Obstructive Sleep Apnea (OSA) is a common yet serious sleep disorder characterized by repeated interruptions in breathing during sleep. These interruptions, known as apneas (complete cessation of airflow) or hypopneas (significant reduction in airflow), occur when muscle tone decreases while sleeping and tissues of the throat collapse inward to block the airway. These events can lead to fragmented sleep, reduced oxygen levels, and significant strain on the body. As an ENT specialist, I am committed to helping adults identify and effectively manage OSA, thereby improving sleep quality, daytime function, and overall health.

The cycle of OSA involves airway collapse and a brief arousal from sleep to reopen the airway. While these arousals are often so brief that the individual doesn’t remember them, they prevent restorative deep sleep and can have significant long-term health consequences.

Understanding the Causes and Risk Factors for Adult OSA

Several factors can increase an individual’s likelihood of developing obstructive sleep apnea:

• Excess Weight (Obesity): This is a primary risk factor. Fat deposits around the upper airway can narrow the passage and increase the likelihood of collapse during sleep.
• Neck Circumference: Individuals with thicker necks (generally greater than 17 inches for men and 16 inches for women) may have narrower airways.
• Anatomical Factors:
  • Narrowed Airway: Some individuals may have a naturally narrow throat.
  • Enlarged Tonsils or Adenoids: While more common in children, these can still contribute to OSA in adults.
  • Jaw Structure: A small or recessed lower jaw (retrognathia) can predispose to airway collapse.
• Being Male: Men are two to three times more likely to have sleep apnea than premenopausal women. However, women’s risk increases after menopause.
• Advancing Age: OSA occurs significantly more often in older adults, though the risk may level off after the 60s and 70s.
• Family History: Having family members with sleep apnea can increase your risk.
• Use of Alcohol, Sedatives, or Tranquilizers: These substances relax the throat muscles, which can worsen OSA. It’s advisable to avoid alcohol for at least 4 hours before bedtime if OSA is suspected or diagnosed.
• Smoking: Smokers are three times more likely to have OSA. Smoking can increase inflammation and fluid retention in the upper airway.
• Nasal Congestion: Chronic nasal congestion, whether due to allergies or anatomical problems like a deviated septum, can increase the likelihood of OSA by forcing mouth breathing and increasing airway resistance.
• Certain Medical Conditions:
  • High blood pressure (hypertension)
  • Congestive heart failure
  • Type 2 diabetes
  • Polycystic ovary syndrome (PCOS)
  • Hormonal disorders (e.g., hypothyroidism)
  • Prior stroke
  • Chronic lung diseases such as asthma

Recognizing the Signs: Symptoms of Adult Obstructive Sleep Apnea

Many individuals with OSA are unaware they have it, and symptoms are often first noticed by a bed partner. Common signs and symptoms include:

Nighttime Symptoms:

• Loud, Chronic Snoring: Often very disruptive to others.
• Witnessed Apneas: Episodes where breathing stops, often reported by a bed partner.
• Gasping, Choking, or Snorting Sounds During Sleep: These may occur as breathing resumes after an apneic event.
• Restless Sleep: Frequent tossing and turning.
• Frequent Awakenings: May be brief and unremembered, or involve waking up suddenly feeling short of breath.
• Nocturia: Waking up frequently during the night to urinate.
• Dry Mouth or Sore Throat Upon Awakening: Often due to mouth breathing during sleep.

Daytime Symptoms:

• Excessive Daytime Sleepiness (EDS): Feeling very tired and drowsy during the day, even after what seems like a full night’s sleep. This can lead to falling asleep at inappropriate times (e.g., while working, watching TV, or even driving).
• Morning Headaches
• Difficulty Concentrating or Memory Problems
• Irritability, Mood Swings, or Depression
• Decreased Libido or Sexual Dysfunction
• Waking Up Feeling Unrefreshed

The Diagnostic Process: Identifying and Quantifying OSA

If OSA is suspected, a comprehensive evaluation by a healthcare provider, often an ENT specialist or sleep medicine specialist, is necessary.

• Medical History and Physical Examination: This includes a discussion of your symptoms, sleep habits, lifestyle factors, and any relevant medical conditions. The physical exam will assess your upper airway, including the nose, mouth, throat, and neck, looking for potential areas of obstruction.
• Polysomnography (PSG) – Overnight Sleep Study: This is the definitive test for diagnosing OSA. It can be performed in a specialized sleep laboratory (in-lab study) or, in some cases, at home using portable monitoring equipment (Home Sleep Apnea Test – HSAT).
  • In-Lab Sleep Study: Monitors various physiological parameters during sleep, including brain waves (EEG), eye movements (EOG), muscle activity (EMG), heart rate and rhythm (ECG), airflow, breathing effort, and blood oxygen saturation. This provides detailed information about sleep stages and the severity of sleep-disordered breathing.
  • Home Sleep Apnea Test (HSAT): A simpler version that typically measures airflow, breathing effort, blood oxygen levels, and sometimes heart rate. It’s often used for patients with a high probability of moderate to severe OSA without other significant medical conditions.
• Apnea-Hypopnea Index (AHI): The results of the sleep study are used to calculate the AHI, which is the average number of apneas and hypopneas per hour of sleep. This determines the severity of OSA:
  • Normal: AHI < 5 events per hour
  • Mild OSA: AHI 5-14 events per hour
  • Moderate OSA: AHI 15-29 events per hour
  • Severe OSA: AHI ≥ 30 events per hour

Comprehensive Treatment Options for Adult OSA

The goals of OSA treatment are to normalize breathing during sleep, improve sleep quality, alleviate symptoms, and reduce associated health risks. Treatment choice depends on the severity of OSA, individual patient factors, and preferences.

1. Positive Airway Pressure (PAP) Therapy:

• Continuous Positive Airway Pressure (CPAP): This is the most common and generally most effective treatment for moderate to severe OSA. The patient wears a mask over their nose, or nose and mouth, during sleep. The CPAP machine delivers a constant stream of pressurized air that acts as an “air splint” to keep the airway open.
• Bilevel Positive Airway Pressure (BiPAP or BPAP): Delivers two different pressure levels – a higher pressure for inhalation and a lower pressure for exhalation. It may be used for patients who have difficulty tolerating CPAP or have other coexisting respiratory conditions.
• Auto-Titrating Positive Airway Pressure (APAP): Automatically adjusts the air pressure throughout the night based on the patient’s breathing needs.
  Successful PAP therapy requires consistent nightly use. Humidifiers can help prevent CPAP-related dryness.

2. Oral Appliances (Mandibular Advancement Devices – MADs):

• These custom-fitted dental devices are worn in the mouth during sleep and work by repositioning the lower jaw and tongue forward, thereby opening the airway.
• They are often an option for patients with mild to moderate OSA, or for those with severe OSA who cannot tolerate or have failed PAP therapy.

3. Lifestyle Modifications:

• Weight Loss: For overweight or obese individuals, even modest weight loss can significantly improve or even resolve OSA. Medications like Zepbound, which aid in weight loss, may also be considered for adults with obesity and moderate to severe OSA.
• Positional Therapy: Since OSA is often worse when sleeping on the back (supine position), strategies to encourage side-sleeping (e.g., specialized pillows, wearable devices) can be helpful for some individuals.
• Avoidance of Alcohol and Sedatives: Limiting alcohol and avoiding sedative medications, especially before bedtime, is crucial as they can worsen airway collapse.
• Smoking Cessation: Quitting smoking can reduce airway inflammation and improve OSA.
• Oropharyngeal Exercises: Exercises for the mouth, tongue, and facial muscles may help improve symptoms like daytime sleepiness and snoring by strengthening airway muscles.

1. Surgical Options:

4. Surgical Options:

Surgery may be considered if other treatments are ineffective or not tolerated, or if there is a specific anatomical obstruction that can be corrected.

• Uvulopalatopharyngoplasty (UPPP): Removes excess tissue from the soft palate and uvula to widen the airway at the back of the throat. Often performed for mild OSA or snoring, but its effectiveness for moderate to severe OSA can be variable and may diminish over time. 
• Maxillomandibular Advancement (MMA): A more complex procedure that surgically moves the upper and lower jaws forward to significantly enlarge the airway. It is typically reserved for severe OSA or when other treatments have failed.
• Nasal Surgery (e.g., Septoplasty, Turbinate Reduction): To correct nasal obstruction (like a deviated septum or enlarged turbinates) which can improve nasal breathing and potentially make PAP therapy more tolerable, though often not a standalone cure for OSA.
• Hypoglossal Nerve Stimulation (e.g., Inspire® Therapy): An implantable device that monitors breathing patterns and delivers mild stimulation to the hypoglossal nerve (which controls tongue movement) during sleep. This stimulation causes the tongue to move forward, keeping the airway open. Candidates typically have moderate to severe OSA, are unable to use or benefit from CPAP, and meet specific BMI and airway anatomy criteria confirmed by a drug-induced sleep endoscopy (DISE).

Health Consequences of Untreated Adult OSA

Leaving OSA untreated can lead to serious and potentially life-threatening health problems over time:

• Cardiovascular Disease: Increased risk of high blood pressure, heart attack, heart failure, stroke, and irregular heartbeats (arrhythmias like atrial fibrillation). Sudden drops in oxygen levels during apneas strain the cardiovascular system.
• Type 2 Diabetes: Increased risk of developing insulin resistance and type 2 diabetes.
• Metabolic Syndrome: A cluster of conditions (high blood pressure, abnormal cholesterol, high blood sugar, increased waist circumference) linked to heart disease.
• Daytime Fatigue and Accidents: Severe daytime sleepiness increases the risk of motor vehicle accidents and workplace errors.
• Cognitive Impairment: Difficulty with concentration, memory, and decision-making.
• Mood Disorders: Increased risk of depression and anxiety.
• Complications with Medications and Surgery: OSA can increase risks associated with certain medications (especially sedatives and opioids) and general anesthesia.

Partnering with Dr. Cable for Better Sleep and Health

Obstructive Sleep Apnea is a manageable condition. If you suspect you have OSA, or if you’ve been diagnosed and are seeking treatment solutions, a comprehensive evaluation is the first step. Dr. Cable offers expert diagnosis and consideration of the full range of treatment options, from conservative measures to advanced surgical interventions, tailored to your specific needs and aimed at restoring restful sleep and improving your overall health.

If you experience symptoms like loud snoring, witnessed breathing pauses, or excessive daytime sleepiness, schedule a consultation with Dr. Cable to discuss your sleep health.

Further Reading:

1. American Academy of Sleep Medicine (AASM) – Patient Resources
2. National Sleep Foundation – Sleep Apnea Information
3. Mayo Clinic – Obstructive Sleep Apnea
4. American Thoracic Society – What is Obstructive Sleep Apnea in Adults?