Sleep Apnea

Sleep Apnea a serious condition in which airflow is reduced or blocked during sleep. The sleeping person awakens in order to breathe, often unknowingly, hundreds of times during the night. Total collapse of the airway causes snoring, snorting or gasping. Potential consequences of sleep apnea include high blood pressure, heart disease, heart attack, stroke, impotence, and memory loss. Potential symptoms of apnea include snoring, excessive daytime sleepiness, irritability and morning headaches.

Symptoms

The hallmark symptom of the disorder is excessive daytime sleepiness. Additional symptoms of sleep apnea include restless sleep, loud snoring (with periods of silence followed by gasps), falling asleep during the day, morning headaches, trouble concentrating, irritability, forgetfulness, mood or behavior changes, weight gain, increased heart rate, anxiety, depression, increased frequency of urination, bedwetting, esophageal reflux and heavy sweating at night. Obstructive Sleep Apnea is more likely to occur in men than in women, and in people who are overweight or obese. All other factors being equal, people with larger neck measurements are also more likely to suffer from this condition.

Obstructive Sleep Apnea occurs more frequently in people with Down Syndrome than in the general population. A little over 50% of all people with Down Syndrome suffer from sleep apnea (de Miguel-Díez, et al 2003), and some advocate routine testing of this group (Shott, et al 2006)

Diagnosis

The typical patient with obstructive sleep apnea is an overweight middle-aged male with a neck size of more than 17 inches. However, the condition is also common in women and not all sufferers are overweight. Almost everybody who has obstructive sleep apnea is a snorer, often a very heavy snorer. Pauses in breathing during sleep are commonly noticed by a bed partner but this history is often lacking and up to five "events" per hour are considered normal. One of the more consistent symptoms is "nonrestorative sleep," meaning that the patient wakes in the morning feeling unrefreshed no matter how much he slept during the night. Excessive daytime sleepiness is common in sleep apnea of any severity, but some patients complain of fatigue rather than sleepiness and others notice neither. Other symptoms include hypertension, anxiety/depression, trouble concentrating, and nocturnal awakenings.

The most accurate diagnostic tool, polysomnography, can establish the diagnosis and assist in identifying the type of sleep apnea present. This test is usually done overnight in specialized sleep laboratories, either freestanding or in a hospital. Portable sleep recording systems that can perform unattended polysomnography in the patient's home or hospital bed are used in certain circumstances, but in-laboratory testing with a technician present remains the gold standard and is required by many insurers, (eg. Medicare of the United States) before they will pay for treatment of the condition.

Screening devices, measuring fewer parameters than traditional polysomnography, are sometimes used to determine if patients are likely to test positive for obstructive sleep apnea. The value of such devices is the subject of debate and study among sleep medicine professionals. Some feel that such devices can reduce costs and conserve resources, while others feel that the devices are unnecessary: a positive result leads to polysomnography anyway, while a negative result cannot be trusted if the patient still complains of symptoms.

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