Sleep apnea: a noisy danger
Sleep apnea: a noisy danger
Assoc. Professor, Dr. Supakorn Rojananin, M.D.
Deputy Dean of Public Relations and Special Affairs
Faculty of
Lately, a senior decent, non-drinker doctor, 55, had a car accident with broken limbs during driving back from upcountry about 150 km. from
According to Professor, Dr. Arth Nana, Chief of Division of Respiratory Diseases and Tuberculosis, sleep apnea is a temporary stoppage of breathing during sleep, occurring over 10 seconds a time in over 5 times per hour. Severity of sleep apnea depends on the number and duration of apnea, 5-10 times per hour is considered as mild, 15-30 times is moderate and over 30 times per hour is severe which needed a prompt treatment.
Naturally all must sleep in about one third of their lives. Over halves will have more or less bad experiences about their sleep, such as insomnia, over-sleeping, having bad dreams, neck pain on awaking, loud snoring, etc., but few are unaware of having sleep apnea unless they have a test. Obstructive type is the most common form when the upper airway is narrowed or obstructed during sleep. Longstanding untreated sleep apnea will cause high blood pressure, heart arrhythmias, coronary heart disease, stroke, prone to have traffic accidents and shorter life spans.
There was no figure how common it is in
As explained by Dr. Arth, most obstructive sleep apnea (OSA) is caused by the relaxation of the muscle of upper airway from the mouth to pharynx during sleep. During inspiration, most people successfully maintain a patent airway but the negative pressure will easily narrow or completely occlude the relaxed airway in OSA causing inadequate amount of air or even no air passing through to the lung. This will cause a transient hypoxemia (low blood oxygen) in a period of time while other respiratory muscles of chest and abdominal wall consequently take more effort. The retention of carbon dioxide from apnea will reflex the brain to interrupt the deep sleep activating the relaxed airway to open and resume breathing again.
Loud snoring is a sign of having narrowing upper airway but not all will develop apnea. Only 20-30% of severe and persistent snoring had a complete obstruction.
People at risk are those older age that have loud snoring, obesity, frequent alcohol or sleeping pill intake, short neck, short jaw, or people with nasal congestion from allergy, hypothyroidism, acromegaly and children with tonsilar hypertrophy.
These people will also have an unrefreshing sleep, morning headache, a dry mouth upon awaking, depression, difficulty concentration, impaired memory, loss of libido, and excessive daytime sleepiness or sleepy on driving, etc.
For those who are suspicious of having OSA, a diagnostic test is now available by using a sleep test or the so-called Polysomnography. Patients need to sleep overnight in the hospital laboratory with monitoring devices to record EKG for heart beats, EMG for muscle activity, blood oxygen saturation, brain waves, air flow of the upper airway, thoracic and abdominal muscle movement, and audio monitoring for snoring, etc.
At present, Siriraj can handle the tests up to 250 cases per year and will expand our service to accommodate 500 cases in 2007.
Treatment of OSA depending on its severity, as pointed out by Dr. Arth. In mild sleep apnea, the treatment is just by adjusting the behavior. Losing weight, sleeping on the side and stop drinking and cessation of sleeping pill are often recommended. Oral mouth devices sometimes are useful to reduce snoring by bringing the jaw forward or elevation the soft palate or retain the tongue from falling back in the airway and blocking breathing.
Moderate to severe sleep apnea is usually treated with a small device called C-PAP or continuous positive airway pressure. This device will blow air into the nose via nose mask, keeping the airway open and unobstructed.
Surgery is another option when conservative treatment fails. Many procedures had been introduced, such as, uvulo-palato-pharyngoplasty (UPPP), mandibular myotomy, laser assisted uvuloplasty, tonsillectomy, etc. However, the type and extent of surgery depends on causes and risk factors in individual patient and must be considered only by your physician after having had a thorough investigation.
