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Obstructive sleep apnea
Obstructive sleep apnea is a condition in which the flow of air pauses or decreases during breathing while you are asleep because the airway has become narrowed, blocked, or floppy.
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A pause in breathing is called an apnea episode. A decrease in airflow during breathing is called a hypopnea episode. Almost everyone has brief apnea episodes while they sleep.
This article discusses obstructive sleep apnea in adults.
Sleep apnea - obstructive; Apnea - obstructive sleep apnea syndrome; Sleep-disordered breathing; OSA
Causes, incidence, and risk factors
All of the muscles in your body become more relaxed during sleep. This includes the muscles that help keep the airway open and allow air to flow into the lungs.
Normally, the upper throat still remains open enough during sleep to let air pass by. However, some people have a narrower throat area. When the muscles in their upper throat relax during sleep, their breathing can stop for a period of time (often more than 10 seconds). This is called apnea.
The snoring in people with obstructive sleep apnea is caused by the air trying to squeeze through the narrowed or blocked airway. However, everyone who snores does not have sleep apnea. Other factors that may also increase your risk include:
Sleeping on the back also increases sleep apnea episodes.
A person who has obstructive sleep apnea often is not aware of the apnea episodes during the night. Often, family members witness the periods of apnea.
A person with obstructive sleep apnea usually begins snoring heavily soon after falling asleep. Often the snoring gets louder. The snoring is then interrupted by a long silent period during which there is no breathing. This is followed by a loud snort and gasp, as the person attempts to breathe. This pattern repeats.
Many people wake up unrefreshed in the morning and feel sleepy or drowsy throughout the day. This is called excessive daytime sleepiness (EDS).
People with sleep apnea may:
Problems that may occur with this condition:
Signs and tests
The health care provider will perform a complete history and physical exam. This will involve carefully checking your mouth, neck, and throat. You may be given a survey that asks a series of questions about daytime sleepiness, sleep quality, and bedtime habits.
A sleep study (polysomnogram) is used to confirm obstructive sleep apnea.
Other tests that may be performed include:
The goal is to keep the airway open so that breathing does not stop during sleep.
The following lifestyle changes may relieve symptoms of sleep apnea in some people:
Continuous positive airway pressure (CPAP) is now the first treatment for obstructive sleep apnea in most people. CPAP is delivered by a machine with a tight-fitting face mask.
Many patients have a hard time sleeping with CPAP therapy. Good follow-up and support from a sleep center can often help overcome any problems in using CPAP. For information on this treatment, see: CPAP.
Some patients may need dental devices inserted into the mouth at night to keep the jaw forward.
Surgery may be an option in some cases. This may involve:
Surgery to remove the tonsils and adenoids often cures the condition in children. It does not seem to help most adults.
People with poorly treated sleep apnea often have:
Because of daytime sleepiness, people with sleep apnea have an increased risk of:
With treatment, the symptoms and problems of sleep apnea should be totally corrected.
Untreated obstructive sleep apnea may lead to or worsen heart disease, including:
Calling your health care provider
Call your health care provider if:
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Tomfohr LM, Ancoli-Israel S, Loredo JS, Dimsdale JE. Effects of continuous positive airway pressure on fatigue and sleepiness in patients with obstructive sleep apnea: data from a randomized controlled trila. Sleep. 2011;34:121-126.
Epstein LJ, Kristo D, Strollo PJ Jr., et al. Adult Obstructive Sleep Apnea Task Force of the American Academy of Sleep Medicine: clinical guideline for the evaluation, management, and long-term care of obstructive sleep apnea in adults. J Clin Sleep Med. 2009;5:263-276.
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Aurora RN, Casey KR, Kristo D, et al. Practice parameters for the surgical modifications of the upper airway for obstructive sleep apnea in adults. Sleep. 2010;33:1408-1413.
Reviewed by:Denis Hadjiliadis, MD, Assistant Professor of Medicine, Division of Pulmonary, Allergy and Critical Care, University of Pennsylvania, Philadelphia, PA. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
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