OBSTRUCTIVE SLEEP APNEA-HYPOPNEA SYNDROME

The following discussion is for general informational purposes only and is not meant to provide the reader with specific medical advice. Please consult with your personal physician, or with a neurologist, for specific advice, guidance and information regarding your particular circumstances.

DESCRIPTION

Sleep related breathing disorders such as obstructive sleep apnea-hypopnea (OSAHS) syndrome are common, affecting up to 5 percent of the adult population.  It is caused by partial to complete collapse of the airway while sleeping.  Snoring is a common complaint associated with sleep related  breathing disorders and is brought up by the bed partner.   A sensation of gasping or choking in sleep, and recurrent dreams of suffocating or drowning may also be associated with sleep related breathing disorders.   Frequently, a bed partner may witness periods of apnea, defined as complete cessation of breathing for 10 seconds or longer while sleeping.   An overnight polysomnogram, or sleep study, is the most commonly used test diagnose the problem.  Sleep apnea is associated with obesity as well as certain craniofacial features including deviated nasal septum, high arched narrow palate, mandibular hypoplasia, and a large neck circumference.

SYMPTOMS

Sleep related breathing disorders can cause both nighttime and daytime symptoms.  Common nighttime symptoms include snoring, witnessed breathing abnormalities, frequent awakenings, sensations of choking and gasping, frequent urination after sleep, and dry mouth with the need to keep a glass of water at the bedside.  Common daytime symptoms include excessive sleepiness, clumsiness,  loss of dexterity, irritability, personality changes, memory impairment, decreased libido, impotence, and headaches.  Undiagnosed and untreated sleep apnea can increase the risk of hypertension, cardiac disease, stroke, as well as accidents due to excessive daytime sleepiness.

TREATMENT

Treatment of all sleep related breathing disorders is aimed at preventing airway collapse.  This can be achieved through several means including dental devices, surgery, and positive airway pressure therapy.  Dental devices are available through dentists and orthodontists who have special interests in the treatment of sleep apnea.  Surgical options typically involve removing the tonsils if still present, correcting nasal septum deviation, and reducing turbinate size.  More aggressive surgical interventions aim to advance the mandible and tongue to create space behind the tongue and are only available at highly specialized centers.  Continuous positive airway pressure (CPAP) therapy is the gold standard for treating sleep apnea and related disorders.  It involves wearing a special interface at night which is connected to a device that, calibrated to deliver a specific air pressure.  The pressurized air forms a splint that opens up the airway at all points, preventing collapse.