Sleep-Disordered Breathing

Sleep-disordered breathing broadly refers to a group of disorders characterized by abnormalities of respiratory pattern (such as stoppages in breathing) or the abnormal reduction in gas exchange while sleeping. Obstructive sleep apnea (OSA) is the most common type of sleep-disordered breathing problem.

An estimated 50 million people in the United States suffer from OSA. OSA occurs when the upper airway (near the back of the mouth) collapses during sleep, obstructing the airway leading to a stoppage of one’s breathing. OSA is caused by multiple factors, including sleep-induced relaxation of the throat muscles and tongue, enlarged tonsils and adenoids, an abnormally small airway diameter in the back of the mouth and throat, and extra soft tissue in the throat due to being overweight.

OSA leads to pauses in breathing during sleep. These pauses (apneas) may last more than 20 seconds and can occur from 5-80 times each hour, depending on severity. Each apnea may lead to an unconscious mini-arousal and usually ends with a gasp or snort that marks the resumption of breathing. Due to these many mini-arousals, people with OSA suffer from fragmented, unrefreshing sleep. Furthermore, the decrease in gas exchange during an apnea can lead to immediate consequences such as decreased blood oxygen levels, increased blood carbon dioxide levels, and dramatic elevations in intrathoracic negative pressure. It should also be noted that OSA patients almost always snore. Importantly, untreated OSA can cause high blood pressure, heart attacks, stroke, memory problems, weight gain, headaches, job impairment, and motor vehicle crashes.

Treatment for mild OSA may involve lifestyle modification such as losing weight, avoiding alcohol, nicotine and medicines that cause drowsiness, and sleeping on one’s side instead of back. Some patients use oral appliances that advance the lower jaw or tongue and are fitted by dentists or orthodontists. Treatment for moderate to severe OSA commonly involves continuous positive airway pressure (CPAP). Surgery involving soft palate and tonsil resection is typically reserved for those patients who are not compliant on CPAP.

CPAP involves the wearing of a tight-fitting face mask attached by a tube to an airflow generator. The airflow generator blows air into the throat at sufficient pressure to prop the throat open during sleep. Problems with the CPAP include the need for individualized pressure titration, claustrophobia, facial skin irritation, dry or stuffy nose, stomach bloating, sore eyes, headache, and inconvenience.

Surgical treatments for OSA include uvulopalatopharyngoplasty (UPPP), laser-assisted uvulopalatoplasty (LAUP) and tracheostomy.

If you think you might have obstructive sleep apnea, contact your physician.

The following list of resources can help you learn more about sleep apnea: