Overview
Obstructive sleep apnea (OSA) is the repeated complete or partial blockage of the upper airway during sleep, leading to breathing pauses. During an episode, oxygen decreases, the patient briefly wakes up (usually unaware), and breathes again. This can repeat dozens to hundreds of times a night.
It is seen in 15-20% of middle-aged men; it also occurs in women and children. Untreated, it significantly increases the risk of heart disease, stroke, and diabetes.
Symptoms
During sleep:
- Loud snoring
- Witnessed breathing pauses (by partner, family)
- Waking up gasping
- Frequent awakenings
- Tossing, waking up tossing
- Excessive sweating
- Frequent night urination
During the day:
- Excessive sleepiness (most prominent)
- Morning headache
- Fatigue
- Difficulty concentrating
- Memory problems
- Irritability, depression
- Erectile dysfunction
- Increased risk of traffic accidents
- Falling asleep at work
Causes
Relaxation and blockage of upper airway muscles during sleep:
- Excessive relaxation of throat, tongue muscles
- Structural narrowing (tongue size, jaw structure)
- Tonsil, adenoid enlargement
- Soft palate looseness
- Neck circumference thickness
Risk Factors
- Obesity (strongest risk factor)
- Being male
- Over age 40
- Large neck circumference (men >43 cm, women >38 cm)
- Family history
- Smoking, alcohol
- Nasal congestion (septum deviation, polyps)
- Hypothyroidism, acromegaly
- Postmenopausal women
- Sleep position (on back)
- Use of sedatives, sleeping pills
- In children: tonsil/adenoid enlargement
Complications
- Cardiovascular:
- High blood pressure (resistant)
- Atrial fibrillation
- Heart attack
- Heart failure
- Stroke
- Metabolic:
- Diabetes
- Insulin resistance
- Metabolic syndrome
- Other:
- Traffic and work accidents
- Depression
- Cognitive decline
- Sudden cardiac death
- Surgical complications (anesthesia)
- Fatty liver
When to See a Doctor
- If your partner or close circle reports loud snoring
- Breathing pauses during sleep
- Waking up persistently tired
- Excessive daytime sleepiness
- Uncontrolled blood pressure
- Unexplained headaches
- Concentration, memory problems
- Sexual dysfunction
Diagnosis and Treatment
Diagnosis:
- Detailed sleep history
- Epworth Sleepiness Scale
- Polysomnography (sleep test): Gold standard
- Apnea-Hypopnea Index (AHI):
- <5: Normal
- 5-15: Mild
- 15-30: Moderate
-
30: Severe
- Home sleep tests
Treatment:
1. CPAP (Continuous Positive Airway Pressure):
- Gold standard
- Pressurized air through a mask to nose/mouth
- Lifelong use
- Significantly improves symptoms
- Reduces complication risk
2. Other devices:
- BiPAP: Two pressure levels
- APAP: Auto-adjusting
- Oral appliances (MAD): In mild cases, advance the lower jaw
3. Surgery:
- Tonsillectomy, adenoidectomy (especially in children)
- Uvulopalatopharyngoplasty (UPPP)
- Hyoid suspension
- Bimaxillary advancement surgery
- Hypoglossal nerve stimulation (Inspire)
- Bariatric surgery (with obesity)
4. Lifestyle changes:
- Weight loss (critical)
- Sleeping on the side (not on back)
- Quit alcohol, smoking
- Avoid sedatives
- Regular sleep
- Treat nasal congestion
Prevention
- Maintain a healthy weight
- Quit smoking
- Do not drink alcohol within 3 hours of bedtime
- Avoid sleeping on your back
- Sleep on your side (you can sew a tennis ball to a pillow behind you)
- Treat allergies, sinus problems
- Exercise regularly
- Do not eat heavy meals before sleep
- Evaluate large tonsils/adenoids in children
- Get a sleep test if you are at risk