Snoring and Sleep Apnea by Richard Z. Lu, M.D.

Board Certification: Family Practice

Recently quite a few patients asked me about snoring during sleep and feeling tired during the day.  One of the most likely causes is obstructive sleep apnea, which is a condition in which someone stops breathing during sleep.  The usual symptoms include snoring, day-time sleepiness, and feeling tired throughout the day.

There are two types of sleep apnea: obstructive and central sleep apnea.  Obstructive sleep apnea (OSA) is the more common type.  In the case of obstructive sleep apnea, the muscles behind the throat become so relaxed during sleep that a portion of the airway is obstructed, which in turn leads to insufficient inflow of the oxygen causing the level of oxygen in the blood to drop (hypoxia).  In more severe cases, it may eventually lead to sudden wakening and acute gasping for air from normal sleep.

OSA most commonly occurs in middle-aged males but it can happen in any age group.  There is an incidence of 2-4% in the general population, but can be as high as 10% in middle-aged males.  Some of the risk factors for OSA include overweight, consumption of alcohol, history of sinus disease, enlarged tonsils, and jaw deformity.  In the U.S., being overweight is probably the single most important factor that contributes to OSA.  In addition to its link to obesity and overweight, it can also cause significant impact on quality of life.  Some studies have shown that people with OSA are at greater risk for many other medical conditions, including hypertension (high blood pressure), heart disease, stroke and irregular heart beat (arrhythmia).

The diagnosis of OSA can often be difficult.  Usually a detailed history of the sleep issue with a thorough examination of the throat are necessary.  It is often beneficial for the person’s spouse/partner to be present during the office visit, so they can give a better history of what happened during the sleep cycle. The most common test that physicians order for OSA is polysomnography, which involves an overnight stay in a special sleep clinic.  There also has been newer at-home sleep study developed, that offer equal accuracy in the diagnosis of sleep apnea.

Once a diagnosis of OSA is made, it should first be managed through lifestyle changes.  Weight loss remains the priority in terms of modifying risk factors for sleep apnea.  The target BMI in order to improve obstructive sleep apnea is less than 25.  In many clinical trials, it has been shown that even a reduction of BMI to under 30 sometimes can lead to significant improvement of sleep apnea.  Other lifestyle changes that may improve sleep apnea include minimizing alcohol intake and avoid taking insomnia medications.  Continuous positive airway pressure (CPAP) has also been shown to be a very effect treatment of OSA, but the noise level associated with a CPAP machine can become one of the deterring factors that patients stop using the CPAP machine.  The last resort for the treatment of OSA is surgery when specific abnormalities are found that are contributing to the condition.