OBSTRUCTIVE SLEEP APNOEA
Obstructive Sleep Apnoea (OSA) has similar anatomical mechanisms to snoring, however there are also other non-anatomical factors which may complicate treatment.
What is OSA?
OSA is characterised by airway collapse during sleep leading to restriction of the airway space. This restriction may be complete (apnoea) or partial (hypopnoea), resulting in a decreased oxygen supply to the brain. When the brain detects the lower oxygen levels, it signals the body to wake up and resume normal breathing. Breathing pauses can last from a few seconds to more than a minute and can occur hundreds of times throughout the night. Although most people won't remember waking up, the repetitive awakenings during sleep can disrupt and negatively impact the quality of sleep. Additionally, the decreased oxygen flow to the brain and body may lead to other health issues.
Daytime fatigue, snoring and waking up choking or gasping for breath are all signs of possible OSA.
What are the risks of OSA?
OSA can disrupt your sleep and lead to excessive daytime fatigue. If left untreated, OSA may eventually lead to a deterioration in mental and physical health. There is strong evidence linking OSA to several health conditions including: (1)
- Hypertension (high blood pressure)
- Cardiovascular disease including heart attack, arrhythmias, atrial fibrillation and heart failure.
- Stroke
- Diabetes
- Gastric reflux
- Mental health conditions including depression and anxiety.
- Pregnancy related complications
- Daytime sleepiness and fatigue leading to higher risk of work place and motor vehicle accidents.
How do I know if I have OSA?
Diagnosis of OSA involves a sleep study. There are several different types of sleep studies available.Your GP will discuss your symptoms and may directly organise a sleep study or refer you to a sleep physician who specialises in sleep conditions. A sleep study will evaluate your sleep stages, breathing patterns, oxygen levels and muscle activity. Any pauses in breathing will be assessed and then categorised into mild, moderate or severe.
How is OSA treated?
In addition to the therapies listed for snoring, additional treatment options for OSA will depend on the severity of OSA and include:
- Continuous Positive Airway Pressure (CPAP) machine -This is an air pump that gently blows air through a face mask into the airway to keep the airway open during sleep and is considered the gold standard for treatment.
- Oral appliances - Mandibular Advancement Splints (MAS) are recommended for the treatment of mild to moderate OSA and in those who cannot tolerate or have failed CPAP (2,3,4). These devices hold the lower jaw, tongue and soft palate in a forward position and prevent collapse of these structures into the airway improving the airway's ability to stay open during sleep.
References:
1. Espiritu, J.R.D. (2021). Health Consequences of Obstructive Sleep Apnea. In: Kim, K.B., Movahed, R., Malhotra, R.K., Stanley, J.J. (eds) Management of
Obstructive Sleep Apnea. Springer, Cham. https://doi.org/10.1007/978-3-030-54146-0_3
3. Ramar et al. Clinical Practice Guideline for the Treatment of Obstructive Sleep Apnea and Snoring with Oral Appliance - Therapy: An Update for 2015.
https://jcsm.aasm.org/doi/10.5664/jcsm.4858
4. Ellender et al (2024). Management of obstructive sleep apnoea in primary care. Australian Journal of General Practice. 53(6) 363-369
https://doi: 10.31128/AJGP-08-23-6933
