Obstructive Sleep Apnoea (OSA)

Obstructive Sleep Apnoea (OSA) is a common sleep disorder characterized by repeated episodes of partial or complete upper airway obstruction during sleep, resulting in reduced or completely halted airflow despite ongoing breathing efforts. This condition affects approximately 4% of middle-aged men and 2% of middle-aged women, although it can occur at any age.

Symptoms

• Loud Snoring: One of the most common symptoms, occurring in approximately 90% of patients with OSA. However, not everyone who snores has OSA.
• Daytime Sleepiness: Excessive daytime sleepiness (EDS) is a hallmark symptom, resulting from fragmented and poor-quality sleep.
• Nocturnal Awakenings: Patients may experience frequent awakenings during the night, often with a sensation of choking or gasping for air.
• Morning Headaches: Morning headaches are common due to the low oxygen levels and increased carbon dioxide levels in the blood during sleep.
• Cognitive Impairment: Difficulty concentrating, memory loss, and decreased cognitive function can occur as a result of chronic sleep deprivation.
• Mood Disturbances: Depression, anxiety, and irritability are common among patients with untreated OSA.
• Nocturia: Frequent nighttime urination is often reported by patients with OSA, possibly due to increased atrial natriuretic peptide levels during sleep.

Causes and Risk Factors

The exact cause of OSA is multifactorial, involving a combination of anatomical and physiological factors. Key risk factors include:

• Obesity: Excess weight, particularly around the neck and throat area, increases the risk of developing OSA.
• Family History: A family history of OSA may increase an individual's risk due to inherited anatomical characteristics.
• Anatomical Abnormalities: Enlarged tonsils, a large tongue, or a narrow airway can contribute to the development of OSA.
• Age: The risk of developing OSA increases with age, particularly after the age of 40.
• Male Sex: Men are more likely to develop OSA than women, although the risk for women increases after menopause.
• Smoking and Alcohol Consumption: Both smoking and alcohol consumption can increase the risk of developing OSA.

Treatments

Treatment for OSA depends on the severity of the condition and may involve a combination of lifestyle modifications, oral appliances, and medical devices. The primary goal is to keep the airway open during sleep, thereby improving oxygenation and reducing symptoms.

• Lifestyle Modifications:
  • Weight Loss: For overweight or obese patients, weight loss can significantly reduce the severity of OSA.
  • Exercise Regularly: Regular physical activity can help improve sleep quality and reduce symptoms of OSA.
  • Avoid Alcohol and Sedatives: Avoiding alcohol and sedative medications before bedtime can help reduce the risk of airway obstruction during sleep.
  • Quit Smoking: Smoking cessation can help reduce inflammation in the upper airway, thereby decreasing the severity of OSA.
• Continuous Positive Airway Pressure (CPAP) Therapy: The most common treatment for moderate to severe OSA, CPAP involves wearing a mask over the nose and/or mouth during sleep. The device delivers a constant stream of air pressure into the airways, keeping them open.
• Oral Appliances: Custom-made oral appliances can help advance the position of the lower jaw, thereby increasing the size of the upper airway and reducing obstruction.
• Surgery: In some cases, surgery may be necessary to remove excess tissue or other obstructions in the upper airway. Common surgical procedures include uvulopalatopharyngoplasty (UPPP), radiofrequency ablation, and maxillomandibular advancement.
• Alternative Therapies: Other treatments, such as positional therapy (sleeping on one's side) and nasal dilators, may also be recommended to help manage symptoms of OSA.

Complications and Prognosis

If left untreated, OSA can lead to significant complications, including:

• Cardiovascular Disease: Increased risk of high blood pressure, heart attacks, strokes, and cardiac arrhythmias.
• Type 2 Diabetes: OSA has been linked to an increased risk of developing type 2 diabetes.
• Cognitive Impairment: Chronic sleep deprivation can lead to long-term cognitive impairment and increased risk of dementia.
• Motor Vehicle Accidents: Excessive daytime sleepiness increases the risk of motor vehicle accidents.

With proper treatment, most patients with OSA can experience significant improvement in symptoms and quality of life. Regular follow-up appointments with a healthcare provider are essential to monitor treatment efficacy and make any necessary adjustments.