Obstructive Sleep Apnea - When the Snoring Stops

While snoring is hardly a medical problem itself, it may be one of several signs that a patient suffers from obstructive sleep apnea (OSA). OSA results when the upper airway relaxes during sleep and breathing is interrupted. Friends or family may observe the snoring progress to what sounds like choking and eventually apnea where breathing actually stops. During this time carbon dioxide (which is exhaled during normal breathing) starts to accumulate in the bloodstream. Simultaneously, oxygen levels fall. Eventually, the brainstem detects these changes and stimulates the patient to breathe. This may result a gasp or an awakening, the patient resumes breathing, and the cycle repeats itself.

This is important because decreased oxygen levels constrict the blood vessels in the lungs and force the right side of the heart to work harder to pump blood through them. Over time, OSA can lead to chronic hypertension, and in some cases, heart failure over time.

Patients with OSA often complain of sluggishness as they don't enjoy normal, restorative sleep patterns. Patients may experience a sore throat, headaches, and may doze off repeatedly during the day even while at the wheel.

OSA is especially important to diagnose and treat in patients who are on or will be put on pain medications or anti-anxiety medications since these drugs may cause the soft tissues of the mouth and upper airway to relax, thus increasing the likelihood of apneic episodes. Additionally, opiate medications such as hydrocodone or morphine decrease the brain's responsiveness to higher carbon dioxide levels. There are well documented cases where patients with untreated OSA have died after being put on opiates after surgery without proper monitoring of their oxygen levels.

Risk factors for OSA include: obesity, thick neck circumference, use of sedatives including alcohol, age (older), smoking, chronic throat problems, and male gender.

A diagnosis of obstructive sleep apnea is made with a sleep study during which the frequency and severity of the apnea are recorded.

Treatment usually involves having the patient sleep in a mask that delivers positive pressure to to the airway (e.g. CPAP mask). Sometimes surgery is offered if removing tissue can open up the throat passages.

In summary, if a patient complains of poor sleep and energy levels, has high blood pressure, is overweight, falls asleep easily during the day, and snores loudly or experiences episodes of apnea as witnessed by others, he/she probably needs a sleep study. In this case, a physician would be wise to order a sleep study before starting a narcotic medication (especially a long-acting drug). Patients with OSA or who are suspected of having sleep apnea should have their oxygen levels monitored when placed on pain medication in the hospital if they are not wearing a CPAP mask.

As hard as it for some patients to get used to wearing the CPAP mask, many experience an improvement in their blood pressure and feel a renewed sense of energy. Symptoms like headache may disappear, and the threat of right heart failure may be eliminated.

If you suspect that you or a loved one suffers with obstructive sleep apnea, consult your physician.