So, you were diagnosed with Sleep Apnea, now what?

By Jordan Harborth, FNC-P Nurse Practitioner at Neurology Solutions

What is Obstructive sleep apnea

OSA is a common disorder that often goes undiagnosed, either because healthcare providers fail to inquire about it or because patients don’t complain about it. It occurs when the upper airway becomes blocked, leading to symptoms such as snoring, oxygen desaturation, hypopneas, and disrupted sleep. The blockage usually happens when the tongue and/or soft palate collapse against the pharyngeal wall. Sleep apnea is a major contributor to daytime somnolence or sleepiness and has also been linked to significant morbidity and mortality. Although it was previously believed to affect only 2% to 4% of adults, recent studies suggest that the prevalence may be higher, with estimates ranging from 10% to 30% of the adult population.

How to get diagnosed

Fortunately, obtaining a sleep apnea diagnosis has become more convenient in recent years. Home sleep studies can accurately determine whether you have sleep apnea. Depending on the results, an in-lab sleep study may be necessary, particularly if a titration study is required. This study involves testing different pressures, masks, and other variables to identify the most suitable treatment for your sleep apnea.

Risks of untreated OSA

If left untreated, sleep apnea can increase the risk of cardiovascular disease, hypertension, stroke, and metabolic disorders such as prediabetes and diabetes. It is also a common cause of excessive daytime sleepiness, which can lead to workplace errors, traffic accidents, and even fatalities. Now, let’s discuss the range of treatment options for sleep apnea that are currently available.

  • Sleep Hygiene
    • Optimizing sleep hygiene can significantly improve OSA symptoms. Recommendations include avoiding alcohol and sedatives near bedtime, refraining from daytime napping, avoiding stimulating activities before sleep (such as watching television), and limiting late afternoon caffeine intake.
  • Weight Loss
    • Being overweight is a significant risk factor for OSA, as approximately 60–90% of adults with OSA are overweight. Excess fat deposits in the neck, known as pharyngeal fat, can obstruct the upper airway during sleep. Maintaining a healthy weight is crucial in the treatment of OSA, particularly for individuals with a body mass index (BMI) greater than 25. Effective weight loss can lead to reduced reliance on continuous positive airway pressure (CPAP) therapy, improving compliance and potentially even curing OSA. Additionally, increased abdominal girth from excess fat can compress the chest wall, reducing lung volume and diminishing airflow, making the upper airway more susceptible to collapse during sleep. OSA risk continues to escalate with rising BMI, and even a 10% weight gain is associated with a six-fold increase in OSA risk.
  • PAP Therapy (CPAP, BiPAP, ASV)
    • Continuous positive airway pressure (CPAP) is the treatment of choice for moderate-to-severe obstructive sleep apnea (OSA). CPAP is a steady flow of air which is pumped through the nose and/or mouth into the airways of the lungs, which then keeps the airways open during sleep, thus eliminating the “obstruction”. 
    • Bilevel positive airway pressure (BiPAP) functions similarly to CPAP but delivers two different levels of air pressure instead of a continuous level.
    • Adaptive servo-ventilation (ASV) machines work by automatically monitoring a person’s breathing and adjusting to deliver air pressure levels that fit the patient’s breathing patterns, instead of preset levels as with CPAP and BiPAP.
    • it is estimated that approximately 60% of OSA patients do not comply with PAP therapy due to issues such as mask discomfort, skin irritation, noise, claustrophobia, or a perceived lack of benefit.
    • If a patient is intolerant to PAP therapy, for the reasons previously mentioned, then they should be evaluated for anatomical problems that may be amenable to surgery. For certain patients with OSA, surgery may be an alternative or adjunct to PAP therapy.
  • Surgery
    • Inspire is a new surgical option that is becoming more popular, although still relatively new. Inspire electrically stimulates the hypoglossal nerve, which stimulates the tongue and airway muscles to open your airway. You turn Inspire on using a remote control before going to bed and turn it back off when you wake for the day. Inspire does have a battery given it is electrical stimulation, which is implanted beneath your collar bone, and lasts approximately 11 years before needing to be replaced. Inspire is indicated for patients with moderate to severe sleep apnea who have failed PAP therapy.
    • If CPAP therapy is not tolerated, or remains symptomatic despite compliance, surgical airway correction can be considered, which may include altering the anatomy of the nasal cavity, nasopharynx, oropharynx, and/or hypopharynx, as well as completely bypassing the normal airway. While most surgical procedures for OSA have shown improved clinical outcomes, they are not considered curative for OSA in general. Surgery is typically reserved for patients with severe OSA.
  • Oral Appliance (OA)
    • Oral Appliance (OA): Oral appliances work by advancing the mandible and/or tongue, which helps open the upper airway. Compared to CPAP, oral appliances are typically more affordable and require less maintenance, resulting in increased patient compliance.

Conclusion

It is imperative that you treat your underlying OSA given the increased risks associated with untreated sleep apnea. Consult with your healthcare provider about obtaining a sleep study if you have any of the signs/symptoms discussed. There are many treatment options available today in order to help properly treat OSA and reduce risks associated with untreated OSA.

Resources

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5698527/

https://pubmed.ncbi.nlm.nih.gov/32286648/

https://pubmed.ncbi.nlm.nih.gov/23074535/

https://pubmed.ncbi.nlm.nih.gov/35251830/

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