Obstructive Sleep Apnea, known as OSA, is as a cessation of breathing during sleep caused by a complete or partial obstruction in the upper airway (i.e. pharynx). These episodes can be categorized as apnea, cessation for periods longer than 10 seconds or hypopnea, cessation for periods less than 10 seconds. These episodes of respiratory cessation can occur hundreds of times during a night’s sleep, in people with OSA. Snoring is the most common sign of OSA.
The subsequent reduction of oxygen in the blood and body is known as hypoxia, sends stress signals to the brain creating episodes of arousals to awaken and improve breathing. The reduction in oxygen levels places unhealthy stress on the body’s organ systems, including the circulatory and neurological systems. Furthermore, the episodes of sleep disturbance arousals brought about these apnea/hypopnea events lead to disturbances in normal sleep patterns or the normal cycle or stages of sleep (REM, stage, I, II, II and IV). This results in sleep disturbance. Daytime symptoms of OSA include sleepiness, lethargy, fatigue, depression, forgetfulness, irritability, and more.
From a public health perspective, OSA is the new (not-so) silent epidemic in health care responsible for a growing number of fatalities and health problems. OSA has been strongly linked to problems such as obesity, heart disease, hypertension, heart attacks, strokes, diabetes, GERD, depression, motor vehicle accidents, ADD, even cancer and many more. It is estimated that only 85% of the population with OSA have been diagnosed. If left untreated, the average remaining life expectancy of an overweight adult with severe OSA is as little as 10 years, not to mention the reduction in their quality of life. Studies have shown that a person with OSA has 8x the likelihood of a fatal automobile accident if untreated. Furthermore, once OSA is reported to the insurance data bank, diagnosis may negatively impact the ability to be under written for a life insurance policy. According to a recent study by the Harvard School of Medicine School of Public Health, the financial costs of OSA in the United States are estimated to be between $65 billion to $165 billion dollars. Other astonishing epidemiological facts about OSA in the United States are as follows:
• 1 in 5 Americans have OSA
• 1 in 15 have moderate OSA
• Only 15% of patients have OSA have been diagnosed and treated
• Growing patient awareness and physician training are rapidly increasing the pool of diagnosed patients
• The pool of patients diagnosed with OSA is growing at 15%/year OSA can only be diagnosed through a proper sleep study known as a polysomnogram or PSG, and be only by a medical doctor, preferably a board certified sleep physician. These tests are often uncomfortable and expensive, but very thorough.
Home study tests (HST) are becoming more and more popular and many insurance companies are requiring an HST prior to covering the expense of a full blown PSG. HST are very simple and have the advantage that they can be performed in the comfort of your own bed under your normal sleeping conditions.
They are also very affordable and studies have shown them to have a sensitivity of 92% to 95% compared to PSG. At our practice we have recently introduced a home study test, known as the WatchPAT™, for our patients who may be at risk for OSA. Figures 1 and 2 illustrate the simplicity of this device:
Treatment for OSA include
• Weight loss
• Positional Therapy
• Nasal Decongestion
• Oral Appliances
• UPPP – uvulopalatopharyngoplasty
• MMA – Maxillo-mandibular advancement