Sleep apnea, also spelled sleep apnoea, is a sleep disorder characterized by pauses in breathing or periods of shallow breathing during sleep.  Each pause can last for a few seconds to a few minutes and they happen many times a night. In the most common form, this follows loud snoring.

There may be a choking or snorting sound as breathing resumes. As the disorder disrupts normal sleep, those affected may experience sleepiness or feel tired during the day. In children it may cause problems in school, or hyperactivity.

There are three forms of sleep apnea: obstructive (OSA), central (CSA), and a combination of the two called mixed. OSA is the most common form.^[1] Risk factors for OSA include being overweight, a family history of the condition, allergies, a small airway, and enlarged tonsils.

In OSA, breathing is interrupted by a blockage of airflow, while in CSA breathing stops due to a lack of effort to breathe. People with sleep apnea may not be aware they have it. In many cases, it is first observed by a family member. Sleep apnea is often diagnosed with an overnight sleep study. For a diagnosis of sleep apnea, more than five episodes per hour must occur.

Treatment may include lifestyle changes, mouthpieces, breathing devices, and surgery. Lifestyle changes may include avoiding alcohol, losing weight, stopping smoking, and sleeping on one’s side.

Breathing devices include the use of a CPAP machine. Without treatment, sleep apnea may increase the risk of heart attack, stroke, diabetes, heart failure, irregular heartbeat, obesity, and motor vehicle collisions.

OSA affects 1 to 6% of adults and 2% of children. It affects males about twice as often as females. While people at any age can be affected, it occurs most commonly among those 55 to 60 years old. Central sleep apnea affects less than 1% of people.

A type of central sleep apnea was described in the German myth of Ondine’s curse where the person when asleep would forget to breathe.

Signs and Symptoms

People with sleep apnea have problems with excessive daytime sleepiness (EDS), impaired alertness, and vision problems. OSA may increase risk for driving accidents and work-related accidents. If OSA is not treated, people are at increased risk of other health problems, such as diabetes.

Death could occur from untreated OSA due to lack of oxygen to the body. Moreover, people are examined using “standard test batteries” to further identify parts of the brain that may be adversely affected by sleep apnea, including those that govern:

• “executive functioning”, the way the person plans and initiates tasks
• paying attention, working effectively and processing information when in a waking state
• using memory and learning.

Due to the disruption in daytime cognitive state, behavioral effects may be present. These can include moodiness, belligerence, as well as a decrease in attentiveness and energy. These effects may become intractable, leading to depression.

There is evidence that the risk of diabetes among those with moderate or severe sleep apnea is higher. There is increasing evidence that sleep apnea may lead to liver function impairment, particularly fatty liver diseases (see steatosis).

Finally, because there are many factors that could lead to some of the effects previously listed, some people are not aware that they have sleep apnea and are either misdiagnosed or ignore the symptoms altogether.

Risk Factors

Sleep apnea can affect people regardless of sex, race, or age. However, risk factors include:

• being male
• obesity
• age over 40
• large neck size (greater than 16–17 inches)
• enlarged tonsils or tongue
• small jaw bone
• gastroesophageal reflux
• allergies
• sinus problems
• a family history of sleep apnea
• deviated septum

Alcohol, sedatives and tranquilizers may also promote sleep apnea by relaxing throat muscles. Smokers have sleep apnea at three times the rate of people who have never smoked.

Central sleep apnea is more often associated with any of the following risk factors:

• being male
• an age above 65
• having heart disorders such as atrial fibrillation or atrial septal defects such as PFO
• stroke

High blood pressure is very common in people with sleep apnea.

Mechanism

When breathing is paused, carbon dioxide builds up in the bloodstream. Chemoreceptors in the blood stream note the high carbon dioxide levels. The brain is signaled to awaken the person, which clears the airway and allows breathing to resume. Breathing normally will restore oxygen levels and the person will fall asleep again.

To find out if you or a loved one have sleep apnea, contact Alaska Sleep Clinic today for your FREE 10-minute sleep evaluation.