DO YOU SNORE ?? KNOW ABOUT OSA

Snoring is a fairly common problem. There's nothing more disgusting than the sound of someone snoring when you're trying to fall asleep. Or maybe it's you who snores, and people tease you about the noise you make in your sleep. Snoring isn’t just embarrassing loud noise, perhaps its a sign of serious health problem. It is often associated with a sleep disorder what is called as Obstructive sleep apnea (OSA) – a condition which occurs due to narrowed upper airways during sleep.

WHAT HAPPENS IN OSA :

During sleep, the muscles and tissues of the throat loses its tone & become relaxed leading to airway narrowing (collapse) in certain individuals . When air passes forcefully through this -  it creates a vibrating sound called snoring. Eventually the airway completely blocks leading to

1.  Apnea (stoppage of breathing for more than 10 seconds).

2. Hypopnea (reduction in the airflow leading to decrease in oxygen levels and/Or arousal from sleep) . 

When these apnea and hypopnea occurs ,the person feels chocked up and get aroused from sleep as a protective phenomenon to open his airway , to normalise breathing and oxygen levels. The person changes his position and slowly go to sleep again to get aroused due to apnea or hypopnea. This cycle gets repeated nearly every 10 to 15 mins leading to frequent arousals from sleep.This inhibits the person going into deep sleep and hence results in sleep deprivation.

PICTORIAL REPRESENTATION OF SNORING AND OSA

WHO CAN DEVELOP OSA :

-- Most important risk factor is Obesity . Adult with BMI of 30 or higher are at high risk of OSA especially if they have central obesity & fat deposition around neck.

-- People with Short and thick neck , narrowed upper airway by birth or due to development defects like macroglossia , retrognathia etc , genetic factors , thyroid disorders (hypothyroidism), excessive consumption of alcohol / sedatives .

WARNING SIGNS OF OSA : 

Not all snorers have OSA , but most people who have OSA snore. The probability of having OSA increase if you are having any or few of the following symptoms along with snoring.

-- Loud snoring , which disturbs bed partner or even audible to next room.

-- Repeated awakenings from sleep.

-- Sensation of choking or breathing discomfort during sleep. (Usually observed by bed partner).

-- Unrefreshing sleep - Not feeling fresh in the morning after night’s sleep with morning headaches.

-- Excessive daytime sleepiness.

-- Easily falls asleep while watching TV / while sitting idle.

-- Difficult to concentrate while working.

HEALTH PROBLEMS DUE TO OSA :

--  Individuals with OSA will have poor sleep quality which results in morning headaches , loss of interest in work , easy tiredness.

-- Long term sleep deprivation leads to –  "OXIDATIVE STRESS". This will make them more prone to develop following diseases - diabetes , hypertension , Stroke , heart failure ,thrombo-embolism , kidney problems , depression etc.

-- Untreated OSA will result in poor control of pre existing disease like diabetes , hypertension, thyroid disease , asthma etc. They may require higher dosage of medication to keep their sugars and blood pressure under control.

-- Excessive daytime sleepiness can increase errors at work , hamper their work performance. While driving it can lead to road traffic accidents.

-- Obese people with OSA will find it difficult to reduce weight despite prompt weight reduction measures.

COMPLICATIONS OF UNTREATED OSA

HOW OSA IS DIAGNOSED :

Sleep study ( Polysomnography ) is required to establish diagnosis of OSA. It involves recording detailed information about  how the body acts during sleep. This test is performed overnight during sleep in specially designed sleep lab. The technician attaches sensors to the  participant’s body, and the sensors keep track  of a number of body functions, such as brain waves, breathing pattern, snoring ,blood oxygen levels etc. Sleep study mainly detects episodes of apneas and hypopneas during sleep, also the consequence and response of the body to it . Depending upon the number of episodes ( AHI index if more than 5 per hour) OSA is diagnosed . Level - I sleep study done in a sleep lab with video monitoring is more sensitive than home based sleep study.

SLEEP STUDY

TREATMENT :

OSA is a treatable disease.

-- CPAP therapy is a well established treatment modality in these patients with excellent results. Based on sleep study results pulmonologist/sleep specialist will decide whether CPAP therapy is required. CPAP therapy significantly reduce the episodes of apnea / hypopnea. CPAP not only helps the person in getting sound sleep but also it protects him/her from the dangerous consequences of OSA. 

-- Other measures include weight loss , sleeping on lateral side (to avoid sleeping on back ) , cutting down alcohol and smoking . Some may require surgery and other modes of treatment. 

               Snoring is a neglected entity in our indian setup , awareness about OSA and it's consequences is very poor in India. Not all snorers have OSA. But if you are suffering from symptoms /signs of OSA as described above consult your chest physician and get sleep study done. 

AUTHOR :

Dr. Ajith Eti 
Chest physician  
SS Hospital, Davanagere and 
USIRU -The Breathe clinic, Davanagere
Ph: 9900806121
email id : ajith.eti1@gmail.com