Sleep Apnea

Sleep apnea is a sleep-related breathing disorder: Those affected suffer breathing interruptions during sleep.

The noises are loud and irregular compared to regular snoring (also a sleep-related breathing disorder). Sleep apnea mainly affects men who have too many pounds on their ribs.

Here you can read everything you need to know about sleep apnea.

Article overview

1. Description
2. Examinations and diagnosis
3. Symptoms
4. Causes and risk factors
5. Treatment
6. Course of the disease and prognosis

Sleep apnea: description

Snoring is a common phenomenon that increases with age. Almost every second person produces the nocturnal noises:

During sleep, the muscles of the mouth and throat relax, the airways become narrower. The typical fluttering noise of the uvula and soft palate is created, but this usually does not result in a brief respiratory arrest.

It is different with sleep apnea: Here, the snorer’s breathing repeatedly stops briefly. The term “sleep apnea” comes from the Greek: “A-Poe” means something like “without breath.”

Sleep apnea disturbs sleep and ensures that those affected do not wake up refreshed in the morning. This often also applies to the person next to the bed, disturbed by the thunderous and irregular snoring and breathing pauses. Sleep apnea syndrome is dangerous because the short breathing pauses during sleep can expand into long-lasting, threatening respiratory arrests.

Note:

Sleep apnea and regular snoring are classed as sleep-related breathing disorders (SBAS). These breathing disorders occur exclusively or primarily during sleep.

Sleep apnea: frequency

There are no precise figures on how often sleep apnea occurs – not every “snorer” sees a doctor. According to the International Classification System for Sleep Disorders (ICSD), around two to seven percent of the total adult population have sleep apnea. Overweight people have particularly affected: about two-thirds of patients with sleep apnea syndrome are too fat.

In addition, the frequency of sleep apnea increases with age.

Forms of sleep apnea

Doctors differentiate between obstructive and central sleep apnea:

Obstructive Sleep Apnea (OSAS)

Obstructive sleep apnea syndrome is the most common type of sleep apnea. During sleep, the muscles of the soft palate relax. As a result, in people with obstructive sleep apnea, the negative pressure generated when breathing in causes the windpipe to collapse, i.e., collapse, at various points in the upper respiratory tract. The air can then no longer flow freely – the sleeper cannot breathe for a short time.

As a result of this respiratory failure, the oxygen content in the blood drops (hypoxemia), and there is an insufficient supply of the tissue. This causes the body to “wake up”:

• It abruptly activates the breathing muscles of the diaphragm and chest.
• The heart also increases its performance.
• The blood pressure rises.

The sleeper usually wakes up briefly. Doctors call this awakening caused by sleep apnea “arousal.” If breathing then starts again, several deep breaths typically follow.

The brief respiratory arrests associated with obstructive sleep apnea can occur up to 100 times a night. The person concerned can usually no longer remember the following day. He kept waking up briefly at night due to a lack of oxygen.

Central sleep apnea

The second form of sleep apnea is central sleep apnea. This form is triggered by a malfunction in the central nervous system (CNS). The upper airways remain open here, but the breathing muscles of the chest and diaphragm do not move sufficiently. As a result, the person concerned inhales too little and not deeply enough. The resulting lack of oxygen alerts the brain, which immediately ensures that a deep breath is taken.

Central sleep apnea mainly affects the elderly. It is often harmless and usually does not require treatment – unless it is combined with a weak heart or nerve disorder. Then those affected should go to the doctor.

Sleep apnea: examinations and diagnosis

Anyone who snores (often noticed by their partner, but not by the person affected) and who suffers from respiratory arrest during sleep should consult an ear, nose, and throat (ENT) doctor. There are several steps involved in diagnosing “sleep apnea” – there is no such thing as “one” sleep apnea test.

The doctor will first ask you about your medical history (anamnesis), for example:

· Do you have any previous illnesses?

· Do you have insomnia?

· Do you take medication (e.g., sleeping pills or sedatives)?

· How about your alcohol consumption?

· Do you use drugs?

· What are your sleeping habits?

In addition to these questions, the doctor may ask you to fill out a questionnaire. A physical examination follows this. The ENT doctor looks for anatomical abnormalities in the oral cavity and in the nasopharynx – for example, bite irregularities (position of the jaws relative to each other), curvatures of the nasal septum, or nasal and pharyngeal polyps. The paranasal sinuses are easy to visualize with imaging techniques.

The doctor will also determine your body mass index (BMI) from your height and weight.

Sometimes, clarification of sleep disorders and sleep-related breathing disorders also requires polysomnography – examining and measuring various parameters during sleep. You usually have to spend one to two nights in a sleep laboratory for this. Doctors analyze your sleep behavior, breathing during sleep, and other factors that indicate sleep disorders (sleep apnea screening). Electrodes attached to the skin help in this process, registering, among other things, the airflow of breathing, the pulse rate, the oxygen content in the blood, and the movements of the chest. 

Also, in the multiple sleep latency test (MSLT), the patient has to take a short nap of around 20 minutes every two hours. The test records the tendency to fall asleep and the degree of daytime sleepiness.

For some time now, there have also been devices for breathing breath analysis during sleep at home. They enable similar recordings to those in the sleep laboratory but do without belts and nasal cannula. Instead, the measurement can be made on the patient’s finger, for example, where a probe measures the minor changes in the blood vessels and thus concludes breathing.

Note：

Current medical guidelines for sleep-related breathing disorders advocate using home devices to aid in the diagnosis of sleep apnea.

Sleep apnea: symptoms

Typical symptoms of sleep apnea are repeated pauses in breathing during sleep. The respiratory arrests last between 10 and 120 seconds and occur more than five times an hour. This is followed by phases of excessive breathing (hyperventilation) and loud and irregular snoring (when the patient is breathing hard). In addition to snoring, partners and relatives often notice the pauses in breathing at night while the person concerned is unaware of them.

Consequences of sleep apnea

Sleep apnea has consequences. In general, sleep is disturbed, so that those affected suffer from a chronic sleep deficit and tiredness during the day. They are also forgetful and have trouble concentrating. This also increases the risk of accidents on the road.

Some people with sleep apnea also have anxiety or depression. In part, the breathing disorder leads to headaches (especially in the morning hours) and decreased sexual desire. Erectile dysfunction can occur in men.

Sleep apnea in children

Obstructive Sleep Apnea Syndrome (OSAS) can also affect children. According to experts, breathing disorders may also play a role in sudden infant death syndrome.

Older children with OSAS often appear sluggish and clumsy. They usually stand out in school because of their poor performance.

Sleep apnea: causes and risk factors

Various factors contribute to the development of obstructive sleep apnea syndrome. These include:

· body mass index too high (overweight)

· age (the frequency of sleep apnea increases with age)

· Gender (men are more often affected than women)

· Taking sleeping pills or sedatives (muscles in the roof of the mouth relax more quickly and close the airways)

· Deviations in the structure of the facial skull (craniofacial peculiarities): An example is a lower jaw that is too small or falling back or a crooked nasal septum.

Further risk factors are smoking, alcohol, pregnancy, and existing diseases such as rheumatism, acromegaly, hypothyroidism, or polycystic ovarian syndrome. A large tongue, enlarged tonsils (tonsils), nasal polyps, and a lot of fatty and connective tissue at the entrance to the airways can also promote sleep apnea. In general, rough sleeping times can make symptoms worse.

Central sleep apnea is rare and is caused by disorders in the central nervous system (CNS). Due to neurological damage, the control of the respiratory muscles works poorly.

One possible cause is Lyme disease. Patients with heart failure often (sometimes on an obstructive) suffer from central sleep apnea. Central sleep apnea can also occur due to chronic kidney failure (chronic kidney failure) or shortly after a stroke.

Sleep apnea: treatment

You can find out which therapy options are available for sleep apnea in the article Sleep apnea treatment.

Sleep apnea: disease course and prognosis

Obstructive sleep apnea should be treated because it affects health as well as professional and private life:

· Patients with daytime sleepiness are up to seven times more likely to have an accident on the road.

· Sleep apnea is related to high blood pressure, cardiac insufficiency, coronary heart disease, and cardiac arrhythmias.

· A connection with pulmonary hypertension, diabetes mellitus, kidney failure (kidney failure), and arteriosclerosis seems likely.

· Obstructive sleep apnea syndrome is generally associated with increased mortality.

In people with dementia, sleep apnea treatment is also essential because the sleep-related breathing disorder further promotes mental decline.

Sleep apnea during pregnancy can harm the unborn baby. However, there are currently no controlled studies to recommend therapy for sleep apnea (and other sleep-related breathing disorders) in pregnant women.

Apart from the possible health consequences, snoring and sleep apnea also burden the partnership.