OSA (Obstructive Sleep Apnea)

OSA (Obstructive Sleep Apnea)

What is OSA?
Obstructive sleep apnea or OSA is a sleep disorder where one stops breathing intermittently or has difficulty breathing adequate amount of air while asleep. Lack of air exchange can decrease the amount of oxygen in the body and can cause damage to important structures such as the brain and the heart. Severe snoring and awakening while gasping for air can disrupt a deep and restful sleep.

Why do I have sleep apnea?
Sleep apnea is usually due to a small jaw or loss of muscle tone. Enlarged tonsils, a large tongue or a small jaw can block the airflow while lying down. The throat muscles can collapse making the airway narrow. Genetic studies suggest that patients with a family member who has OSAS are 1.5 times more likely to have the disorder (knowledge update).

How do you diagnose sleep apnea?
OSA is diagnosed with a sleep study done at home or at a center. A sleep study called polysomnography records brain waves, oxygen level in your blood, hear rate, eye movement, sleep position, blood pressure and oral nasal airflow. From the data that is collected you can get an APNEA- HYPOPNEA INDEX (AHI). Apnea is when you stop breathing for 10 or more seconds and hypopnea is when the airflow is low and the blood oxygen level drops by 4%. The AHI is the number of apnea and hypopnea events per hour. A radiographic scan and, or fiberoptic pharyngoscopy (camera placed through the nose) allows examination the area of obstruction.

What are the signs of decreased sleep?
  • Excessive daytime sleepiness
  • Loud snoring
  • Breathing cessation that is observed by another person
  • Awakening due to gasping of air
  • Dry mouth on awakening
  • Memory loss
  • Mood alterations, Depression
  • Short term memory loss
  • Reduced libido
Daytime sleepiness is a sign of sleep apnea. Take the Epworth sleepiness scale test. (Link) This scale is a subjective indicator of obstructive sleep apnea. A higher score suggests further investigation.

What are the some of the consequences of sleep apnea?
  • Hypertension (high blood pressure)
  • Heart attack (Myocardial ischemia)
  • Congestive heart failure
  • Arrhythmia
  • Stroke (cerebrovascular accident)
What are risk factors?
  • Large neck
  • Small jaw
  • Male
  • Family history of sleep apnea
  • Narrow airway
  • Chronic nasal congestion
  • Over weight
How do you diagnose sleep apnea?
Clinical and radiographic examination along with a sleep study is recommended.

What are the treatments for sleep apnea?
Depending on the severity of the apnea there are conservative measures such as CPAP (Continuous positive airway pressure) and night guards may improve the sleep apnea. Some patients require surgical treatments. CPAP or continuous positive airway pressure is commonly used as a initial modality. It has a low patient acceptance rate due to noise, discomfort and dry mouth related to the machine. Oral appliance that mechanically gives a jaw thrust and can open up the airway and are effective in selective cases. When conservative modalities are ineffective, surgical treatment is discussed. Moving the jaw forward surgically to help open up the airway is one of the treatment options. Allowing the tongue to have more space and pulling the muscles of the tongue that are attached to the jaw forward prevents the tongue from falling back and blocking the passage of air. The muscles of the neck and tongue attach to the chin. Moving the chin forward via a genioplasty can create more space in select cases.

Dr. Song and Dr. Um have extensive experience in diagnosing and treating adult sleep apnea. Sleep apnea can potentially
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