What is Obstructive Sleep Apnea (OSA)?
Obstructive sleep apnea (OSA) is the most common sleep disorder affecting approximately 50 million Americans. This condition prevents patients from getting the recommended seven to nine hours of good sleep each night.
This condition is characterized by repeated breathing interruptions due to tissue collapse in the throat, which prevents airflow into the lungs and causes oxygen starvation. These episodes may, depending on severity, occur multiple times per hour leading to an interrupted and unrestful sleep pattern and ultimate to damage to the heart, vessels and brain.
What are symptoms of OSA?
Snoring is commonly observed with OSA, but it is important to understand that OSA can be present even if patients do not snore or even if they do not have some of the common sleep apnea symptoms:
- Morning headaches
- Daytime sleepiness and fatigue
- Depression and anxiety
What causes OSA?
OSA is often seen in overweight males with an increase neck circumference of 17.5 inches. However, it can also be seen in normal weight patients who have an unfavorable throat anatomy (e.g. large tonsils, large tongue or over-bite) that results in tissue collapses.
How is OSA diagnosed?
Clinical suspicion based on a physical exam by the physician or based on observations by the bed partner/ patient will trigger a sleep study which measures how well you sleep. A sleep study can either be done at home (home sleep study) or in a dedicated sleep lab, which is sometimes more accurate.
How is OSA treated?
It is very important to treat OSA to avoid complications such as heart attacks and strokes. Depending on how severe sleep apnea is, there are a variety of different treatment options. Weight loss, positional sleep devices, mandibular advancement devices (to move jaw and tongue forward) are treatment options, while continuous positive airway pressure (CPAP) is considered standard of care.
Multiple sleep surgical treatment options are also available to widen the upper airway and improve or cure OSA. Newer therapies like Upper Airway stimulation (Inspire Therapy) have recently gained increasing popularity due to their very high success rates.
Who should make an appointment?
Approximately 40 to 50 percent of all OSA patients are unable to tolerate continuous positive airway pressure (CPAP) at night. As a result, these patients are at an increased risk to experience other medical problems such as:
- Irregular heartbeat
- Stroke and heart attack
- High blood pressure
- Weight gain
- Worsening of diabetes
- Reduced life expectancy
Patients who are unable to use CPAP are encouraged to make an appointment with our specialists to learn more about other treatment options. MetroHealth offers state-of-the-art care for patients who suffer from OSA. A team of experienced physicians will address patients concerns and symptoms at a multidisciplinary level in order to treat OSA and to improve quality of life.
Which sleep surgery works best?
Advances in upper airway and sleep surgery can offer a definitive solution for many OSA patients to get rid of their CPAP. In other cases, surgery can be part of a comprehensive approach making the use of CPAP or oral appliances more tolerable.
The goal of sleep surgery is to reduce anatomical obstruction in the nose, palate, throat and along the tongue. Often patients have multiple areas of obstruction which must be treated to maximize airway patency. Unfortunately, there is no single surgery that helps everyone because each OSA patient has a different anatomy.
Therefore, prior to recommending any sleep surgery, MetroHealth's ENT providers will usually perform an upper airway exam to determine which treatment or surgery works best for each individual patient. This involves the patient being in a "sleep-like" state which is much more representative of their sleep apnea condition than performing an exam while a patient is awake. This exam is called Drug Induced Sleep Endoscopy (DISE).
Additional resources
