OBSTRUCTIVE sleep apnea (OSA) is a disorder characterised by multiple interruptions of breathing during sleep due to temporary obstructions in the airway. Obstructions can be due to lax, collapse, excessively bulky or malformed upper airway tissues and manifested as inadequate volume of breathing (hypopnea) or breathing stop (apnea).
OSA is a common disorder, but is often neglected. United States health authorities estimate that one in every five American adults has some degree of OSA. In our population, the prevalence of sleep-disordered breathing is ranged similarly at about 15 to 20 per cent in adults and seven to nine per cent in children. Among the risk factors for OSA are obesity, being elderly, being male, smoking and upper airway inflammatory diseases, like rhinitis, asthma and pharyngeal reflux.
Most people with OSA are overweight individuals who snore regularly, but this condition may affect even thin and fit persons who do not snore. Generally, airway muscles tend to relax and collapse when we sleep. The thick fatty tissue at the neck predisposes to further upper airway collapse, leading to partial obstruction in the airway during sleep. This is manifested by snoring and breathing pauses during sleep.
The effect of poor-quality sleep leads to tiredness, excessive sleepiness, early-morning headache, poor performance at work or school, increase in road traffic accidents, social issues like marital disharmony, divorce and psychiatric disorders, like depression and attention deficit disorders.
The most serious and fatal complication of OSA is cardiovascular-related diseases, such as hypertension, diabetes, stroke and heart attack, which are the biggest cause of death.
People over 50 are more likely to develop OSA, but the effect of the disease is more pronounced in the young. A study published in the European Respiratory Journal in 2005 showed increasing mortality rates, with younger age in patients with OSA. The study showed that people with OSA in their 20s had 10 times the risk of death compared with people above 50 with OSA.
The study also showed declining mortality rates with age, in that, those above 60 with OSA have the same risk of death with people of the same age without OSA. The effect is more significant with the increasing severity of OSA, determined by the increasing number of breathing obstructions that patients experience during sleep.
An International Islamic University Malaysia research team published a study on OSA and young Malaysians below 40 in a leading otolaryngology journal in 2012. Our findings indicated that persons with mild OSA (five to 15 obstructive episodes in one hour of sleep) were three times at risk of having hypertension than persons without OSA. Moreover, persons with severe sleep apnea (more than 30 obstructions per hour of sleep) were eight times more likely to get hypertension than normal people.
We also found that persons already diagnosed with hypertension were three times at risk of having comorbid OSA than those without hypertension. In our study population, obesity was the strongest factor that predisposed one to OSA and significantly lead to the development of cardiovascular diseases like hypertension in OSA individuals.
There should be more awareness that sleep-related breathing disorder is a common disease, and the effect of the disease can be fatal if not diagnosed and treated early. The effect is more pronounced in young individuals, thus, it is essential that young patients with sleep apnea are diagnosed and treated early.
If you happen to be a snorer, and you feel sleepy and tired during the day, you could be suffering from OSA. The chances are higher if you are overweight, male and a smoker. You should seek medical help, especially if you are young, as the chances of getting cardiovascular diseases and mortality are higher.
Diagnosis involves taking your blood pressure and pulse rate, and then performing a cardiovascular and respiratory examination. Your upper airway is then assessed by using a soft fibre-optic camera to determine any anatomic obstruction. This is followed by a sleep test to confirm the diagnosis of OSA and to determine how severe the disease is.
Treatment of OSA will be decided upon the severity and presence of any anatomic obstruction in the airway. You may need to wear a breathing device during sleep or you may need to undergo upper-airway surgery. In many mild cases of OSA, changing to a healthier lifestyle and weight reduction are often sufficient treatment measures.
The sleep test consists of the recording of several body parameters during sleep. However, the test is costly and still not widely available in the country. Given the magnitude of the problem and the available resources, it remains a continued struggle to find a suitable cost-effective means of screening for sleep apnea among the general population.
It is the wish of government healthcare providers who are treating OSA to have the sleep test available in all public hospitals in the country. Doctors in the private sector hope that the government recognises this disease as a serious pathology and allows insurance companies to pay for the sleep test, as this is not being done presently.
The writer is a consultant ear, nose and throat surgeon and a medical lecturer
at International Islamic University Malaysia