Understanding Obstructive Sleep Apnea
Dr. Fawad Kahn is an internist practicing in Eau Claire, WI. Dr. Kahn specializes in the medical treatment of adults. Internists can act as a primary physician or a consultant to a primary physician. They manage both common and rare diseases. Dr. Kahn provides comprehensive care and manages treatment with surgeons as well.... more
Understanding Obstructive Sleep Apnea
Over the last two decades, we have learned a lot more about OSA and its impact on quality of life and health. One in five senior adults have OSA and even with more awareness, the majority of the cases remain undiagnosed. Obstructive Sleep Apnea is known to increase the risk of Hypertension, Diabetes Mellitus, Dementia, Parkinson’s Disease, Atrial Fibrillation, Coronary Artery Disease, and Congestive Heart Failure. Poor sleep quality due to OSA causes fatigue, daytime sleepiness, and poor memory and significantly increases the risk of motor vehicle accidents.
Snoring, witnessing pauses in breathing during sleep, and feeling unrefreshed in the mornings are the major warning symptoms of OSA. Obesity is a major risk factor for OSA however non-obese individuals can also have severe Sleep Apnea. Family history is also a significant risk factor. Memory changes, poor concentration, and mood disorders are also common symptoms of OSA.
Sleep apnea evaluation usually starts with a primary care consultation. PCP will order a sleep study or make a referral to a sleep specialist. There are two types of sleep studies. One is done at home and called a Home Sleep Apnea Test (HSAT) and the other one is an in-lab, overnight Polysomnogram (PSG). HSAT is more convenient and cheaper and may work for most individuals however has some limitations and has an increased chance of being falsely negative. In-lab PSG is much more accurate however an overnight stay at a sleep lab is required.
Sleep studies help us answer two questions. Does an individual have sleep apnea and how severe is the sleep apnea is. In a sleep study, we look at oxygen saturation and the number of times the individual stops breathing or breath shallowly. In-lab study also provides additional information about sleep staging and the quality of sleep by monitoring EEG.
Treatment options depend on the severity of OSA and individual preferences. CPAP is by far the most common treatment due to its effectiveness, reliability, long-term safety, and long-term tolerance. CPAP use can be difficult for the first few weeks however most patients adapt and do well long term. Improvement in quality of life is a big incentive for CPAP treatment adherence.
Oral appliances are a good treatment option for mild OSA patients. Hypoglossal nerve stimulation is a relatively newer option that may be appropriate for some patients. Surgery for upper airway correction may work well for carefully selected patients. Treatment choice is a major factor in long-term success and should be made after offering the choices to patients and discussing the pros and cons of treatment options.
Fawad Khan MD
