Obstructive sleep apnea (OSA) is a disorder that affects more than 18 million Americans, and many of them do not even know they have it. People with OSA actually stop breathing while they are asleep—sometimes for more than a minute and as often as 60 times a night.

What causes OSA?

Doctors think that OSA is caused by the soft, fleshy tissue at the back of the throat (called the soft palate). While you are awake, the muscles around the soft palate keep your airway open. But as you fall asleep, these muscles start to relax. In people with OSA, the muscles relax so much that the soft palate tissue collapses and blocks the airway.

If your airway becomes blocked, your breathing slows or stops altogether. At this point, it is your body's natural reaction to wake you up, usually with a snorting or choking sound. You then fall asleep again right away, so, in the morning, you probably will not remember waking up during the night. Because OSA can happen so many times in one night, you may never reach the deep stages of sleep that your body and brain need to feel really rested.

What are the risk factors for OSA?

Being overweight or obese are the main risk factors for OSA. Older age is also a risk factor. Men have a greater risk than women for OSA, but a woman's risk seems to increase after menopause. Other factors that can cause OSA include 

• A stuffy nose (nasal congestion)
• Marfan syndrome
• An underactive thyroid gland (called hypothyroidism)
• Down syndrome
• Alcohol use
• Sleeping pills
• Smoking
• Swollen tonsils and adenoids
• Larger or thicker neck size
• Diabetes
• Family history

What is the link between OSA and heart problems?

The link between OSA and coronary artery disease (CAD), heart attack, and stroke is still unclear. Doctors do not know whether people with OSA are at greater risk of these conditions or if their OSA and heart problems are caused by other risk factors, such as obesity. 

Obstructive sleep apnea is also very common in patients with heart failure. For heart failure patients, OSA can make their condition worse because of the stress it places on the heart during sleep. 

People with OSA usually have high blood pressure (hypertension). Many patients who get their OSA under control will see small decreases in their blood pressure. 

Some patients who have recently had a heart attack are at greater risk of OSA, so doctors often recommend that patients undergo screening for OSA.

People with OSA are also much more likely to develop abnormal heart rhythms (arrhythmias).

What are the signs and symptoms of OSA?

There are many signs and symptoms of OSA. The most common sign is snoring, but not everyone who snores has OSA. Here are some other signs and symptoms of OSA: 

• You feel very tired during the day
• You wake up during the night and feel short of breath
• You wake up in the morning with a headache, dry mouth, or sore throat
• Your partner wakes you because you have stopped breathing
• You have to urinate many times during the night
• You cannot fall asleep or stay asleep all night (insomnia)  

Because you are not getting the sleep you need, OSA can increase your risk of car crashes and on-the-job accidents. Not getting enough sleep has also been linked to memory loss, depression, and erectile dysfunction.

How is OSA diagnosed?

If your doctor thinks that you might have OSA, he or she will refer you to a sleep disorder center, where you might have to spend the night. Here are some of the tests that doctors might perform during the night: 

• Polysomnography, which uses equipment to monitor your heart, lung, and brain functions, your breathing patterns, and your arm and leg movements while you are asleep.
• Overnight oximetry, which is a test that measures the amount of oxygen in your blood while you are asleep.  

In some cases, your doctor may provide you with portable tests that you can do at home. Your doctor may also refer you to an ear, nose, and throat specialist (ENT or otolaryngologist) to rule out any other problems in your nose or throat.

How is OSA treated?

There are many treatments for OSA, including lifestyle changes, nighttime therapies, and surgery.  

Lifestyle changes
If your OSA is mild, there are many lifestyle changes you can make. 

• Lose weight. Even modest amounts of weight loss have been shown to help patients with OSA.
• Avoid alcohol and sleeping pills, which relax the muscles at the back of your throat.
• Sleep on your side. When you sleep on your back, your soft palate slides to the back of your throat. There are sleep aids and pillows available to help you stay on your side during the night. Even something as simple as a tennis ball attached to the back of your pajama top can prevent you from rolling on your back while you sleep.
• Spray a saline nasal spray in your nose before you go to sleep. Saline sprays are best, because they do not contain medicines.  

Nighttime therapies
If lifestyle changes do not work, your doctor may recommend more advanced therapies.

• Nighttime oral devices or mouthpieces. These devices are designed to keep your throat open while you sleep. Most of these devices work by moving your jaw forward (called mandibular advance devices) or by keeping your tongue in a different position (called tongue-retaining devices). Your doctor will refer you to a dentist who can fit you properly for a mouthpiece. You may need to try many different mouthpieces before you find the one that works best for you.
• Continuous positive airway pressure (CPAP), which is usually recommended for moderate or more severe cases of OSA. With CPAP, you sleep with a mask placed over your nose. A machine sends a continuous amount of air pressure through the mask. This air pressure is greater than the air you would normally breathe during the night, and it is strong enough to keep your airway open. This non-invasive method is very effective for treating OSA.
• Bi-level positive airway pressure (BiPAP), which is another type of CPAP. Some patients have trouble breathing out against the air pressure that the machine sends through the mask. Bi-level CPAP machines can sense when patients are breathing in and out, so they reduce the air pressure through the mask when patients are breathing out. Your doctor may recommend a bi-level machine if you have other breathing disorders.

Surgery
Surgery for OSA can include anything from tissue removal to jaw surgery to soft palate implants. For some patients, having their tonsils removed or correcting a deviated septum in the nose is enough to stop their OSA.

• Tissue removal (uvulopalatopharyngoplasty or UPPP). In this procedure, doctors remove tissue from the back of your mouth and the top of your throat.
• Jaw surgery (maxillomandibular advancement). In this procedure, doctors move your jaw forward to make more room behind your tongue and soft palate.
• Tracheostomy. This procedure is only done if other treatments do not work and your OSA is life threatening. In this procedure, surgeons place a tube through an opening made in your neck. During the day, you keep the tube covered and you breathe through your nose, as you normally would. At night, you uncover the tube to let air pass directly in and out of your lungs.
• Implants. The Pillar procedure, also called palatal restoration, is a limited-access treatment for mild to moderate OSA. The procedure involves implanting 3 small, polyester-woven rods in the soft palate. The rods work like a scaffold to stiffen the soft palate and stop it from collapsing into your airway.

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Sleep Apnea