Dos and Don’ts of Snoring Solutions – The New Indian Express

Sleep apnea is a potentially serious disorder in which breathing repeatedly stops and starts again. It is due to a repetitive collapse of the upper airways during sleep. Sleep apnea is generally underreported and underdiagnosed. The prevalence in the general adult population varies between 15 and 30%.

WHY SLEEP APNEA NEEDS TO BE TREATED

  • Untreated sleep apnea has many potential consequences and adverse clinical associations, including excessive daytime sleepiness, impaired daytime function, metabolic dysfunction, and increased risk of cardiovascular and cerebrovascular disease.

  • Adverse effects include drowsy driving and accidents, neuropsychiatric dysfunction, pulmonary hypertension, type 2 diabetes, and non-alcoholic fatty liver disease.

RISK FACTORS

  • Well-defined risk factors include advanced age, male gender, obesity, facial and upper respiratory abnormalities.

  • Potential risk factors include smoking, family history of sleep apnea or snoring, and nasal congestion.

  • Sleep apnea is associated with certain medical conditions such as obesity and hypoventilation syndrome, pregnancy and end-stage renal disease, congestive heart failure, chronic lung disease and diabetes mellitus.

SYMPTOMS

The most common signs and symptoms include:

  • Loud snoring

  • Out of breath while sleeping

  • Waking up with a dry mouth

  • morning headache

  • Difficulty staying asleep (insomnia)

  • Excessive daytime sleepiness (hypersomnia)

  • Difficulty staying alert while awake

  • Irritability

CONDITIONS THAT MIMIC SLEEP APNEA

Conditions that mimic sleep apnea include restless legs syndrome, narcolepsy, sedatives, gastroesophageal reflex disorders, swallowing disorders, nocturnal seizures, nocturnal asthma, insomnia, and panic attacks.

DIAGNOSTIC

Recommendations for testing patients who have excessive daytime sleepiness and 2 out of 3 of the following:

Habitual snoring

  • Apnea observed

  • Gasping or choking during sleep

  • Diagnosed hypertension

  • Many assessment tools and questionnaires like the ESS, Berlin, stop-bang questionnaires are generally not used for diagnostic testing because they are inaccurate and not superior to a good history and physical examination.

TESTS

The diagnosis is confirmed by a sleep study or polysomnography (PSG). It is a unique non-invasive test that can be performed at home or in a laboratory/hospital. The diagnosis of sleep apnea is based on the presence or absence of associated symptoms as well as the frequency of absence of respiratory events during sleep (ie.

TREATMENT

The management of a patient with sleep apnea begins with firmly establishing the diagnosis and its severity. The patient should be informed of the risk factors, natural history and consequences of sleep apnea. It is important to note that all patients should be warned of the increased risk of motor vehicle accidents associated with the absence of treatment. The treatment options are:

MYTHS

  • Sleep apnea is not a disease, it is a disorder

  • Sleep apnea is not only observed in obese patients

  • Prevalence is not uncommon as it is underdiagnosed

  • Establishing the diagnosis and understanding the disorder is key

  • By simply breaking the variations of the sleep cycle, many illnesses and deaths can be prevented.

  • No invasive testing is required

  • The beneficial treatment option is to use CPAP/BIPAP without medication.

  • It is not a lifelong disease, behavioral changes can reverse the disease and the use of CPAP/BIPAP

(The author is Chief and Senior Consultant, Critical Care and Critical Care Department, Kauvery Hospitals Electronic City)