HEALTHNET

An Invisible Killer - Sleep Apnea Syndrome

(Posted on 2 June 2008)

Sleep Apnea Syndrome is very common in Hong Kong. It is estimated that over 100,000 people are suffering from this illness.

What is Sleep Apnea?

Sleep apnea is periods when you stop breathing while you are sleeping. These interruptions in your breathing, which can last 10 seconds or longer, occur when the muscles in your soft palate, uvula, tongue and tonsils relax during sleep. This is the same process involved with normal snoring, but with sleep apnea, the airway narrows so much that it closes. Your breathing stops, cutting off the flow of oxygen into your body and reducing the elimination of carbon dioxide (CO2) from the blood. Your brain detects this rise in CO2 and briefly wakes you up, re-opening your airways and re-starting your breathing. This process can be repeated several times during the night, more than five times per hour is counted as abnormal.

What are the health risks due to untreated sleep apnea?

Long-term brain oxygen deficit caused by untreated sleep apneas may bring other serious illnesses such as hypertension, cardiopulmonary function failure and stroke.

Sleep Apnea can be further classified into three main categories:

1. Obstructive Sleep Apnea (OSA): It is the most common category of sleep-disordered breathing, mainly caused by excessive soft tissue blocking the throat or an overly narrow upper respiratory tract resulting in breathing difficulty which can leads to periodic obsyrcution eventually.
2. Central Sleep Apnea (CSA): It occurs when the brain fails to send the signal to muscles to breathe. This usually occurs in infants or in adults with heart disease, cerebrovascular disease, or congenital diseases.
3. Mixed Sleep Apnea: Patients will have obstructive and central sleep apnea at the same time, such as the central nervous coordination problems together with airway obstruction.

The cardinal symptom of sleep apnea is loud snoring and periodic apnea during sleep. The other common symptoms are headaches, sore and/or dry throat after waking up in the morning, excessive daytime sleepiness.

 

• Is there a direct relationship between sleep apnea, genes and daily living habits?
• My kids are skinny, should they have less chance of suffering from Sleep Apnea?
• What are the treatments of sleep apnea? What extra attention should the patients be aware in their daily lives?
• Why are we still snoring even without suffering from sleep apnea? Would it affect our health in general?
• What are the ways to improve loud snoring especially when it is affecting your partner's chance for a good night rest and the relationship?
• Assess your day time sleepiness - Epworth Sleepiness Scale

Source: Quality HealthCare

Is there a direct relationship between sleep apnea, genes and daily living habits?

Men may not pay attention to their snoring habit. In fact, it is estimated that about four percent of Hong Kong male population are suffering from this illness. Obesity in middle-aged men constitutes among the high-risk population, due to lack of exercises. Lack of exercise leads to increase in body fat and loose muscle tissues will lead to upper respiratory tract congestion.

Sleep apnea can be divided into the causes of congenital and acquired causes. Congenital factors such as Down's syndrome, brain development, and other development anomaly are affecting children mainly. Sleep Apnea is not a hereditary illness; it is mainly caused by the acquired factors including too much fat in the throat and hypoplastic jaw.

In Hong Kong, people tend to believe that taking sleeping pills can ease the sleeping problem. Sleeping pills in fact will suppress central nervous system, thus triggering Sleep Apnea. Smoking can causes pharyngitis. While taking too much alcohol can narrow the airway and loosen breathing muscle, increasing the potential of tongue throat obstruction and suffocation.

In addition, hypertrophic tonsils and adenoid can compromise the upper airway of children. In fact, unlike adult counterparts, children with obstructive sleep apnea syndrome are caused by hypertrophic tonsils and adenoid. Tonsillectomy and adenoidectomy are effective treatment in children with OSA.

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My kids are skinny, should they have less chance of suffering from Sleep Apnea?

Sleep Apnea is not limited to obese persons. Children tend to have symptoms slightly different from adults. Apart from cardinal symptoms of snoring, children with OSA were observed to have labored breathing and gasping during sleep while in the daytime, they exhibit excessive daytime sleepiness, inability to concentrate and hyperactivity. In addition, children suffering from sleep apnea are not always related to obesity, they are more likely to be thin because the brain hypoxia has affected their growth.

Children suffering from obstructive sleep apnea are three times higher at risk to hypertension than the normal children.

Children having high blood pressure will have higher chance of getting deformed blood vessels, thus increasing the risk of stroke when they grow up. Parents should not take it lightly. If your children present heavy snoring and breathing or short-term pause, mouth breathing, waking up with dry throat and bedwetting, immediate medical diagnosis is strongly recommended.

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What are the treatments of sleep apnea? What extra attention should the patients be aware in their daily lives?

Different treatment methods can be employed for various degrees of sleep apnea.

Improving living habits

The first thing patients must do, is improving their living habits. Patients must be aware of their weight problem, take effective measures to lose or control their weight and exercise regularly. Stop smoking, avoid excessive alcohol and sleeping pills. Take a lateral approach to sleep and use special pillows, can both help to improve the condition.

Continuous Positive Airway Pressure Machine(CPAP)

Positive airway pressure, the most widely recommended treatment for moderate to severe obstructive sleep apnea, entails wearing a mask-like device while you are sleeping. The device supplies pressurized air, which helps prevent the airway from collapsing. The most common of these devices is called CPAP (Continuous Positive Airway Pressure), which provides constant positive air pressure to the oral airway when it is collapsed.

Dental appliance

This device opens up the narrow oral airway by drawing lower jaw or tongue forward during sleep.

Surgery

Surgery can be performed to reconstruct the jaw and enlarge the upper airway if the above treatments are proven to be ineffective, or patients do not prefer wearing a sleeping-mask. The operation process can be divided into stages to counteract the different levels of obstruction in the airway. They include correction of the nasal septum, resection of nasal turbinates, laser assisted uvulpalatal surgery, advancement of mandible and maxilla, tonsillectomy and adenoidectomy etc.

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Why are we still snoring even without suffering from sleep apnea? Would it affect our health in general?

Snoring is caused by a narrowing of your airway, either from poor sleep posture or abnormalities of the soft tissues in your throat. A narrow airway interferes smooth breathing and creates the "snore" sound caused by vibration of uvula. Although Sleep Apnea patients will snore, it does not necessarily means one is suffering from sleep apnea. Snoring itself will not pose a health threat, but if it is caused by sleep apnea, immediate doctor diagnosis is suggested.

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What are the ways to improve loud snoring especially when it is affecting your partner's chance for a good night rest and the relationship?

Finding a cure for your snoring problem can improve the quality of life for you and your loved ones. Losing weight will reduce the fatty tissue in your airway. Eating light and improving your fitness level can significantly improve your ability to breathe freely when you sleep.

For less severe cases, you can use nose paste, mouth guard, and other support to help. While for those acute cases, you may consider increasing the size of your airway by surgically removing the tissues or correcting the abnormalities. In addition, two other approaches could also be considered:

1. Using a laser, radiofrequency energy, or a surgery to remove tonsils, adenoids and excess tissue at the back of the throat or inside the nose, or to reconstruct the jaw.
2. Palatal implantation with Teflon pillars a new surgery, which has shown promising results for snorers recently. Small Teflon implants, less than an inch-long in size, are inserted into the soft palate stiffening the uvula and reduce the snoring sound.

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Assess your day time sleepiness - Epworth Sleepiness Scale

Most snoring people are unaware of the potential threat of sleep apnea. Before seeking doctor's diagnosis, you can try the following sleepiness scale test (Epworth Sleepiness Scale), which will help you assess the level of daytime sleepiness.

Have your ever dozed in the following situations (not just feeling tired, but really fell asleep)? Please try to circle the closest answer.

Criteria:

Total Score:

 

Breaking it down further, you are having excessive daytime sleepiness if you scored higher than 10. If you are having a snoring problem at the same time, you may be suffering from Sleep Apnea already, immediate medical diagnosis is suggested.

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Source: Quality HealthCare

 

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