Disorder involving pauses in breathing during sleep
Medical condition
Sleep apnea
Other names
Sleep apnoea, sleep apnea syndrome
Obstructive sleep apnea: At bottom-center, nasopharyngeal tissue falls to the back of the throat when in a supine posture, occluding normal breath and causing various complications.
~ 1 in every 10 people,[3][9] 2:1 ratio of men to women, aging and obesity higher risk[5]
Sleep apnea (sleep apnoea or sleep apnœa in British English) is a sleep-related breathing disorder in which repetitive pauses in breathing, periods of shallow breathing, or collapse of the upper airway during sleep results in poor ventilation and sleep disruption.[10][11] Each pause in breathing can last for a few seconds to a few minutes and occurs many times a night.[1] A choking or snorting sound may occur as breathing resumes.[1] Common symptoms include daytime sleepiness, snoring, and non restorative sleep despite adequate sleep time.[12] Because the disorder disrupts normal sleep, those affected may experience sleepiness or feel tired during the day.[1] It is often a chronic condition.[13]
Sleep apnea may be categorized as obstructive sleep apnea (OSA), in which breathing is interrupted by a blockage of air flow, central sleep apnea (CSA), in which regular unconscious breath simply stops, or a combination of the two.[1] OSA is the most common form.[1] OSA has four key contributors; these include a narrow, crowded, or collapsible upper airway, an ineffective pharyngeal dilator muscle function during sleep, airway narrowing during sleep, and unstable control of breathing (high loop gain).[14][15] In CSA, the basic neurological controls for breathing rate malfunction and fail to give the signal to inhale, causing the individual to miss one or more cycles of breathing. If the pause in breathing is long enough, the percentage of oxygen in the circulation can drop to a lower than normal level (hypoxemia) and the concentration of carbon dioxide can build to a higher than normal level (hypercapnia).[16] In turn, these conditions of hypoxia and hypercapnia will trigger additional effects on the body such as Cheyne-Stokes Respiration.[17]
Some people with sleep apnea are unaware they have the condition.[1] In many cases it is first observed by a family member.[1] An in-lab sleep study overnight is the preferred method for diagnosing sleep apnea.[15] In the case of OSA, the outcome that determines disease severity and guides the treatment plan is the apnea-hypopnea index (AHI).[15] This measurement is calculated from totaling all pauses in breathing and periods of shallow breathing lasting greater than 10 seconds and dividing the sum by total hours of recorded sleep.[10][15] In contrast, for CSA the degree of respiratory effort, measured by esophageal pressure or displacement of the thoracic or abdominal cavity, is an important distinguishing factor between OSA and CSA.[18]
Treatment may include lifestyle changes, mouthpieces, breathing devices, and surgery.[1] Effective lifestyle changes may include avoiding alcohol, losing weight, smoking cessation, and sleeping on one's side.[20] Breathing devices include the use of a CPAP machine.[21] With proper use, CPAP improves outcomes.[22] Evidence suggests that CPAP may improve sensitivity to insulin, blood pressure, and sleepiness.[23][24][25] Long term compliance, however, is an issue with more than half of people not appropriately using the device.[22][26] In 2017, only 15% of potential patients in developed countries used CPAP machines, while in developing countries well under 1% of potential patients used CPAP.[27][unreliable source?] Without treatment, sleep apnea may increase the risk of heart attack, stroke, diabetes, heart failure, irregular heartbeat, obesity, and motor vehicle collisions.[1]
OSA is a common sleep disorder. A large analysis in 2019 of the estimated prevalence of OSA found that OSA affects 936 million—1 billion people between the ages of 30–69 globally, or roughly every 1 in 10 people, and up to 30% of the elderly.[28] Sleep apnea is somewhat more common in men than women, roughly a 2:1 ratio of men to women, and in general more people are likely to have it with older age and obesity. Other risk factors include being overweight,[19] a family history of the condition, allergies, and enlarged tonsils.[6]
^ abcdefghijklm"Sleep Apnea: What Is Sleep Apnea?". NHLBI: Health Information for the Public. U.S. Department of Health and Human Services. 10 July 2012. Archived from the original on 19 August 2016. Retrieved 18 August 2016.
^Haentjens P, Van Meerhaeghe A, Moscariello A, De Weerdt S, Poppe K, Dupont A, Velkeniers B (April 2007). "The impact of continuous positive airway pressure on blood pressure in patients with obstructive sleep apnea syndrome: evidence from a meta-analysis of placebo-controlled randomized trials". Archives of Internal Medicine. 167 (8): 757–64. doi:10.1001/archinte.167.8.757. PMID17452537.
^Patel SR, White DP, Malhotra A, Stanchina ML, Ayas NT (March 2003). "Continuous positive airway pressure therapy for treating sleepiness in a diverse population with obstructive sleep apnea: results of a meta-analysis". Archives of Internal Medicine. 163 (5): 565–71. doi:10.1001/archinte.163.5.565. PMID12622603.