Sleep apnea is a disorder that is still rarely addressed in our society, despite the fact that it is not an uncommon disorder. The latest research suggests that 24 % of adult men and 9 % of women suffer from this disorder. An apnea patient is at risk of being involved in a traffic accident 7.3 times more than an average person.
Apnea occurs during sleep because of a reduction of muscle tone (muscle tension) and relaxation of upper airway muscles (oropharynx), which may cause closure of the airway. At that point the air current through the nose cannot penetrate to the lower airways and apnea occurs – a disruption in breathing. In normal circumstances, these very complex neuromuscular mechanisms of the soft palate, tongue, and pharyngeal wall keep the airway continually open to the air current. Some sleep apnea patients have congenital oropharyngeal wall stenosis, some have an elongated uvula or tonsil hypertrophy, and some have a disproportion between the upper and lower jaw, or have nasal deformations.
As for the nocturnal manifestations of the disorder, such as a disruption in breathing, followed by a ‘struggle’ for air and difficulties in breathing for the patient, these can often seem dramatic to their partners in bed. The patient is often unaware of his/her apnea, even though some experience a feeling of suffocation or lack of air while waking up. The patients’ sleep is restless, they wake up with headaches, they often feel sleepy during the day, have difficulties concentrating and remembering things, they are cranky, depressed and can experience a weakening of the libido.
Apnea is considered to be a disruption in breathing that lasts for 10 seconds or more, while hypopnea is defined as a reduction of air current flow through the respiratory system that lasts for 10 seconds or more. Apnea is characterized by oxygen desaturation of peripheral blood. Anybody can experience an occasional apnea at night, especially following a tiring day, or after consuming alcohol late at night. To be considered a disorder, apnea needs to manifest itself more than 5 times in one hour or the sum of apneas or hypopneas in one hour of sleep needs to be more than 10.
The development of the disorder is usually gradual, almost unnoticeable. Apneas start to manifest in patients who have a history of snoring, and the patients are often unaware of their disorder. Some visit the doctor after being nudged by their partners, who witness their restless sleep cycles and difficulties breathing during sleep, while some visit due to excessive daytime fatigue. The patients feel fatigue even after 8 or 10 hours of sleep. They often fall asleep during monotonous situations, which can result in fatal consequences, if it happens while driving a car. Over time, the patient also develops a gradual loss in cognitive functions, which means they get overly forgetful, have trouble concentrating and experience difficulties while performing more complex mental activities. Also, apnea syndrome patients are at a higher risk of having a stroke, atrial fibrillations, high blood pressure and cardiac arrest. If left untreated, one can develop central apnea, where the patient’s brain gives the order to stop breathing even if the airway is open.
Diagnosing this disorder is performed in a laboratory for sleeping disorders based on a polysomnographic test. The examination is completely painless; several thin wires are attached to the patient’s upper lip and chest area, and while he sleeps in a suite a test device monitors and later digitally analyses all the required parameters for an estimation of airway condition during sleep and the severity of the condition. After setting a diagnosis, the patient is usually required to have an otorhinolaryngological examination to determine if there are possible anomalies of the oropharyngeal opening and nasal cavity, and to perform the possible necessary surgical corrections.
If it is not adequately treated, the disorder usually has a chronic, often times progressive deterioration, which means that patients get more fatigued during the day, their difficulties remembering things get worse, and the risk of potential complications gets higher. Patients are advised not to consume alcohol during the evening and late at night because it increases the severity of the apnea.
If apneas occur only when sleeping on the back, patients are advised to have a tennis ball sewn into the back of their pajamas that will bother them at night and by doing so stop them from sleeping in an unwanted position. A reduction of excessive body weight is advised for all patients with obstructive sleep apnea. In the case of significant anatomical deformations, surgical correction or wearing oral appliances is advised.
The only effective treatment for moderate and severe forms of sleep apnea (which in the last few years has also been suggested for mild forms of apnea / hypopnea with the index number 5 or higher, according to the world’s leading experts in this field) is using the Continuous Positive Airway Pressure device – CPAP.
The device consists of a small turbine which creates a positive air current that flows through a mask onto the patient’s face. This keeps the patient’s airways continually open. This is a sophisticated device, which operates with almost no sound, and is soothing for the patient.
Apnea patients use the device without hesitation because it enables them to sleep peacefully, without the feeling of suffocation, and because they wake up well rested. After only several nights of using the CPAP, patients already feel less fatigued during the day, their cognitive functions (memory and concentration) improve, their blood pressure normalizes, and many of them have less trouble losing excessive weight.
Using the CPAP device enables patients to freely operate motor vehicles and machines, which is normally not suggested for untreated patients with increased feelings of daytime fatigue. Also, regular use of the CPAP at night reduces the risk of oxidative stress, which is caused by frequent apneas during the night. This also reduces all chronic risks such as stroke, high blood pressure, atrial fibrillation and heart failure.
Primarius Pavao Krmpotić, MD, PhD