MEDICAL SURFARI: DO YOU STOP BREATHING?

If you've read Charles Dickens' work, "The Posthumous Papers of the Pickwick Club", you may recall one of his characters named Joe who was an obese, red-faced boy. Dickens' multiple descriptions of his state of somnolence were probably one of the first descriptions of sleep apnea in popular literature.

Obstructive sleep apnea is a condition of repetitive long pauses in breathing during sleep, usually because of blockage of the airway in the throat. These pauses usually last for ten seconds or more and they may occur as many as 400 times per night. The condition has been linked to fatigue, premature death, hypertension, stroke, ischemic heart disease and motor vehicle accidents.

It is a fairly common disorder as it affects as many as 2-5 percent of adult females and 4-15 percent of adult males. Most people who suffer from this disorder are snorers. They may not suspect that they have this condition since they do not have specific daytime symptoms and the nighttime symptoms often go unrecognized.

Snoring is just a sign that the upper airway caliber has narrowed to a critical degree. This causes air to speed up as it passes through the narrowed area, creating turbulence and noise. If the narrowing becomes too severe it promotes closure of the airway, resulting in apnea (failure to breathe). Apnea has been arbitrarily defined as a failure of airflow that lasts at least ten seconds and people are generally considered to have sleep apnea if they have more than ten apneas per hour of sleep. Sleep apnea syndrome refers to people with sleep apnea at night who also have excessive daytime sleepiness.

Who should be suspected of having sleep apnea? If you have been unusually sleepy during the day and snore a lot at night or if you have been told by a spouse or partner that you snore and do not breathe properly at night, these may be signs of sleep apnea. If you have a small or recessed jaw or if you are obese and despite an adequate number of hours of sleep you feel unrefreshed in the morning, you may have sleep apnea. Others wake up several times at night for no particular reason. Also, if you have unexplained heart or respiratory failure or difficulty with memory or concentration and excessive daytime fatigue, you may have sleep apnea. Other factors that seem to increase the likelihood of airway obstruction during sleep include obesity, use of alcohol, use of sleeping pills, nasal congestion, sleeping on one's back and sleep deprivation.

Although the diagnosis may be suspected by symptoms and signs, it is generally confirmed by a sleep study conducted overnight in a sleep disorders clinic. During the test brain activity, breathing patterns, oxygen level and heart rate are recorded. The treatment varies, depending upon the severity of the situation. Sometimes through weight loss, avoidance of alcohol and sleeping pills as well as the use of nasal decongestants, this condition can be managed. Some patients require continuous positive airway pressure (CPAP) as prescribed by their physician. This system consists of a mask for the nose connected to a bedside unit via a flexible hose, which delivers continuous positive airway pressure keeping the air passages open. There are also other oral appliances that can be made to help keep the throat open and prevent obstructive sleep apnea. For patients who do not respond well to these nonsurgical measures there are various surgeries that improve the flow of air through the throat and upper air passages to prevent sleep apnea.

Since sleep apnea has been linked to several serious medical problems, it is important to seek treatment if you believe that you may have this condition. Discuss this with your physician, as he or she will need to take all of this information into consideration as well as your other medical history before recommending any particular therapy.

World Wide Web Resources

Sleep Apnea Society of Alberta

www.sleep-apnea.ab.ca/index.html

This site from Canada provides some excellent information on sleep apnea, including treatment, prognosis, and specific topics such as driving and sleep apnea.

American Sleep Apnea Association

www.sleepapnea.org/pubs.htm

Through this web page you can order a variety of publications related to sleep apnea, including issues of "Wake-up Call - The Wellness Letter for Snoring and Apnea".

Dr. Scott Gibbs is a Cape Girardeau neurosurgeon and editor-in-chief of Mosby's Medical Surfari. You may e-mail questions to him at drgibbs@semissourian.com or write in care of the Southeast Missourian, P.O. Box 699, Cape Girardeau, Mo., 63701.