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Obstructive Sleep Apnea Syndrome

Obstructive sleep apnea syndrome

Obstructive Sleep Apnea Syndrome (OSA) is a condition when during sleep a respiratory arrest occurs, after which the sleeping person snores loudly, sometimes tossing and turning, and then starts breathing again.

In patients at risk of developing OSA, the nasopharynx and/or oropharynx partially or completely overlaps during sleep. Obstructive sleep apnea occurs when breathing decreases, even if it does not stop completely.

The prevalence of OSA in adults is 2–9%, but the disease is poorly recognized and rarely diagnosed even when the patient is symptomatic. In men, OSA occurs 4 times more often, in obese people (body mass index [BMI]> 30) – 7 times more often. Severe OSA (apnea-hypopnea index (AHI) more than 30 / hour) increases the risk of death in middle-aged men.

Obstructive sleep apnea is a leading cause of excessive daytime sleepiness (sometimes called awakening sleepiness), an increased risk of car accidents, job loss, and sexual dysfunction. Relationships with bed partners, roommates/housemates can also deteriorate, as OSA symptoms can negatively affect their sleep.

Long-term cardiovascular complications of advanced OSA include poorly controlled hypertension, heart failure and atrial fibrillation (even after catheter ablation), and other arrhythmias. OSA also increases the risk of non-alcoholic steatohepatitis, probably due to repeated nocturnal hypoxia.

Apnea syndrome causes and symptoms

Apnea syndrome causes and symptoms

To cure a disease, you must first define it.

1. Apnea syndrome causes:

  • Weakness of the tone of the muscles of the pharynx, as a result of which, during sleep, the airways collapse with a violation of their air permeability;
  • Developmental abnormalities leading to a narrow airway (e.g., small mandible, large tongue);
  • Anatomical defects at the level of the nose and throat (polyps, the curvature of the nasal septum, enlargement of the tonsils, adenoids, pathological growth of the nasopharyngeal tonsil, tumor formations);
  • Obesity;
  • Endocrine diseases: for example, hypothyroidism (causes swelling of the pharyngeal structures), acromegaly, all of which interfere with the normal passage of air through the respiratory tract;
  • Neurological diseases leading to a decrease in muscle tone (strokes – acute disturbance of cerebral circulation with the death of a portion of brain tissue; myopathy, myodystrophy);
  • Violation of the tone of the muscles of the pharynx due to the influence of alcohol, certain drugs (hypnotics, tranquilizers);
  • Chronic obstructive pulmonary disease – characterized by a narrowing of the airways and a violation of their air permeability (bronchial asthma, chronic obstructive pulmonary disease);
  • Smoking;
  • Allergy.

2. Apnea syndrome symptoms:

  • Restless sleep, excessive motor activity is present in a dream (often turning from side to side);
  • Lack of vigor after sleep, there is a feeling of morning fatigue and weakness after waking up;
  • Sleepiness during the day, tendency to fall asleep during breaks from work, while driving;
  • Morning headaches;
  • Increased arterial (blood) pressure (mainly at night and in the morning);
  • Frequent urination at night (more than 2 times per night);
  • Decreased potency;
  • Depression, irritability, decreased concentration, and memory;
  • Rapid heartbeat (tachycardia), heart rhythm disturbances – arrhythmias.

sleep apnea diagnostics

Diagnostic criteria include daytime and nighttime symptoms and sleep monitoring with> 5 episodes of hypopnea and/or apnea per hour if symptoms are present or ≥ 15 episodes per hour if they are not. To be diagnosed, a patient must have at least 1 of the following symptoms:

  • Daytime sleepiness, episodes of accidental falling asleep, sleep after which the person feels overwhelmed, fatigue, or difficulty maintaining normal sleep;
  • Episodes of awakening, accompanied by holding the breath, difficulty breathing, choking;
  • Loud snoring and/or respiratory arrest during sleep as reported by the patient’s relatives.

When making a diagnosis of obstructive sleep apnea, it is necessary to communicate with the patient’s relatives or roommates. The differential diagnosis of daytime sleepiness is represented by various diseases and includes:

  • Decreased duration and quality of night sleep with poor sleep hygiene;
  • Sedation or altered mental status with medication, chronic illness, metabolic disorders, drug therapy;
  • Depression;
  • Alcoholism and drug addiction;
  • Narcolepsy.

Other primary sleep disorders (periodic limb movements during sleep, restless legs syndrome)

In the following categories of patients, it is necessary to collect an anamnesis carefully:

  • Age around 65 or older;
  • Complaining of daytime tiredness, sleepiness, or difficulty falling asleep;
  • Overweight;
  • Poorly controlled hypertension, atrial fibrillation or other arrhythmias, heart failure (which can cause obstructive sleep apnea syndrome), stroke, or diabetes.

Sleep apnea studies

An area of ​​continuing interest is studies that classify patients into clinical groups based on symptomatology and comorbidities, as they lead to individualized approaches to the management of OSA.

An objective examination should aim to identify nasal obstruction, hypertrophy of the palatine tonsils, structural features of the pharynx, and clinical manifestations of hypothyroidism and acromegaly.

Obstructive sleep apnea syndrome treatment

Obstructive sleep apnea diagnostic tools

Increasingly, portable diagnostic tools (home sleep testing) are being used to diagnose obstructive sleep apnea

 

  1. Portable monitors can measure heart rate, pulse oximetry, effort, position, and nasal breathing to objectively assess respiratory distress during sleep self-assessment, thereby determining AHI / IDN.
  2. Portable diagnostic tools are often used in conjunction with questionnaires (e.g. STOP-Bang, Berlin Questionnaire) to calculate patient risk (sensitivity and specificity of the test depend on the likelihood of having the disease before the test).
  3. When portable instruments are used, comorbid sleep disorders (e.g. restless legs syndrome) are not excluded.
  4. Follow-up polysomnography may be required to determine AHI / IDN values ​​at different stages of sleep and with changes in body position, especially when considering surgery or therapy other than positive airway pressure.

 

Polysomnography is the best technique for confirming the diagnosis of obstructive sleep apnea and quantifying the severity of OSA. 

 

  1. Polysomnography includes continuous measurement of respiratory efforts using plethysmography, airflow (nasal and oral) using special sensors, oxygen saturation by oximetry, sleep architectonics based on EEG data, as well as electromyography of the chin (for hypotension), and electrooculography to register rapid movements eye. Polysomnography allows you to identify sleep phases and establish the duration of periods of apnea-hypopnea.
  2. During the study of obstructive sleep apnea, video surveillance is carried out, and an ECG is recorded, making it possible to identify episodes of rhythm disturbances against the background of apnea.
  3. Also, the muscular activity of the limbs is monitored (to identify the causes of non-respiratory awakening, for example, restless legs syndrome and periodic limb movement syndrome) and body position (apnea occurs only in the supine position).

 

There is an apnea / hypopnea index (respiratory distress index) reflecting the average number of all respiratory events per hour of sleep.

 

  • The Apnea-Hypopnea Index (AHI), defined as the ratio of the total number of episodes of apnea and hypopnea during sleep to the number of hours of sleep, is a general summary measure used to describe respiratory disorders during sleep. AHI values ​​can be calculated for different stages of sleep.
  • The Respiratory Failure Index, a similar indicator of the AHI, describes a series of episodes of certain short-term awakenings associated with difficulty breathing (so-called respiratory effort awakenings, RERA), plus the number of episodes of apnea and hypopnea per hour of sleep.
  • The Awakening Index (AI), the number of awakenings per hour of sleep, can be calculated using EEG monitoring. The awakening index can correlate with the apnea-hypopnea index or the respiratory failure index. But in 20% of cases, apnea and desaturation are not accompanied by awakenings, or there are other reasons for awakenings.

 

If the apnea-hypopnea index is> 5, it is necessary to diagnose obstructive sleep apnea; with AHI> 15, moderate apnea is diagnosed,> 30 – severe. Loud snoring heard in the adjoining room is 10 times more likely to have an Apnea-Hypopnea Index> 5. Awakening Index and Respiratory Distress Index have only a moderate correlation with the patient’s symptoms.

Obstructive sleep apnea syndrome treatment and forecast

Treatment

  • Elimination of risk factors;
  • CPAP therapy or oral aids;
  • Surgery or neurostimulation (for anatomical abnormalities or diseases that do not respond to the use of devices).
  1. Treatment is selected on an individual basis and depends on the severity of the disease. The goal of OSA treatment is to reduce the number of episodes of hypoxia and sleep fragmentation. The criterion for the treatment effectiveness is the disappearance of symptoms and a decrease in AHI below the threshold value (10 per hour). Treatment is aimed at eliminating risk factors and directly at OSA. Specific treatment for OSA includes continuous positive pressure therapy, oral appliances, and surgical techniques.
  2. Complementary therapies are commonly used, although their value as first-line therapy for obstructive sleep apnea has not been proven:
  • Modafinil is used to eliminate residual sleepiness in patients with obstructive sleep apnea against the background of effective CPAP therapy;
  • Oxygen therapy improves blood oxygenation, but its positive clinical effect is difficult to predict. In addition, in some patients, oxygen therapy can lead to the development of respiratory acidosis and headaches in the morning;
  • Many drugs have been tried (tricyclic antidepressants, theophylline, dronabinol, a combination of atomoxetine plus oxybutynin), but they are not recommended for routine use due to low efficacy, low therapeutic index, or lack of replication of results;
  • The use of over-the-counter nasal dilators and throat sprays in snoring patients is not well understood;
  • Laser uvulopalatoplasty, uvular splints, and radiofrequency ablation are available treatments for loud snoring in patients without obstructive sleep apnea. Although these procedures can temporarily reduce the volume of snoring, the effectiveness diminishes for several months to several years.

Forecast

When effective treatment is prescribed, the prognosis of obstructive sleep apnea is favorable.

  1. Untreated or unrecognized obstructive sleep apnea syndrome can lead to cognitive impairment as a result of insomnia, which in turn can lead to serious injury or death due to accidents, especially car accidents.
  2. Patients who experience drowsiness should avoid driving a car, handling heavy equipment, and other types of work in which accidental falling asleep can be dangerous.
  3. Side effects of sleepiness include disability and sexual dysfunction.
  4. In addition, perioperative complications, including cardiac arrest, have previously been associated with obstructive sleep apnea, which may result from anesthetic-induced airway obstruction following extubation. 

Therefore, before performing any surgery, patients should report the diagnosis to their anesthesiologist and be provided with a constant positive airway pressure during the use of preoperative drugs and the recovery period.

FAQ

  • How is obstructive sleep apnea syndrome treated?

Obstructive sleep apnea syndrome is a disease that is based on the closure of the upper airways due to a decrease in the tone of their soft tissues. The optimal method of treatment today is CPAP therapy, which does not involve surgical intervention.

  • Why do you wake up at night from lack of air?

This is the first and main cause of suffocation and shortness of breath. It is short-term repeated choking at night that is the first symptom of apnea. The flow of air during breathing is periodically blocked by the soft tissues of the pharynx since the muscles serving to support its relaxation during sleep.

  • What is apnea in women?

Apnea is a disorder in which breathing stops repeatedly during sleep. It can last from 10 seconds to three minutes. Recent studies have shown that 20% of men and 9% of women between the ages of 30 and 60 do not know they have sleep apnea.

  • How to get rid of sleep apnea?

To eliminate mild apnea, it is usually enough to lose weight and not sleep on your back. If you regularly drink alcohol in the evenings, it is sometimes enough to give up alcohol. If nasal breathing is severely disturbed, surgery may be necessary.

  • Can sleep apnea be cured?

Sleep apnea deaths per year are as follows: The American Sleep Apnea Association estimates that 38,000 people in the United States die each year from heart disease, of which sleep apnea is a complicating factor.

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Lone Star Neurology
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Daneisha Johnson
Daneisha Johnson
22:20 19 May 22
Dr. Askari was very kind and explained everything so I could understand. The other staff were nice as well. I would... have gave 5 stars but I was a little taken aback when I checked in and had to pay 600.00 upfront. I think that should have been discussed in a appointment confirmation call or email just so I could have been prepared.read more
Jean Cooper
Jean Cooper
16:54 29 Apr 22
I love the office staff they are friendly and very helpful. Dr. JODIE is very caring and understanding to your needs... and wants to help you. I will go back. would recommend Dr. Dr. Jodie to other Patients in a heart beat. The team works well together.read more
Linda M
Linda M
19:40 02 Apr 22
I was obviously stressed, needing to see a neurologist. The staff was so patient and Dr. Ansari was so kind. At one... point he told me to relax, we have time, when I was relaying my history of my condition. That helped ease my stress. I have seen 3 other neurologists and he was the only one who performed any assessment tests on my cognitive and physical skills. At one point I couldn't complete two assessments and got upset and cried. I was told, it's OK. That's why you're here. I was truly impressed, and super pleased with the whole experience!read more
Leslie Durham
Leslie Durham
15:05 01 Apr 22
I've been coming here for about 5 years. The staff are ALWAYS friendly and knowledgeable. The Doctors are the absolute... best!! Jodie Moore is always in such a great mood which is a plus when you are already stressed. Highly recommendedread more
Monica Del Bosque
Monica Del Bosque
14:13 25 Mar 22
Since my first post my thoughts have changed here. It's unfortunate. My doctor and PA were great, but the office staff... is horrible. They never call you back when they say they will, they misinform you, they cause you too much stress wondering what's going on, they don't keep you posted. They never answer the phone. At this point I've left four messages in the last week, and I have sent three messages. Twice from their portal and one direct email. No response. My appointment is on Monday morning at 8:30am, no confirmation on my insurance and what's going on. What the heck is going on, this is ridiculous!I've given up... the stress her office staff has put me through is just not worth it. You can do so much better, please clean house, either change out your office staff, or find a way for them to be more efficient please. You have to do something. This is not how you want to run your practice. It leaves a very bad impression on your business.read more
Ron Buckholz
Ron Buckholz
23:32 23 Mar 22
I was actually pleasantly surprised with this visit! It took me a long time to get the appointment scheduled because no... one answers your phones EVER! After a month, I finally got in, and your staff was warm, friendly, and I was totally impressed! I feel like you will take care of my needs!read more
Steve Nabavi
Steve Nabavi
16:28 16 Mar 22
It was a nice visit. Happy staff doing all they can do to comfort the patients in a very calming environment. You ask... me they are earned a big gold star on the fridge. My only complaint they didn't give me any cookies.read more
Katie Lewis
Katie Lewis
16:10 10 Feb 22
Had very positive appointments with Jodie and Dr. Sheth for my migraine care. Jodie was so fast with the injections and... has so much valuable info. I started to feel light headed during checkout and the staff was SO helpful—giving me a chair, water, and taking me into a private room until I felt better. Highly recommend this practice for migraine patients, they know what they’re doing!!read more
Joshua Martinez
Joshua Martinez
16:02 10 Dec 21
I was scheduled to be checked and just want to say that the staff was fantastic. They were kind and helpful. I was... asked many questions related to what was going on and not once did I feel as though I was being brushed off. The front desk staff was especially great in assisting me. I'm scheduled to go back for a mri and am glad that I'll be going there.read more
Isabel Ivy
Isabel Ivy
21:42 03 Nov 21
I had such a good experience with Lone Star Neurology, Brent my MRI Tech was so awesome and made sure I was very... comfortable during the appointment. He gave me ear plugs, a pillow, leg support and blanket, easiest MRI ever lol 🤣 My 72 hour EEG nurse Amanda was also so awesome. She made sure I was take care of over the 3 days and took her time with the electrodes to make sure it was comfortable for me! Paige was also a huge help in answering all my questions when it came to my test results, and letting me know her honest opinions about how I should go forth with my treatment.read more
Leslie Luce
Leslie Luce
17:37 20 Oct 21
The professionalism and want to help attitude of this office was present from the moment I contacted them. The follow... up and follow through as well as their willingness to find a way to schedule my dad was above and beyond. We visited two offices in the same day with the same experience. I am appreciative of this—we spend a lot of time with doctors and this was top notch start to finish.read more
robert Parker
robert Parker
16:38 16 Apr 21
I love going to this office. The staff is friendly and helpful. The doctor is great. I am getting the best... neurological tests and treatment I have ever had. The only reason I did not give them a 5 star rating is because it is impossible to reach a live person at the office to reschedule appointments. Every time I have tried to get through to the office it says all people are busy and I am sent to a voicemail. If they could get their phone answering fixed, I would give them a strong 5 stars.read more
MaryAnn Hornbaker
MaryAnn Hornbaker
00:26 25 Feb 21
Dr. Harney is an excellent Dr. I found him friendly , personable and thorough. I evidently am an unusual case. ... Therefore he spent a Hugh amount of time educating me. He even gave me literature to further explain my condition and how to follow up. This is something you rarely get from your doctors. So I am more than please with my doctor and his staff.read more
Roger Arguello
Roger Arguello
03:05 29 Jan 21
Always courteous, professional. The staff is very friendly and always work with you to find the best appointment time.... The care team has been great. Always taking the time to listen to your concerns and to find the best treatment.read more
Margaret Rowland
Margaret Rowland
01:12 27 Jan 21
I have been a patient at Lone Star Neurology for several years. Now both my adult daughters also are patients there. I... love Jodie. She is always so prompt whether it is a teleamed call are a visit in the office. She takes the time to explain everything to me and answers all my questions. I am so blessed to have Jodie as my doctor.read more
Susan Miller
Susan Miller
03:01 13 Jan 21
My husband had an accident 5 years ago and Lone Star Neurology has been such a blessing to us with my husbands care.... Jodie Moore is his provider and she is amazing! Jodie is very knowledgeable, caring, and thorough. She takes her time with you, making sure your needs are met and she is happy to answer any questions you may have. Lone Star Neurology’s patients are very lucky to have Jodie providing their care. Thank you Lone Star Neurology and especially Jodie for everything you have done for us. Jodie, you are the best!read more
Windalyn C
Windalyn C
01:32 09 Jan 21
Jodie is wonderful. She is very caring and knowledgeable. I have been to over a dozen neurologists, and none were able... to help me as much as they have here. Thanks!read more
Katie Kordel
Katie Kordel
00:40 09 Jan 21
Jodi Moore, nurse practitioner, is amazing. I have suffered from frequent, debilitating headaches for almost 20 years.... She has provided the best proactive and responsive care I have ever received. My quality of life has been greatly improved by her caring approach and tenacity in finding solutions.read more
Ellie Natsis
Ellie Natsis
15:41 07 Jan 21
I have had the best experience at this neurologist's office! For over a year I have been receiving iv treatments here... each month and my nurse, Bobbie is beyond wonderful!! She's so attentive, knowledgeable, caring, and detail oriented. She makes an otherwise uncomfortable experience much more pleasant and definitely puts me at ease! She also helps me with my insurance,ordering this specialty medication and dealing with the ordering process which is no easy feat.Needless to say, she goes above a beyond in every way and I'm so grateful to this office and to Bobbie for all they do for me!read more
Matt Morris
Matt Morris
15:39 07 Jan 21
Let me start by saying that I have been coming here for years. Due to my autoimmune disease, I am in this office... once every three weeks for multiple hours at a time. The office is very clean and the staff very friendly. My only complaint would be there communication via phone. They aren't the best at responding if you leave a voicemail and expect a call back. I understand that this is prob just due to the sheer number of alls they receive daily. What I can say I like the best about the office are the people. Bobby who handles my infusions is great. I never have any issues with her setting up my infusions. She is very quick to reply to messages sent via text and if she were to leave then my whole opinion of the office may change. I also enjoy people like Matt, Lauren, and Jodi. I appreciate all that they do for me and without this team I'm not sure I would be as happy as I am to visit the office as frequently as I have to. Please ensure that these folks are recognized as they are what makes my visit to this office so tolerable :).read more
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