Snoring & Sleep Apnea

Snoring is a common sleep disorder that can affect all people at any age. An estimated 30 million, or 1 in 8 people, snore. Although it occurs more frequently in men and people who are overweight, studies estimate that 45% of men and 30% of women snore on a regular basis. Snoring has a tendency to worsen with age.

  • Impact of Sleep Disorders
  • What is Snoring?
  • What is Upper Airway Resistance Syndrome?
  • What is Obstructive Sleep Apnea?
  • Signs and Symptoms of Obstructive Sleep Apnea
  • Sleep Apnea Risk Factors
  • Signs and Tests
  • Treatment Options
  • Self Test
  • Epworth Sleepiness Scale

 

Facts about snoring and obstructive sleep apnea:

  • Individuals who snore have a high likelihood of having (or developing) obstructive sleep apnea
  • Approximately 18 million Americans suffer from sleep apnea
  • Some 28 percent of men over the age of 65 suffer from sleep apnea
  • Up to 50 percent of sleep apnea patients have high blood pressure
  • Risk of heart attack and stroke also may increase among those who have sleep apnea
  • Nearly 60 percent of Americans suffer from day time sleepiness, a side effect of sleep apnea
  • Snoring and mild-moderate apnea is improved and often eliminated in many patients who use oral appliances
  • Prevalence of Obstructive Sleep Apnea (OSA) in the USA
  • OSA – 20 million

            - Compare with
            - Asthma – 10 million
            - Diabetes – 16 million

  • More common in males than females
  • Progressively worsens with age
  • Progressively worsens with increasing weight
  • Each year, sleep disorders add an estimated $15.9 billion to national healthcare bill.
  • Untreated apneic's have 2.8x hospitalized days than treated apneic
  • Motor Vehicle Accidents
                   
    1997 Dement - $12.4 Billion MVA related to sleep disorder patients
                                    - 7-15x increase in accident frequency
                                    - 8x increase in at-fault frequency
  • Sleep Deprivation – the main factor in Exxon Valdez and Challenger Accidents
  • Obstructive Sleep Apnea contributed to the 2004 death of football great Reggie White.

Impact of Sleep Disorders

  • Reduced quality of life and cognitive performance
  • Up to 10 times higher frequency of automobile accidents
  • Increased cardiovascular disease
  • Insulin resistance
  • Impaired glucose metabolism
  • Impaired endocrine function
  • Headaches
  • Attention Deficit/Hyperactivity Disorder
  • Increased mortality
  • Individuals with undiagnosed sleep disorders are heavy users of medical services
  • 44% of women with Polycystic Ovarian Syndrome (PCOS) have obstructive sleep apnea
  • Cardiovascular Disease in OSA patients

    57% have Hypertension
    25% have Ischemic Heart Disease
    17% have Coronary Heart Disease
    7% have had Stroke
  • Pregnancy

    In one large study, 14% of pregnant snorers developed hypertension and 10% developed preeclampsia
  • Weight & Metabolic Functioning

    Perpetual lack of sleep in healthy young adults results in changes in glucose metabolism and endocrine functioning
    Clear correlation between lack of sleep and increased sympathetic nervous system activity 
  • Three Categories of Sleep Disorders

    Snoring
    Upper Airway Resistance Syndrome
    Obstructive Sleep Apnea

What is Snoring?

  • Classified as the most moderate manifestation of sleep disordered breathing
  • Considered an indication of the existence or the onset of a sleep breathing disorder

What is Upper Airway Resistance Syndrome?

  • Younger than Obstructive Sleep Apnea patients, and generally female
  • Accompanied by gastro esophageal reflux, depression, bruxism, hypothyroidism, and asthma
  • Marked by apnea and hypopnea

    Apnea – Cessation of airflow at the nostrils and mouth lasting at least 10 seconds
    Hypopnea- An episode of shallow breathing (airflow reduced by at least 50%) during sleep lasting 10 seconds or longer, usually associated with a decrease in blood oxygen saturation.

What is Obstructive Sleep Apnea?

  • The complete cessation of breathing for a minimum of 10 seconds
  • It occurs due to a narrowing of the throat caused by the tongue falling back and the tissues in the back of the throat collapse, blocking the airway, thus no air gets to the lungs
  • The event can last up to 90 seconds and can occur as many times as 150 times an hour

    Obstructive Sleep Apnea is classified in the following manner, determined by an overnight sleep study:
    Normal– Less than 5 apnic events per hour
          Mild – 5-19 apnic events per hour
          Moderate – 20-39 apnic events per hour
          Severe – 40 or more events per hour
    The sleep study reports these events by numerical value and are called AHI/RDI results.

Signs and Symptoms of Obstructive Sleep Apnea

  • Snoring: Intermittent with pauses
  • Excessive Daytime Sleepiness
  • Awakenings with gasping or choking
  • Fragmented, non-refreshing, light sleep
  • Poor memory, clouded intellect, difficulty concentrating
  • Irritability, personality changes
  • Decreased sex drive, impotence
  • Morning headaches
  • Gastro-esophageal reflux (GERD)
  • Dry mouth upon awakening
  • Overweight
  • Depression
  • Perspiring during sleep
  • Heartburn
  • Frequent nocturnal urination
  • Confusion upon awakening

Sleep Apnea Risk Factors

  • Obesity
  • Increasing Age
  • Male Gender
  • Anatomy Abnormalities of Upper Airway
  • Family History
  • Alcohol or Sedative Use
  • Smoking
  • Neck size
  • If External Neck Circumference is:

    Men > 17 inches
    Women > 16 inches

Signs and Tests

The health care provider will perform a physical exam. This will involve carefully checking your mouth, neck, and throat. You will be asked about your medical history. Often, a survey that asks a series of questions about daytime sleepiness, sleep quality, and bedtime habits is given.

A sleep study (polysomnogram) is used to confirm obstructive sleep apnea.

Other tests that may be performed include:

  • Arterial blood gases
  • Electrocardiogram (ECG)
  • Echocardiogram
  • Thyroid function studies

Treatment Options

  • Lifestyle changes

    Avoiding alcohol and sedatives at bedtime
    Weight management and weight loss
  • Dental Oral Appliances

    To help advance the position of your tongue and soft palate to keep your air passages open
  • Medical Interventions

    CPAP -Continuous Positive Airway Pressure – this approach involves wearing a pressurized mask over your nose while you sleep. The mask is attached to a small pump that forces air through your airway, which keeps it open. CPAP eliminates snoring and prevents sleep apnea. Although CPAP is the preferred method of treating obstructive sleep apnea, some people find it uncomfortable.
    Surgery
         UPPP (Uvulopalatopharyngoplasty) – traditional surgery where you're given a general anesthesia and your surgeon tightens and trims excess tissues ; a type of face-lift for your throat.
         LAUP Laser Surgery – Outpatient surgery where your doctor uses a small hand-held laser beam to shorten the soft palate and remove your uvula. Removing excess tissue enlarges your airway and reduces vibration. You may need more than one session to get your snoring under control. Laser surgery isn't advised for occasional or light snoring, but it's an option if your snoring is loud and disruptive. Laser surgery generally isn't recommended for sleep apnea.
         Somnoplasty – Radiofrequency tissue ablation. –During this outpatient procedures using local anesthesia, doctors use a low-intensity radiofrequency signal to remove part of the soft palate to reduce snoring. The technique causes slight scarring of the soft palate, which may help to reduce snoring.
         Dental Surgery- Tongue Reduction, Tongue-tying, Mandibular Jaw Advancement
     

Self Test

The only way to be sure if you have obstructive sleep apnea is to have a sleep test either at home from a qualified sleep physician or in a hospital sleep center, but a score of 9 or above on this test is an indication that you should see your doctor.

Epworth Sleepiness Scale

The Epworth Sleepiness Scale is a “test” based on a patient's own report that establishes the severity of sleepiness. A person rates the likelihood of falling asleep during specific activities. Using the scale from 0-3 below, patients rank their risk of dozing in the scenarios below.

How likely are you to doze off or fall asleep in the following situations? Choose the most appropriate number for each situation:

0 = would never doze

1 = slight chance of dozing

2 = moderate chance of dozing

3 = High chance of dozing

Activity

1) Sitting and Reading

2) Watching TV

3) Sitting, inactive in a public place (theatre, office, meeting, etc.)

4) As a passenger in a car for an hour without a break

5) Lying down to rest in the afternoon

6) Sitting and talking to someone

7) Sitting quietly after lunch without alcohol

8) In a car, while stopped for a few minutes in traffic

Total

After ranking the risk of dozing for each activity, calculate the total score. The range is 0-24, with the higher score, the more sleepiness

Scoring:
                0-9 = Average daytime sleepiness

                10-15 = Excessive daytime sleepiness

                16-24 = Moderate to severe daytime sleepiness

Breaking it down further, excessive daytime sleepiness is greater than 10. Primary snorers usually have a score less than 10, and individuals with moderate to severe sleep apnea usually have a score greater than 16.

See your healthcare professional for advice if you snore, have been told that you awake gasping for breath, or if you are sleepy during the day.