Obstructive Sleep Apnea, or OSA, has become more common due to America’s obesity epidemic. OSA is the term used to describe a patient who, during the deeper stages of sleep when muscles are most relaxed, allows their upper airway to be sucked closed as they try to draw in a breath.
While many patients think that OSA involves “stopping breathing,” in truth, it is actually better described as choking. It occurs more often for people who carry more weight in the area between their collar bones and pelvic bones, because the diaphragm must move that weight out of the way to inflate the lungs adequately.
The heavier we are in the midsection, the greater the suction force required to inflate the lungs. At some point, as the suction force increases, airway resistance noise will start to occur (snoring) and not far beyond that point is apnea (choking). Studies have shown that although the oxygen does drop and might be the cause of interruption of deep sleep, more often then not, it is the work of trying to pull air into the lungs through a closed tube that causes a person with OSA to rise out of deep sleep and stiffen their airway muscles enough to end the choking.
These airway-related awakenings typically do not cause the person to come fully out of sleep but rather typically only to a lighter stage of sleep and hence most OSA patients have never “caught themselves choking” during sleep. In fact, many OSA patients report sleeping through the night rather well and because of that, they are inclined to dismiss OSA as a possibility. This could be a big mistake. To see why, keep reading!
Our earliest experience with OSA involved patients who were extremely sleepy, so much so that they might fall asleep while being interviewed about their medical problems or worse yet while carrying out daytime activities such as driving. Physicians learned to consider OSA as a possible diagnosis whenever they encountered such excessively sleepy patients.
Over the years, we have learned that there are a number of other symptoms that may be due to OSA. These include any of the following: generalized fatigue, poor concentration, depressed mood, acid reflux (heartburn), bedwetting, muscle ache, night sweats, sleep interruption (with or without insomnia), early morning awakening, ankle swelling, headache, erectile dysfunction, waking up with chest pain, waking up with palpitations, tooth grinding, hallucinations, waking up unable to move, excessive movement in bed, and shortness of breath on exertion. It has been linked to high blood pressure, diabetes, atrial fibrillation, coronary artery disease, stroke, heart failure, gout, attention deficit disorder, and various other medical problems. The point is there may be more at stake in not getting diagnosed and treated than the symptoms listed above. An Internet search of OSA combined with any of the above symptoms or conditions will make for interesting reading.
Diagnosis of OSA involves monitoring oxygen, pulse rate, airflow, respiratory effort, with or without sleep stage determination from brainwave recordings. Monitoring had previously been done only in sleep labs, but more recently is being done in the home setting using portable monitors. One night of testing is usually enough. Most patients are treated with CPAP (continuous positive airway pressure) devices to be used during sleep. These devices are sophisticated fans that deliver pressurized air through the nose to keep the airway open even during deep sleep when the airway tends to become flimsy. Symptom improvement follows quickly after the start of treatment.
• Rick Pisani is a specialist in pulmonary/critical care and serves as one of Snoqualmie Valley Hospital’s hospitalists, caring for admitted patients.
