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SLEEP APNEA TREATMENT
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MULTIPLE SLEEP LATENCY TEST
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SLEEP APNOEA SYMPTOMS
Sleep apnoea refers the periodic cessation of air moving in and out of the lungs during sleep. Airflow must stop for an interval that is longer than the normal pause between breaths in order to be called an apnoea. This interval is usually defined as 10 seconds or more for adults.
There are three basic types of sleep apnoea:
• Central apnoea: No air moves in and out of the lungs because the person makes no effort to breathe for a certain period of time
• Obstructive apnoea: The person tries to breathe, but cannot take in air because a portion of the throat is blocked
• Mixed apnoea: This is an event when initially there is no effort to breathe; then when the person resumes making efforts to breath, the airway is obstructed and no air moves into the lungs.
There are also related breathing events termed hypopnea rather than apnoea. Events identified as hypopneas are those in which there is airflow into the lungs but it is abnormally reduced either because the throat is partially obstructed (obstructive hypopnea) or because the patient reduces
his/her breathing effort (central hypopnea) for a certain period of time.
This topic review will focus on the most common type of sleep apnoea, obstructive sleep apnoea (OSA) or obstructive sleep apnoea-hypopnea (OSAH).
CAUSES — OSA and OSAH are caused by abnormal closure of the airway during sleep.
The throat is surrounded by muscles that open or close the airway during speech or swallowing. These muscles are also important in allowing air to flow normally into and out of the lungs during
If these throat muscles relax inappropriately during sleep, or if the throat is abnormally small, the
airway may partially close. This results in snoring and a decrease in the flow of air into and out of the lungs. An episode of partial airway closure is called a sleep hypopnea. Complete closure of the airway results in cessation of all air movement, and is called an obstructive apnoea. A person may have both apnoeas and hypopneas during sleep.
The main symptoms of OSA and OSAH are loud snoring and severe daytime sleepiness. However, a person can have these conditions and not be aware of either of these symptoms. For example, if the person does not have a bed partner, he or she may not be aware of the snoring. Sleepiness can also come on gradually and build up over time to the point where the person accepts it as normal.
Other symptoms include:
• Restless sleep
• Awakening with choking, gasping, or smothering
• Awakening with chest pain or discomfort
• Morning dry mouth or sore throat
• Morning confusion
• Morning headaches
• Personality change
• Memory impairment, difficulty concentrating
• Frequent awakenings to urinate
In addition, patients with high blood pressure have an increased risk of having OSA, particularly if they are overweight.
DIAGNOSIS — A healthcare provider may suspect sleep apnoea based upon a patient's symptoms. The patient's neck circumference may be measured, as large neck size is associated with increased risk of sleep apnoea. If a bed partner has observed the patient during episodes of choking or gasping in the night, this also raises the suspicion these conditions are present. However, the diagnosis can be established with certainty only by testing the patient during sleep.
Patients with OSA are usually referred to a sleep laboratory t for a full sleep study using a polysomnogram. The polysomnogram measures:
• Blood oxygen level
• Heart rate and electrocardiogram (ECG)
• Breathing effort and airflow
• Duration of the various stages of sleep
• Body position
• Limb movement
The Sleep Centre Katherine offer at home sleep studies using the SOMNOtouch PSG and Philips Alice PDx sleep diagnostic devices. These at home devices combines the comfort, function and power for Obstructive Sleep Apnoea screening, follow up and diagnosis in polysomnography and sleep disorder studies.
RISKS — Aside from feeling tired, complications attributed to OSA and OSAH include poor concentration. Studies have shown that patients with severe OSA/OSAH are more than twice as likely to be involved in a motor vehicle accident than people without these conditions. In addition, there is some evidence that untreated OSA/OSAH is associated with an increased risk for cardiovascular problems such as high blood pressure, heart attack, abnormal heart rhythms, or
stroke. This increased risk may be due to the wide fluctuations in heart rate and blood pressure observed in patients with OSA/OSAH during sleep. However, further research is needed to clearly document whether sleep apnoea contributes to any of these problems.