Sleep On It

The etiology of OSA lies in the fact that in susceptible individuals,the side walls of the throat fall together to cause collapse of the adjacent wind pipe and airways leading to complete cessation of breathing in the lungs. This leads to pauses in breathing during sleep,which are known as apneas. In severe illnesses,the patient may be suffering from more than 30 such episodes per hour of sleep. Intermittent collapse of airways is the reason for loud snoring and frequent arousals.

Generally,such patients fall asleep during routine daytime activities such as reading,watching TV,sitting inactively,driving a car at a constant speed or when stopped for a few minutes in traffic. Usually,these brief episodes of sleep do not seem to relieve their overall urge of sleepiness. They also have irritability,mood swings,depression,poor concentration abilities and memory difficulties. Bed partners may report loud and interrupted snoring associated with choking or gasps. This often occurs in a crescendo pattern with the loudest noises occurring at the very end.

Sleep apnea is more common in men than in women. Sleep apnea is most common in middle-aged adults,but is also rarely seen among children. Obesity,smoking,consumption of alcohol and sedatives and having an anatomically short neck are risk factors for sleep apnea. It may run in families as well.

MANAGEMENT
OSA is diagnosed on the basis of clinical symptoms and sleep studies. Questions about day time sleepiness,sleep quality and bedtime habits both from the patient and his partner and a thorough clinical examination of mouth,nose and throat enables the clinician to find clues for the disease. A sleep study known as polysomnography is used to confirm the diagnosis of obstructive sleep apnea. Weight reduction,oral appliances,positional therapy,positive pressure therapy,and surgery are various available treatment options. Of these,positive pressure therapy by CPAP machine is the most commonly prescribed and effective therapy for OSA. In the end,prognosis is excellent if effective treatment is timely prescribed and utilized.

The writer is an interventional senior consultant cardiologist at INSCOL hospital,Chandigarh and Fortis Hospital,Mohali