Sleep Apnea, Breath Pauses and Loud Snoring During Sleep

Sleep Apnea, Breath Pauses and Loud Snoring During Sleep


SLEEP APNEA/HYPOPNEA SYNDROME


Sleep apnea or Central Sleep Apnea syndrome is characterized by recurrent upper airway obstruction during sleep when loss of normal pharyngeal tone allows the pharynx to collapse passively during inspiration Which causes Loud Snoring and Breath Pauses (apnea) in affected person.

Etiology and Causes of Sleep Apnea
Male gender
Obesity
Tonsillar hypertrophy
Nasal obstruction
Hypothyroidism
acromegaly
Ingestion of alcohol or sedatives before sleep

Clinical features of Sleep 


If narrowing is slight, it leads to snoring. If upper airway narrowing progresses to the point of occlusion or near occlusion, sleeping person increase respiratory effort and try to breathe until the increased effort transiently awaken him. This recurrent cycle of apnea, awakening, apnea, awakening may repeat itself many hundreds of times per night. Patient complains of day - time sleepiness, he feels he has been asleep all night but wakes unfreshed.
Bed partner reports loud snoring and often have noticed multiple breathing pauses (apnea).
Patient also complains of difficulty in concentration, impaired cognitive function, impaired memory and work performance, depression, loss of libido, irritability and nocturia.
Hypertension and ischemic heart disease are also complications.
Examination
Nasal obstruction
Narrow oropharynx due to excessive soft tissue folds, large tonsils or prominent tongue. Features of pulmonary hypertension or cor-pulmonale may be present.

Investigations of Sleep Apnea


Polysomnography: this is the overnight study of breathing, oxygenation (oxygen saturation) and sleep quality. It shows apnea episodes as long as 60 seconds, oxygen saturation falls often to very low level and brady or tachy arrhythmias.

Treatment of Sleep Apnea


• Weight loss
• Strict avoidance of alcohol and hypnotic medications.
• Nasal continuous positive airway pressure (nasal CPAP) is curative in many patients.
• Treatment of curable conditions such as deviated nasal septum.
• Uvulopalatopharyngoplasty : a procedure consisting of resection of pharyngeal soft tissue and amputation of approximately 15 mm of free edge of the free edge of the soft palate and uvula is helpful in about 50% of cases.