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Sleep Apnea

Wake Forest Baptist Approach The Wake Forest University Baptist Medical Center’s Sleep clinic is a diagnostic and therapeutic clinic for all sleep related illnesses.  Types of sleep related illnesses treated: Obstructive sleep apnea Obesity hyperventilation syndrome Periodic limb movements Restless leg syndrome Narcolepsy Insomnia Diagnostic techniques include: Polysomnography CPAP BiPAP titrations Multiple sleep latency studies John Conforti, M.D., is board certified in pulmonary and critical care medicine and is board eligible in sleep medicine. He has received extensive training as an interventional pulmonologist under Kevin Kovitz, M.D. who trained in Marseilles, France under internationally renowned  Jean-François Dumon, M.D., a pioneer in interventional bronchoscopy.  This training includes rigid bronchoscopy, laser therapy, adenomatous polyposis coli (APC) gene, electrocautery, metallic and silastic stent placement and balloon bronchoplasty. He is also trained in cardiopulmonary exercise testing in both athletes and disease states.     Obstructive sleep apnea Massively enlarged tonsils can cause episodes of cessation of breathing known as obstructive sleep apnea. Cessation of breathing can last 10 seconds or longer, causing extremely low levels of oxygen in the blood. Definition: Obstructive sleep apnea is a condition in which a person has episodes of stopped breathing during sleep. See also: Central sleep apnea Sleep disorders Alternative Names: Sleep apnea - obstructive; Apnea - obstructive sleep apnea syndrome Causes, incidence, and risk factors: Normally, the muscles of the upper part of the throat keep help keep the airway open and allow air to flow into the lungs. Even though these muscles usually relax during sleep, the upper throat remain open enough to let air pass by. However, some people have a narrower throat area, and during sleep, relaxation of the muscles causes the passage to completely close. This prevents air from getting into the lungs. Loud snoring and labored breathing occur. During deep sleep, breathing can stop for a short period of time (often more than 10 seconds). This is called apnea. An apnea episode is followed by a sudden attempt to breathe, and a change to a lighter stage of sleep. The result is fragmented sleep that is not restful, leading to excessive daytime drowsiness. Older obese men seem to be at higher risk, although as many as 40% of people with obstructive sleep apnea are not obese. The following factors may also increase your risk for obstructive sleep apnea: Certain shapes of the palate and jaw Large tonsils and adenoids in children Large neck or collar size Large tongue Narrow airway Nasal obstruction Recent weight gain Drinking alcohol or using sedatives before sleep may make you more likely to have an episode of apnea. Symptoms: It is important to emphasize that, often, the person who has obstructive sleep apnea does not remember the episodes of apnea during the night. The main symptoms are usually associated with excessive daytime sleepiness due to poor sleep during the night. Often, family members, especially spouses, witness the periods of no breathing. A person with obstructive sleep apnea usually snores heavily soon after falling asleep. The snoring continues at a regular pace for a period of time, often becoming louder, but is then interrupted by a long silent period during which there is no breathing. This is followed by a loud snort and gasp, and the snoring returns. This pattern repeats frequently throughout the night. Symptoms that may be observed include: Abnormal daytime sleepiness, including falling asleep at inappropriate times Awakening unrefreshed in the morning Depression (possibly) Episodes of no breathing (apnea) Lethargy Loud snoring Memory difficulties Morning headaches Personality changes Poor concentration Restless sleep Additional symptoms that may be associated with this disease: Hyperactive behavior, especially in children Leg swelling (if severe) Signs and tests: The health care provider will perform a physical exam. This will involve carefully checking your mouth, neck, and throat. You will be asked about your medical history. Often, a survey that asks a series of questions about daytime sleepiness, sleep quality, and bedtime habits is given. A sleep study (polysomnogram) is used to confirm obstructive sleep apnea. Other tests that may be performed include: Arterial blood gases Electrocardiogram (ECG) Echocardiogram Thyroid function studies Treatment: The goal is to keep the airway open so that breathing does not stop during sleep. The following may relieve symptoms of sleep apnea in some individuals: Avoiding alcohol or sedatives at bedtime Dental devices inserted into the mouth at night to keep the jaw forward Weight management or weight loss If these measures do not help, your doctor may recommend continuous positive airway pressure (CPAP) therapy. CPAP is the first-line treatment for obstructive sleep apnea. For information on this treatment, see:CPAP Surgery may be an option in some cases. This may involve: Uvulopalatopharyngoplasty (UPPP) to removing excess tissue at the back of the throat Tracheostomy to create an opening in the windpipe to bypass the blocked airway if anatomical causes are present (rarely done) Surgery to remove the tonsills and adenoids may cure the condition in children; it does not seem to help most adults. Expectations (prognosis): When treated correctly, obstructive sleep apnea may be controlled. However, many patients are unable or unwilling to tolerate CPAP therapy. Complications: During the nonbreathing episodes, blood oxygen levels falls. Persistent low levels of oxygen (hypoxia) may cause many of the daytime symptoms. If the condition is severe enough, pulmonary hypertension may develop, leading to right-sided heart failure or cor pulmonale. Other complications include: Abnormal heart rhythm (arrhythmia) Excessive carbon dioxide levels in the blood Heart disease High blood pressure Sleep deprivation Stroke Calling your health care provider: Call your health care provider if you have excessive daytime sleepiness, or if you or your family notice symptoms of obstructive sleep apnea. If you have this condition, call if symptoms do not improve with treatment or if new symptoms develop. Decreased consciousness, extreme sleepiness, hallucinations, personality changes, and persistent confusion can be a sign of a medical emergency. Seek immediate medical attention or call your local emergency number, such as 911. Prevention: Children with very large tonsils and adenoids may develop sleep apnea and related problems. They should be evaluated by a health care provider to determine whether they need to have their tonsils or adenoids removed. See: Tonsillectomy References: Patel NP, Ahmed M, Rosen I. Split-night polysomnography. Chest. 2007 Nov;132(5):1664-71. Basner RC. Continuous positive airway pressure for obstructive sleep apnea. N Engl J Med. 2007 Apr 26;356(17):1751-8. Patil SP, Schneider H, Schwartz AR, Smith PL. Adult obstructive sleep apnea: pathophysiology and diagnosis. Chest. 2007 Jul;132(1):325-37. Darrow DH. Surgery for pediatric sleep apnea. Otolaryngol Clin North Am. 2007 Aug;40(4):855-75. Friedman M, Schalch P. Surgery of the palate and oropharynx. Otolaryngol Clin North Am. 2007 Aug;40(4):829-43.

Review Date:9/11/2008 Reviewed By:Allen J. Blaivas, DO, Pulmonary, Critical Care, and Sleep Medicine, Department of Veteran Affairs, VA New Jersey Health Care System, East Orange , NJ . Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.