Obstructive sleep apnea syndrome (OSAS) is a debilitating sleep and breathing disorder defined as the cessation of breathing for 10 seconds or more (an apnea) at least five times per hour of sleep. During sleep, the body's muscles relax, which can cause excess tissue to collapse into the upper airway (back of the mouth, nose and throat) and block breathing. When breathing is interrupted by an obstruction in the airway, the body reacts by waking enough to start breathing again. These arousals may occur hundreds of times each night but do not fully awaken the patient, who remains unaware of the loud snoring, choking and gasping for air that are typically associated with obstructive sleep apnea. Obstructive sleep apnea sufferers never get "a good night's sleep" because repeated apneas and arousals deprive patients of REM and deep-stage sleep, leading to chronic daytime exhaustion and long-term cardiovascular stress.
Obstructive sleep apnea has a profound impact on an individual's health. Excessive daytime sleepiness caused by disruption of normal sleep patterns leads to a significant increase in the rate of accidents for obstructive sleep apnea patients, including a sevenfold increase in automobile accidents. Over the long term, obstructive sleep apnea is associated with greater risk of hypertension and cardiovascular disease and the National Commission on Sleep Disorders Research estimates that 38,000 cardiovascular deaths due to sleep apnea occur each year.
In addition, loud snoring and intermittent breathing interruptions can affect the quality of sleep of the obstructive sleep apnea patient's bed partner. Witnessing an apnea can be a frightening experience because the obstructive sleep apnea patient appears to be suffocating. Frequently, it is a sleep-deprived bed partner who convinces the apneic patient to seek medical help.
Twenty-four percent of adult men and nine percent of adult women, or more than 20 million Americans, are estimated to have some degree of obstructive sleep apnea. Of these, six million are estimated to have cases severe enough to warrant immediate therapeutic intervention. However, obstructive sleep apnea was not well understood or recognized by primary care physicians until recently, and only a fraction of these 20 million obstructive sleep apnea patients have been diagnosed and treated by a physician. The number of patients currently undergoing treatment is probably less than 500,000.
While obstructive sleep apnea is commonly associated with obesity and male gender, it affects a broad cross-section of the population. Other risk factors include habitual snoring, which is often a precursor of more serious upper airway disorders such as obstructive sleep apnea. In fact, results from a recent study indicate that one in three men and nearly one in five women who snore habitually suffer from some degree of obstructive sleep apnea.
Treatments for Obstructive Sleep Apnea depend on the severity of the problem. While treatment can be life-saving for severe cases, people with mild to moderate sleep apnea often find the treatments too cumbersome. In light of this problem, physicians in our department have pioneered minimally invasive therapies, such as Somnoplasty, that now help patients with all degrees of OSA with far fewer adverse effects than traditional therapies.
Continuous Positive Airflow Pressure (CPAP) involves wearing a mask that supplies a steady stream of air through the nose during sleep. The airflow keeps the nasal passages open sufficiently to prevent sleep apnea.
Several dental appliances, or oral mandibular advancement devices, are available that hold the tongue in a specific position and/or force the lower jaw forward. These adjustments help keep the airway open during sleep.
At the Department of Otolaryngology/HNS, we perform several types of surgery for patients with obstructive sleep apnea. Please see linked pages for more detailed information on these treatments.