Snoring & Sleep Apnoea Management, snoring, snoring treatments, snoring appliances, treatment of snoring, stop snoring, obstructive slip apnoea, apnea, hypertension, cardiac disk, sudden Stoppage of resculation, sudden Stoppage of breathing, intevated suggestion of respiration, evaluation of Snoring, sudden daytime sleepiness, daytime sleepiness daytime drowsiness, Dr. Kumar P. Doshi, MD, Pulmonology, FCCP, Bronchoscopy, Spirometries , Sleep Apnea Studies and Management , Allergy tests

Sleep apnea is a condition where the individual (usually one who snores) literally stops breathing during sleep. If left untreated, sleep apnea can be potentially life threatening over time. Obstructive sleep apnea is caused by a blockage in the airways. This is caused by the tissue at the back of the throat relaxing and collapsing during sleep. The brain will wake the sleeping person up to remind them to breathe and thus ensure that the body receives enough oxygen to survive. As a consequence of this, people with sleep apnea end up having unsatisfying and broken sleep. Who Should Get A Sleep Study Done? Any young Hypertensive (as sleep apnea could be the cause of high blood pressure). Obese patients who snore and have gaps in their breathing or choking sounds are heard by the partner. Snorers who are excessively sleepy in the day time. An obese Hypertensive whose blood pressure is not coming under control.


Normal Airway	Narrowed Airway

Physiological consequences of Sleep Apnea

Oxygen desaturations
Increase in carbon dioxide in the blood
Arousal from increased work of breathing and changes in blood gases
Arousals cause an increase in sympathetic nervous activity; this causes heart rate and blood pressure to increase, which are thought to relate directly to hypertension, heart disease, and increased incidence of stroke
(Morgan. Acute and Chronic Cardiovascular Responses to Sleep-Disordered Breathing. Sleep 1996;19(10):S206-9)
Neuropsychological (daytime functional) impairment

Statistics

The Wisconsin Sleep Cohort (Young et. al, 2002) revealed that 4% of male adults (age 30-60) and 2% of females are affected by obstructive sleep apnoea
The percentage of this group that is diagnosed and treated (Kapur) is only 2.2%
Singapore Pilot Study (Puvanendran, Goh: 1999) - 15% (600,000) Singaporeans affected

Picking up the initial signs

Spouse or partner - Snoring
Witnessed apnoeas or irregular breathing during sleep (gasping, long pauses, etc.
Hypersomnolence / Lack of energy
Memory loss / Loss of concentration
Irritability / decreased tolerence level
Morning headaches
Intellectual deterioration
Sexual dysfunction / Impotence
Signs of depression

A visit to a doctor

Identification of daytime somnolence
Measurement of daytime sleepiness using validated questionnaires
Epworth Sleepiness Score
Johns MW A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep. 1991 Dec;14(6):540- 5.
Berlin Questionnaire taking into account comorbidities

Investigation

Gold standard - Full Polysomnography

Machine for the night time study in the patients residence.

Why treat?

Excessive daytime somnolence and cognitive function deficits
New research indicating that OSA increases cardiovascular morbidity and mortality
Shown to be prevalent in cardiovascular disease
Strong links indicating OSA may be a factor in hastening CHF
CHF with CSR an indicator of reduced transplant free survival

Sudden death from OSA

New England Journal of Medicine, 2005
Death from cardiac causes occurred in 46% of patients with OSA (mean AHI of 39 /hr)
Death from cardiac causes occurred in 21% of non-OSA patients
Relative risk for sudden death, 2.87 for OSA compared with 0.77 for non-OSA patients

Treatment using CPAP (Continuous Positive Airway Pressure)

First described by Prof C Sullivan et al ( Lancet 1981) as treatment for OSA
"The dramatic effectiveness of nasal CPAP and its relative ease of delivery was probably crucial in an accelerated expansion of OSA and other sleep disorders" (William Dement, Thorax 1998.)

A "reverse vacuum cleaner"

Effect of Continuous Positive Airway Pressure (CPAP)

During Sleep the tongue and soft palate are sucked against the posterior oropharyngeal wall

CPAP with low pressure provides a pneumatic splint and keeps the airway open

CPAP Therapy

Most important time in the respiratory cycle is end expiration
Airway narrowing begins at the end of expiration
During inspiration the airway collapses further due to negative pressure
As a result pressure needs to be adequate at end expiration
Consolidates sleep
reduces day time sleepiness and improves neurocognitive functions
Has a beneficial effect in reducing blood pressure and morbidity and mortality associated with OSAS

Surgical operations are also available for management of obstructive sleep apnoea syndrome.