Definition: Obstructive Sleep Apnea (OSA) refers to episodes of partial or complete blockage of airflow during sleep that last 10 seconds or longer. In a given night, the number of complete breathing pauses (apneas) plus partial breathing disruptions (hypopneas) may be as high as 20 to 60 or more per hour. People with sleep apnea usually snore between episodes, and then snort, gasp or choke when they start breathing again. They are deprived of restorative sleep because their slumber is constantly disrupted.
People at Risk: OSA occurs in all age groups and both sexes, more commonly in men than women. As many as 18 million Americans have sleep apnea, and less than 5 percent of sleep apnea sufferers have currently been diagnosed and treated. Likely sufferers snore loudly, are overweight, or have high blood pressure or some physical abnormality in the nose, throat or other parts of the upper airway.
Causes: OSA results from the collapse and obstruction of the airway during sleep. Muscles of the soft palate at the base of the tongue and the uvula relax and sag, block the airway and make breathing labored and noisy, or temporarily stop it altogether.
Implications: OSA is a potentially life-threatening disorder that is associated with irregular heartbeat, high blood pressure, and greater risk of heart attack or stroke. Each apneic event produces increases in systemic and pulmonary artery pressure. Apnea patients typically suffer from excessive daytime sleepiness, such as impaired functioning, depression, memory and judgment problems, and overall decreased quality of life. Prior to diagnosis, OSA patients cost the healthcare system twice as much as those without the disorder1. Untreated OSA patients have more hospitalizations and more physician office visits.
Symptoms: Warning signs include chronic, loud snoring, often interrupted by gasping or choking episodes, daytime sleepiness, fatigue, irritability, mood changes, cognitive difficulties, anxiety and depression. Another indicator is early onset of high blood pressure.
Risk Factors:
- Obesity
- Age
- Male gender
- Anatomic abnormalities in the upper airway or facial structure
- Use of alcohol or sedatives
- Smoking
- Family history
Diagnosis: Polysomnography (PSG) is the standard procedure for diagnosing OSA. PSG records a variety of body functions during sleep, including airflow, breathing effort, heart rate and blood oxygen, as well as the electrical activity of the brain, eye movement and muscle activity. PSG must be performed in a sleep center and attended by a sleep technician. PSG is costly, cumbersome, and often not readily available.
Sleep Solutions' NovaSom™ QSG is the only device cleared by the U.S. Food & Drug Administration specifically designed for unattended and unassisted use in the patient's home, and clinically proven to be equivalent to in-laboratory PSG. Prescribed by a doctor, the system utilizes patented audio digital-signal processing (DSP) technology to sense, airatory events.
- Snoring intensity
- Blood oxygen saturation level
- Pulse rate
- Respiratory effort (chest movement)
Sleep Solutions delivers the diagnostic system directly to the patient's home. An instructional packet and video guides the patient through the setup. The patient simply applies three small, comfortable sensors and then pushes the "Start" button.
Voice prompts guide the patient through the process and alert them if any of the sensors are displaced during the night. After up to 3 nights of use the patient simply places the system back in the original shipping box and returns it to Sleep Solutions using the enclosed prepaid waybill.
Treatment:
Continuous positive airway pressure (CPAP) is the most common first-line therapy. The sleeping patient wears a mask over the nose that is connected to a CPAP machine, adjusted to deliver a constant stream of air through the nasal passages at just the right pressure to keep the airway open.
Several surgical options to expand air passages include Uvulopalatopharyngoplasty (UPPP) to tighten flabby tissue in the throat and palate; Laser-assisted Uvula Palatoplasty (LAUP) and SomnoplastyŽ to remove excess tissue from the back of the throat (uvula and soft palate) using a laser device or radio waves; and genioglossus and hyoid advancement procedures to pull the tongue muscles forward and prevent collapse of the lower throat.
Behavioral therapies include avoidance of alcohol, tobacco, and sleeping pills; weight loss; and use of special pillows and other devices that train patients to sleep on their side.
Dental appliances can be used to reposition the lower jaw and the tongue to open the airway.
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Somnoplasty is a registered trademark of Somnus Medical Technologies Inc.
