Sleep apnea
All about sleep apnea
Over 1 billion people worldwide suffer from sleep apnea. The number of unreported cases is high, as many cases are not diagnosed. Men are affected more often than women.
What is sleep apnea?
Sleep apnoea is a sleep disorder in which breathing pauses occur repeatedly during sleep. These pauses in breathing are caused by a narrowing or blockage of the upper airways and can last from several seconds to several minutes. They significantly impair the quality of sleep. Those affected often experience extreme tiredness and difficulty concentrating during the day. In the long term, sleep apnoea can increase the risk of high blood pressure, heart attacks, strokes and other health problems.
Possible symptoms of sleep apnea
The symptoms of sleep apnea are not always obvious, as the pauses in breathing occur mainly during sleep. However, the most common signs include:
- Loud, irregular snoring with sudden pauses in breathing
- Constant daytime tiredness and recurring microsleeps
- Concentration problems and memory disorders
- Headache in the morning and dry mouth
- Frequent awakenings with palpitations
- Increased urge to urinate at night and loss of libido
Consequences of obstructive sleep apnea
Untreated obstructive sleep apnoea can have serious health consequences. It not only impairs quality of life, but can also significantly reduce life expectancy.
Studies show that people with untreated sleep apnoea syndrome have a significantly higher risk of cardiovascular disease. Life expectancy is often shortened compared to healthy people of the same age. The condition also makes it more difficult to regulate blood pressure and can promote cardiac arrhythmia. The risk of heart attack and stroke is up to three times higher.
Even if some of those affected do not subjectively feel any restrictions, the health risk remains – especially for the cardiovascular system.
Causes of sleep apnea
There are many causes of sleep apnea, but it is usually caused by a narrowing of the upper airways. A common trigger is obesity, as extra fatty tissue can restrict the space for the airways, making breathing more difficult during sleep. Another common cause is enlarged tonsils or palatine tonsils, especially in children, which can block the airways and interrupt breathing. Malpositioned jaws or a curved nasal septum are also anatomical features that can obstruct the air supply and therefore promote sleep apnoea. In addition, weakness of the throat muscles can cause the airways to become unstable and constrict during sleep, which also leads to breathing interruptions.
- Overweight
- Enlarged tonsils or palatine tonsils
- Jaw misalignments
- Curved nasal septum
- Weak throat muscles
Diagnosis of sleep apnea
The diagnosis of sleep apnoea usually requires a thorough examination by a doctor. As a first step, the doctor will take the patient’s medical history and symptoms. To confirm the diagnosis, special tests such as polysomnography (a sleep laboratory examination) or polygraphy (a home sleep study) are often performed. These tests monitor important bodily functions such as breathing, oxygen saturation and heart rate during sleep. For sleep apnea to be diagnosed, there must be at least five pauses in breathing per hour of sleep. These pauses must last at least ten seconds to be considered diagnostically relevant. If typical symptoms of sleep apnea occur, it is important to consult a doctor who can make a professional diagnosis. Self-diagnosis or treatment on your own is not recommended.
To diagnose obstructive sleep apnoea (OSA) in adults with a high probability (e.g. observed pauses in breathing, snoring, daytime sleepiness), an outpatient polygraphy is recommended first. If this shows clear pathological findings, the diagnosis can be made – polysomnography is then not necessary.
However, polygraphy is unsuitable for ruling out OSA as it cannot record sleep stages or wake responses. This means that false-negative results are possible. If the suspicion persists despite inconspicuous findings, further polysomnography in the sleep laboratory is required to rule out differential diagnoses such as hypoventilation.
Source: Obstruktive Schlafapnoe: Klug entscheiden, das Richtige tun | Somnologie
Diagnosis of sleep apnea in children
Habitual snoring in children is defined as audible snoring on at least four out of seven nights. Intermittent snoring – often caused by pauses in breathing (apnea/hypopnea) – is typical of obstructive sleep apnea (OSA). Accompanying symptoms often include an enlarged pharyngeal and palatine tonsil region (adenotonsillar hyperplasia), mouth breathing and slurred speech.
Children with risk factors such as obesity, genetic syndromes or neurological diseases should undergo polysomnography in specialized centers. In uncomplicated cases, anti-inflammatory therapy (e.g. with nasal steroids or montelukast) can be tried first. If this does not respond, a referral should be made to an ENT specialist for clarification of possible surgical treatment (adenotomy/adenotonsillotomy).
Source: Obstruktive Schlafapnoe: Klug entscheiden, das Richtige tun | Somnologie
Treatment options for sleep apnea
The treatment of sleep apnea depends on the severity of the condition and the individual needs of the person affected. There are various approaches that can help to alleviate the symptoms and improve the quality of sleep.
Respiratory therapy
One frequently used method is respiratory therapy, in which a continuous flow of air is used to keep the airways open and thus reduce breathing pauses. This therapy stabilizes sleep and helps those affected to get through the night better.
Splints and aids
In less severe cases, splints and aids such as dental splints or special appliances can also be used. These devices support the airways by moving the lower jaw slightly forward or optimizing the sleeping position, which is particularly effective in cases with mild respiratory disorders.
Surgical intervention
However, if anatomical features are blocking the airways, surgical intervention may also be necessary in certain cases. In this case, surgery is considered to widen the airways and facilitate breathing, which is particularly useful if the blockages are more severe.
PAP Therapy
PAP therapy (positive airway pressure) is effective for obstructive sleep apnoea in reducing breathing stops, daytime sleepiness and cardiovascular risks. However, studies show that only around 70% of patients stick with it in the long term, with an average duration of use of 4.5 hours per night.
Reasons for refusing or discontinuing the therapy include sleep disorders, side effects or lack of subjective benefit. To ensure successful use, intensive support in the first few weeks after starting the therapy is particularly important.
If PAP therapy is not tolerated, effective alternatives should be considered, as even with severe OSA, an alternative treatment is better than no therapy.
Source: Obstruktive Schlafapnoe: Klug entscheiden, das Richtige tun | Somnologie
Note sources:
We have used the article “Obstructive sleep apnea: Deciding wisely, doing the right thing”, written by B.A. Stuck, C. Schöbel, A. Wiater, D. Triché, as a source for some of the texts. Click here for the full article: Obstruktive Schlafapnoe: Klug entscheiden, das Richtige tun | Somnologie
