
  • At least 15 respiratory obstructive events per hour of sleep, even if no symptoms are present.8

Treatment

The treatment of OSA is associated with improvements in sleepiness and quality of life as well as mild improvements in blood pressure.8 The effects of OSA treatment on cardiovascular problems that are associated with heart attacks and strokes are less clear. OSA treatment is focused on reducing the degree of airway collapse that occurs during sleep. Lifestyle changes are an important component in treating OSA, no matter the severity. Continuous positive airway pressure (CPAP) is the most effective treatment for OSA and is usually suggested for people with moderate to severe OSA.8,9

Lifestyle Changes

  • Weight loss
  • Avoidance of alcohol and sedative medications
  • Sleep position. Sleeping on the side can be helpful in people who have positional sleep apnea. Usually these methods are used in people with mild OSA or in addition to other therapies such as CPAP.

Continuous Positive Airway Pressure (CPAP)

  • CPAP treatment uses air pressure delivered through a mask (nasal or mouth) to keep the upper airway open during sleep.
  • Coverage for CPAP machines varies by province and health care insurer.

Other Therapies

  • A dental device can be used to help reposition jaw. This treatment can be considered in mild to moderate cases of OSA.
  • Surgery is very rarely considered.

References

1. Fleetham, J., et al., Canadian Thoracic Society guidelines: diagnosis and treatment of sleep disordered breathing in adults. Can Respir J, 2006. 13(7): p. 387-92.

2. Chen, Y.H., et al., Obstructive sleep apnea and the subsequent risk of depressive disorder: a population-based follow-up study. J Clin Sleep Med, 2013. 9(5): p. 417-23.

3. Young, T., et al., Burden of sleep apnea: rationale, design, and major findings of the Wisconsin Sleep Cohort study. WMJ, 2009. 108(5): p. 246-9.

4. Ellen, R.L., et al., Systematic review of motor vehicle crash risk in persons with sleep apnea. J Clin Sleep Med, 2006. 2(2): p. 193-200.

5. Burschtin, O. and J. Wang, Testosterone Deficiency and Sleep Apnea. Urol Clin North Am, 2016. 43(2): p. 233-7.

6. Peppard, P.E., et al., Increased prevalence of sleep-disordered breathing in adults. Am J Epidemiol, 2013. 177(9): p. 1006-14.

7. Young, T., et al., Predictors of sleep-disordered breathing in community-dwelling adults: the Sleep Heart Health Study. Arch Intern Med, 2002. 162(8): p. 893-900.

8. Epstein, L.J., et al., Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. J Clin Sleep Med, 2009. 5(3): p. 263-76.

9. Giles, T.L., et al., Continuous positive airways pressure for obstructive sleep apnoea in adults. Cochrane Database Syst Rev, 2006(3): p. CD001106.