Snoring is the main symptom of Obstructive Sleep Apnea along with other symptoms and the reason for all major cardiac morbidities and other morbidities in adults as well children.
“Obstructive Sleep Apnea usually happens because of repetitive narrowing of the airway during sleep despite breathing efforts.” The person will unknowingly stop breathing repeatedly throughout sleep. Once the airway is opened or the breathing signal is received, the person may snore, take a deep breath, or awaken completely with a sensation of gasping, smothering, or choking.
The general awareness about this condition is pretty dismal amongst the general public; hence the corrective measures to tackle this problem are not undertaken resulting in potentially serious health complications, such as heart disease, blood pressure, diabetes and depression. It can also leave a person feeling drowsy, increasing the risk of accidents while driving or working and loss of concentration at work, subsequently poor productivity.
Renowned singer Bappi Lahiri died on 15th February 2022 at the age of 69. As per reports, Bappi Lahiri died due to OSA (obstructive sleep apnea) shortly before midnight. He took his last breath in the Criticare Hospital where he was admitted for certain post-Covid issues.
What makes Obstructive Sleep Apnea different from other sleeping disorders?
When we say a person is having difficulty to sleep at night, it could be due to two reasons, either the person is unable to fall asleep or the person does fall asleep at night but wakes up several times due to breathlessness. The two conditions are very different from each other, the first one is a case of insomnia in which you'll visit a psychiatrist while the second one is a case of Obstructive Sleep Apnoea and that is the topic of discussion as there is a lack of awareness amongst the people about this dreaded disease.
“A good laugh and a long sleep are the two best cures for anything” thus goes a well-known Irish proverb. That the importance of proper and hygienic sleep in healthy living has been grossly understated is a sad fact. The inability to switch one’s mind off of all the day’s and life’s mundane affairs can have grave psychological and physiological effects.
“Obstructive Sleep Apnea is characterized by repetitive narrowing/ collapse of the upper airway during sleep despite breathing efforts.” The patients usually present with loud snoring, observed episodes of breathing cessation during sleep, abrupt awakenings accompanied by gasping or choking, excessive daytime sleepiness, awakening with a dry mouth/ sore throat/ morning headache, difficulty in concentrating during the day, mood changes such as depression or irritability, high blood pressure, nighttime sweating, decreased libido, impaired cognition, poor quality of life, hypertension, heart failure, stroke. Such complaints are ignored assuming this to be a manifestation of improper sleep hygiene rather than the real culprit being sleep fragmentation Such patients need to be clinically, endoscopically and radiologically evaluated and should undergo an overnight PSG to rule out central causes of apnoea and measure AHI.
Different studies have quoted different prevalences for OSA. For the Indian population, the prevalence of OSA was found to be 13.74%. OSA in Indian males varied from 4.4 % to 19.7% and in females, it was between 2.5% to 7.4%. Among patients with a body mass index greater than 28, OSA is present in 41%. The prevalence of OSA can be as high as 78% in morbidly obese patients. Up to 93% of women and 82% of men may have undiagnosed moderate to severe OSA, emphasizing the importance of vigilant evaluations for signs and symptoms of OSA.
The incidence of pediatric OSA peaks between 2 to 8 years of age due to the increased growth of tonsils and adenoids relative to the size of the upper airway in this age group which increases to as much as 40 percent in overweight and obese children and this has been increasing over the years because of obesity issues in children. 85 percent of these children are cured of their OSA just by an adenoid tonsil surgery.
Children can present in ways that often differ from the classic adult OSA presentation, most notably resulting in behavioural changes. Parents often endorse a history of snoring, mouth breathing, witnessed apneas, frequent nighttime awakenings, and secondary nocturnal enuresis. Children with OSA have disrupted sleep, which can lead to behavioural issues, including hyperactivity, irritability, or even aggression. These issues are often what prompt parents to bring children to the doctor for evaluation.
In the background of hypertension, obesity and thyroid issues, the patient is at constant risk for pulmonary hypertension thereby there is a long way to go before the patient actually reaches for definitive management.
Treatment:
1. Lifestyle modifications (Exercise & weight management) Primary and most important.
2. Mandibular devices
3. CPAP/ APAP devices
4. Surgical treatment
With improvement in understanding the disease pathology and with the usage of Drug-induced sleep endoscopy (DISE) to evaluate the different levels of obstructions in the airway, the ENT surgeons are able to offer much better surgical treatment plans for the OSA patients with much better success rate to those patients who are not able to tolerate CPAP or not wanting to continue with CPAP due to various reasons. The bottom line of course is that its a highly specialized and challenging surgery that should be done by an expert trained surgeon for this procedure.
Dr. Sandeep Bansal MS, FAMS, FIMSA
Professor & Incharge Sleep Lab
Department of Otolaryngology and Head Neck Surgery
Postgraduate Institute of Medical Education and Research (PGIMER)
Chandigarh
Email: drsandeepb@rediffmail.com