Obstructive sleep apnea (OSA) is a disorder characterised by repeated episodes of partial or total upper airway obstruction leading to arousals from sleep, and changes in oxygen levels during sleep. OSA is probably the most common conditions I see as a sleep medicine specialist. This just isn't surprising, considering that OSA is estimated to affect roughly 20% of the overall population, and is more common in patients who're obese, or have heart or metabolic conditions. corresponding to diabetes.
When untreated, OSA can negatively impact cardiovascular and metabolic health, quality of life, and end in excessive daytime sleepiness, insomnia, problems with considering, and Depression or anxiety. OSA affects people of all ages, backgrounds, shapes, and sizes, and while each patients and physicians have develop into increasingly aware of OSA and its effects lately, roughly 80% of OSA patients still are undiagnosed.
How is OSA diagnosed?
The severity of OSA relies on the variety of sleep interruptions per hour during a sleep study, also often called the apnea-hypopnea index (AHI). Basically, the upper the AHI, the more severe the sleep deprivation. Most population studies show that about 60% of individuals with OSA fall into the mild category. In general, many studies show a linear relationship between AHI and adversarial health outcomes, providing strong support for treatment of moderate and severe OSA, but clinical and/or clinical evidence for treatment of mild OSA. with less clear support for cost advantages.
OSA scores don't all the time correlate with symptoms.
Regardless of the standards used to categorise OSA as mild, moderate, or severe, disease severity doesn't all the time correlate with the extent of symptoms. In other words, some individuals with very mild disease (based on their AHI) could be very symptomatic, with excessive sleepiness or severe insomnia, while others with severe disease have subjectively good sleep quality. they usually should not have significant daytime disturbances.
Sleep disorders also overlap, and patients with OSA can have comorbid insomnia, circadian (internal body clock) disturbances, sleep movement disorders (corresponding to restless legs syndrome), and/or hypersomnia conditions (e.g. may suffer from narcolepsy). To truly optimize a patient's sleep and daytime functioning, an in depth sleep history is required, and sleep problems should be addressed through a comprehensive, multidimensional, and individualized approach. .
Treatment options rely upon the severity of your OSA.
When sleep apnea is moderate or severe, continuous positive airway pressure (CPAP) is taken into account the primary treatment, and is the beneficial treatment. American Academy of Sleep Medicine (AASM). CPAP can essentially normalize respiratory during sleep, by eliminating snoring, apnea, and decreased oxygen saturation. However, to be most helpful, CPAP should be worn constantly throughout sleep. Unfortunately, many OSA studies have set relatively low bars for treatment adherence (many use a limit of 4 hours per night), and don't necessarily take treatment efficacy under consideration (whether insomnia and related daytime symptoms persist despite treatment).
What about mild sleep deprivation?
There are usually not all the time consistent end result data or consensus about treatment recommendations for individuals with mild sleep apnea. However, there are several studies which have demonstrated quality of life advantages in treating mild OSA, including A recent study Published in The Lancet, where researchers from 11 centers across the UK recruited 301 patients with mild OSA to receive CPAP plus standard of care (sleep hygiene counseling) versus standard of care and followed them for 3 months. Results showed that in patients with mild OSA, treatment with CPAP improved their quality of life, based on a validated questionnaire.
This study supports a holistic approach to the diagnosis and treatment of mild OSA. Although not all individuals with mild OSA may have to be treated with CPAP, there are patients who may profit greatly from it.
Treatment will be trial and error until you and your doctor get it right.
When sleep apnea is mild, treatment recommendations are less clear-cut, and needs to be determined based on the severity of your symptoms, your preferences, and other health issues. Working together with your doctor, you'll be able to try a step-by-step approach – if one treatment doesn't work, you'll be able to stop it and take a look at an alternate. Managing mild sleep apnea involves shared decision-making between you and your doctor, and it's best to consider how troubled you might be by your sleep apnea symptoms in addition to other components of your health. There are some that may worsen from untreated sleep deprivation.
Take home suggestions
Conservative approach for mild OSA:
- Maximize the side sleeping position; Try to not sleep in your back.
- Improve weight if obese or obese; Even a 5- to 10-pound weight reduction could make a difference in mild OSA.
- Treat nasal allergies/congestion.
- Avoid alcohol or respiratory depressants near bedtime.
- Make sure you get the proper amount of sleep, and maintain proper sleep and wake times throughout the week.
If you've troubling symptoms related to OSA – corresponding to loud, disruptive snoring, long pauses in respiratory, frequent nighttime awakenings, restless sleep, insomnia, trouble considering, or daytime sleepiness; Too much sleep — or significant health problems that could be exacerbated by OSA (even mild) — corresponding to arrhythmias, hypertension that requires multiple medications to regulate, stroke, or severe mood disorders — Medical treatment needs to be considered for OSA.
Medical treatment for mild OSA:
- Continuous positive airway pressure device (CPAP)
- A dental appliance for the treatment of sleep apnea
- An evaluation with an ear, nose, and throat specialist (ENT) to see if there may be a physical problem (corresponding to severe nasal deviation) that's causing OSA, or making it worse.
If you might be concerned that you might have OSA, discuss with your doctor.
Based in your symptoms, exam, and risk aspects, your doctor may recommend a sleep study, or you might be referred to a sleep medicine specialist. A comprehensive sleep assessment is required to accurately diagnose sleep complaints, as sleep disorders overlap. Treating mild OSA can improve sleep-related symptoms and your quality of life. However, there is no such thing as a one-size-fits-all in terms of sleep disorders, reasonably a multifaceted and individualized approach to finding what works for you.