Obstructive Sleep Apnea: what it is and how to treat it

Sleep apnea syndrome, or Obstructive Sleep Apnea Syndrome (OSA), is a serious disorder in which breathing stops repeatedly and for a few seconds during sleep. The syndrome of sleep apnea can be found in all ages and in both sexes, but more often it concerns men after the age of 40. It is estimated that its general incidence in the population is around 4-6%. Sleep apnea was first described and identified as a clinical syndrome in 1976 by Cristian Guilleminault, head of sleep medicine at Stanford University. It is worth mentioning that a syndrome is defined as the set of clinical symptoms related to the same clinical picture. What are the symptoms? Obstructive apnea occurs mainly during nighttime sleep, where breathing is interrupted (apnea) between episodes of severe snoring. The duration of these episodes is 10-15 seconds or more. In essence, these are episodes of suffocation, which are repeated throughout sleep and in which there are significant pathological disturbances concerning, among other things, the oxygenation of the blood and the heart rate. Sleep apneas are associated with an increased incidence of cardiovascular complications (arterial hypertension, coronary heart disease, myocardial infarction) and cerebrovascular events, and are believed to be involved in the generation of pulmonary hypertension. Apnea is due to the closure of the upper airway at the level of the pharynx and occurs during sleep when there is general muscle relaxation causing the airway to narrow, resulting in resistance to airflow. This narrowing can be complete or partial, so we speak of apnea or hypopnea respectively. Apnea episodes disrupt the normal structure of sleep, causing people with sleep apnea to experience daytime fatigue, sleepiness, or even depression, depending on the severity of the syndrome. The severity of the syndrome depends on the number of apnea-hypopnea episodes that occur per hour during sleep: - Up to 5 episodes per hour can be considered that there is no apnea syndrome, as long as there are no clinical symptoms. - From 5 to 14 episodes per hour, the syndrome is considered mild. - From 15 to 29 episodes per hour, medium grade. - From 30 or more episodes per hour, severe. There are various causes and predisposing factors that cause this condition, such as:

• The increase in body weight
• Familial predisposition
• The alcohol
• Smoking
• Hypertrophy of tonsils
• Craniofacial malformations (micrognathia, macroglossia, etc.)
• Endocrine and metabolic disorders
• Motor neuron disorders

The manifestations (clinical picture) of the apnea syndrome are:

• Heavy snoring and restless sleep
• Small awakenings or waking up with a feeling of suffocation
• Morning headaches
• Daytime fatigue and sleepiness
• Impairment of memory and the ability to concentrate
• Irritability and nervousness

The consequences are many and serious:

• Risk of sudden death while sleeping
• Arterial hypertension
• Stroke
• Disorders of the cardiovascular system
• Psychological and endocrinological disorders
• Traffic or work accidents

One of the common methods used to diagnose sleep apnea is the sleep recording study, which is carried out in an appropriately equipped chamber (sleep laboratory) under the supervision of a specially trained technologist, and various parameters are measured and observed such as: oximetry, eye movements, chest wall, abdomen, legs, recording of air flow in the nose and mouth. Depending on the result of all these measurements, it is established whether or not the examinee suffers from OSA and how serious it is. It is important to note that obstructive sleep apnea syndrome should always be (and is) treated. The treatment consists in changing the lifestyle (ceasing smoking and alcohol), weight loss, however, it can sometimes be done surgically. In a few cases (micrognathia, macroglossia) intraoral appliances (intraoral splints or braces) may help, which promote the lower jaw and tongue to a more anterior position during sleep, so that the airway remains open. In any case, we should not ignore the symptoms of sleep apnea. If you suspect that you suffer from obstructive sleep apnea syndrome, see an experienced pulmonologist immediately. At the same time, by choosing the right pillow you can reduce the symptoms of sleep apnea, enjoying a quality and peaceful sleep. *With information from the article by Nikolaos D. Chainis, Director of the Second Pulmonology Clinic at the Metropolitan Hospital