Obstructive Sleep Apnoea Syndrome: Comprehensive Guide

Obstructive sleep apnoea syndrome (OSAS), commonly known as obstructive sleep apnoea (OSA), is a potentially serious sleep disorder where breathing repeatedly stops and starts during sleep due to a blocked airway. This condition affects millions worldwide, leading to poor sleep quality, daytime fatigue, and increased health risks if untreated.

What is obstructive sleep apnoea syndrome?

Obstructive sleep apnoea occurs when throat muscles relax excessively during sleep, causing the airway to narrow or close. This blocks airflow, reducing oxygen levels in the blood and prompting brief awakenings to reopen the airway. These episodes, called apnoeas, can happen hundreds of times nightly without full awareness, fragmenting sleep.

The term ‘syndrome’ highlights associated symptoms like excessive daytime sleepiness. Unlike central sleep apnoea, where the brain fails to signal breathing muscles, OSA stems from physical blockage. It differs from simple snoring, as apnoeas cause oxygen desaturation and health complications.

Symptoms

Symptoms of OSA divide into nocturnal and daytime manifestations, often noticed by bed partners or through self-observation.

Nocturnal symptoms

• Loud snoring: Vibrations from air passing through narrowed airways, a hallmark sign.
• Pauses in breathing: Observed by partners, lasting 10 seconds or more.
• Gasping or choking awakenings: Sudden arousal to resume breathing.
• Frequent nocturia: Need to urinate often due to arousal and hormone disruptions.

Daytime symptoms

• Excessive daytime sleepiness: Drowsiness despite adequate sleep hours, risking accidents.
• Morning dry mouth or sore throat: From mouth breathing.
• Morning headaches: Linked to oxygen drops and CO2 buildup.
• Concentration difficulties: Impaired focus and memory.
• Mood changes: Irritability, depression, or reduced libido.

In children, symptoms include bedwetting, poor school performance, and hyperactivity.

Causes

OSA arises from airway collapse during sleep. Key factors include:

• Excess weight: Fat deposits around the neck narrow the airway; obesity is the primary risk.
• Age: Risk rises with age, peaking in 60s-70s.
• Narrowed airway: Enlarged tonsils/adenoids, small jaw, or inherited traits.
• Nasal congestion: Doubles risk by forcing mouth breathing.
• Alcohol/sedatives: Relax throat muscles.
• Smoking: Causes inflammation and fluid retention.

Men, postmenopausal women, and those with family history face higher risks.

Complications

Untreated OSA strains the body, leading to:

• Cardiovascular issues: High blood pressure, heart disease, stroke, arrhythmias.
• Daytime impairment: Fatigue, accidents, poor performance.
• Metabolic disorders: Type 2 diabetes, fatty liver.
• Mental health: Depression, irritability.
• Partner disruption: Snoring affects co-sleepers.

Children may experience growth delays or behavioral problems.

Diagnosis

Diagnosis starts with history and symptom review, followed by:

• Epworth Sleepiness Scale: Assesses daytime sleepiness.
• Nocturnal oximetry: Screens oxygen levels.
• Polysomnography (PSG): Gold standard; overnight sleep study measures apnoea-hypopnoea index (AHI).
• Home sleep apnoea testing (HSAT): Portable devices for moderate-high risk patients.

Severity: Mild (AHI 5-15), moderate (15-30), severe (>30).

Treatment

Treatment aims to maintain open airways.

CPAP therapy

Continuous positive airway pressure (CPAP) delivers air via mask, preventing collapse. Most effective for moderate-severe OSA; improves symptoms and risks.

Mandibular advancement devices (MADs)

Oral appliances shift the jaw forward, suitable for mild-moderate cases or CPAP intolerance.

Surgery

Lifestyle changes

• Weight loss: Reduces AHI significantly.
• Avoid alcohol/sedatives.
• Positional therapy: Avoid back sleeping.
• Treat nasal congestion.

Prevention

Maintain healthy weight, exercise, quit smoking, limit alcohol. Early symptom recognition prevents progression.

When to get medical advice

Seek help for loud snoring with pauses, excessive sleepiness, or hypertension. Urgent if witnessed apnoeas or near-misses driving.

Frequently Asked Questions (FAQs)

Q: Is OSA the same as snoring?

A: No, snoring is common, but OSA involves breathing pauses and oxygen drops, requiring diagnosis.

Q: Can children get OSA?

A: Yes, often from enlarged tonsils; symptoms include bedwetting and poor focus.

Q: Does weight loss cure OSA?

A: It reduces severity significantly but may not fully resolve anatomical issues.

Q: Is CPAP uncomfortable?

A: Initially yes, but most adapt; alternatives exist.

Q: Can OSA cause heart attacks?

A: Yes, via repeated oxygen drops straining the heart.

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Medha Deb is an editor with a master's degree in Applied Linguistics from the University of Hyderabad. She believes that her qualification has helped her develop a deep understanding of language and its application in various contexts.

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