Obstructive Sleep Apnea

The most common type of sleep apnea is obstructive sleep apnea, or OSA, which affects upwards of 45 million Americans. This is caused by a blockage of the airway due to a collapse of the soft tissue at the back of the throat during sleep.
People with OSA snore and repeatedly experience brief interruptions of breathing (apnea) during sleep.
This may occur hundreds of times during sleep, which deprives the brain and other vital organs of life-sustaining oxygen.

The prevalence of any OSA is estimated to be 33.9% in men and 17.4% in women 25% on Avg. 5 in 11 adults has mild OSA
75% of severe SDB cases remain undiagnosed

Increased risk factors for Sleep Apnea
Untreated OSA may increase the risk of high blood pressure, heart attack, stroke, obesity, diabetes, heart failure and arrhythmias or irregular heartbeats.

Sleep apnea can also contribute to memory problems and problems at work and automobile/truck-related accidents due to fatigue. Researchers have also linked sleep apnea to erectile dysfunction and obesity, triggered in great part by the disturbed sleep states caused by sleep apnea.

What are the common symptoms OSA?

Common symptoms of obstructive sleep apnea (OSA) include:

- Awakening due to gasping or choking

- Restless sleep

- Memory impairment

- Morning headaches

- Morning sore throat or dry mouth

- Frequent nocturnal urination

- Erectile dysfunction

Once diagnosed, sleep apnea can be successfully treated.
Treatment can restore normal breathing during sleep, reduce stress on your heart, relieve symptoms, and improve quality of life.

How is sleep apnea diagnosed?

If you snore, have daytime fatigue, and have hypertension, it’s worth querying your family physician about the possibility of sleep apnea. Obesity is a risk factor, even though sleep apnea can occur in people of ideal weight. In addition, a large neck size is associated with increased risk of apnea. Men with a neck size greater than 17 inches (women with neck sizes greater than 16 inches) are at risk.
If, following questioning and a physical examination, your doctor suspects that you have sleep apnea.
You can be offered WatchPAT, an at-home sleep apnea test, with 90% correlation to sleep lab tests.
You may be sent to a sleep specialist or an accredited sleep laboratory for a night of extensive specialized monitoring. The gold standard test for obstructive sleep apnea is a sleep study, known as polysomnography (PSG).

What are the traditional options to treat sleep apnea?

There are two diagnosis options:

  • Lifestyle Modification

    For mild OSA, weight loss, avoiding alcohol, smoking cessation, and positional techniques are commonly recommendedThe WatchPAT consistently demonstrates a high degree (up to 90%) of correlation as compared with PSG.

  • PAP therapy

    Positive Airway Pressure (PAP) therapy includes all CPAP (auto and fixed) and Bi-level pressure devices.  All PAP pressure devices are measured in centimeters of water pressure (cm/H2O).  PAP therapy is known as the gold standard in the treatment of OSA. PSG is performed at a sleep disorders center within a hospital or at an independent sleep centers.

  • CPAP

    With CPAP (SEE-pap), the patient is connected to a mask that is connected to a flow generator via 6 feet of pressure tubing.  The air pressure is somewhat greater than that of the surrounding air, and is just enough to keep your upper airway passages open, preventing apnea and snoring.

  • Auto-CPAP (APAP)

    APAP device with an auto adjusting algorithm that increases and decreases the positive pressure delivered to the patient based upon a recorded flow signal.  Pressure is increased due to flow limited breathing, hypopneas, or apneas and decreased due to normal breathing.  These devices are continuously monitoring the flow signal and adjusting based upon a rolling window, generally 5 minutes of flow data.

  • Bi-Level (BiPAP)

    A bi-level PAP device has a higher inspiratory pressure setting than the expiratory pressure setting.  These devices are routinely used in patients with CPAP intolerance or for patients with CPAP pressures greater than 15 cm/H2O.

  • Oral Appliance (OA’s)

    OA’s also known as mandibular advancement devices (MAD’s) are fitted by dentists who specialize in airway management or rarely by ENT’s for mild to moderate OSA. OAs act by moving (pulling) the tongue forward or by moving the mandible and soft palate anteriorly, enlarging the posterior airspace. They open or dilate the airway. Newer designs have separate upper and lower parts that are attached to each other and that allow for adjustability and jaw mobility. A minimum percentage of protrusion to effectively treat OSA is 6-10 mm or up to 75% of the maximum protrusion the patient is capable of performing upon request at the initial examination. This protrusion advance distance is necessary for the OA to be effective. The more protrusion gained, the lower the AHI at the treatment assessment time point.

  • Upper Airway Surgery

    Surgery of the upper airway can take many forms, including in-office surgery or major surgery requiring a hospital stay.  Most in-office surgery, such as laser assisted uvulopalatoplasty (LAUP), are viewed as cosmetic by insurance payers and intended for snoring.  Major surgery can include UPPP, tracheostomy, or maxillomandibular advancement (MMA) but are generally seen as a last resort in patients who cannot tolerate PAP.


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