Sleep Apnea Lecture Notes

Overview

• Sleep apnea is a sleep disorder causing irregular breathing and snoring.
• It can lead to apnea where breathing momentarily stops.
• Results in severe exhaustion due to lack of restful sleep.

Types of Sleep Apnea

1. Obstructive Sleep Apnea (OSA)

   • Most common form.
   • Caused by blockage of airways.
   • Contributing factors:
     • Allergies causing nasal tissue swelling.
     • Swollen adenoids or tonsils.
     • Severe overbite pulling the jaw back.
     • Excess weight in the neck area, especially when lying down.
   • Hormonal changes at night reduce muscle stiffness, leading to airway obstruction.

2. Central Sleep Apnea (CSA)

   • Related to central nervous system issues.
   • Brain intermittently stops effort to breathe (10-30 seconds).
   • Cycle of hyperventilation and apnea:
     • Hyperventilation (Hyperpnea): Rapid breathing decreases CO2 levels (hypocapnia).
     • Apnea: No breathing effort, CO2 levels rise (hypercapnia).
     • Cycle repeats with alternating states of no breathing and hyperventilation.

Symptoms

• Severe sleep deprivation.
• Nocturia (excessive urination at night).
• Stress-induced insomnia.
• Daytime symptoms: difficulty concentrating, headaches, fatigue.
• Loud snoring preceding apneic episodes.

Health Implications

• Rarely fatal but worsens other health issues.
• Lower oxygen levels cause:
  • Anginal chest pain.
  • Arrhythmia (irregular heartbeat).
• Increased risk for heart failure, respiratory failure, diabetes, certain cancers.

Diagnosis

• Requires a sleep study (polysomnogram).
• Monitors brain activity, oxygen and CO2 levels, vital signs, snoring, and movement.

Treatment

• Lifestyle Modifications:
  • Avoid sleeping pills, alcohol, depressive medications.
  • Sleep on the side instead of the back.
• Continuous Positive Airway Pressure (CPAP):
  • Device keeps airways open with pressurized air.
  • Effective if used continuously, but often stopped due to annoyance or difficulty.
• Oral Appliances:
  • Custom-made mouthpieces to improve airflow.
• Surgical Options:
  • Removal of adenoid tissue or jaw realignment.
  • Surgery can be complicated by anesthesia and post-surgical swelling.

Conclusion

• Sleep apnea results from physical or neurological issues affecting breathing.
• If untreated, it can exacerbate other health conditions.
• Important for clinicians to focus on understanding and managing this disorder.