1. WHAT IS OBSTRUCTIVE SLEEP APNEA?

Obstructive Sleep Apnea (OSA) is a common syndrome but VERY few people pay attention properly. In Vietnam, the incidence rate is 14% for men and 5% for women. And in the general population in Vietnam is 8.5%, but in fact, many people still do not know and have not been diagnosed in time. Sleep apnea is a medical condition characterized by obstructive apnea and hypopnea caused by repeated collapse of the upper airway during sleeping. At that time, the amount of oxygen go to the lungs will be limited and the brain will wake you up when it feels excessive oxygen deficiency. This can happen several times a night, or more seriously several hundred times a night. This condition will affect your health in the short and long term and will contribute to chronic diseases if not treated on time, and can even cause death while sleeping.

2. CLASSIFYING OBSTRUCTIVE SLEEP APNEA

Sleep apnea includes

• Obstructive Sleep Apnea (OSA): Caused by the tissues of the airway relaxing too much, leading to the airways becoming blocked..

• Central Sleep Apnea (CSA): Caused by a problem with the nervous system that controls breathing.

• Mixed Sleep Apnea (MSA): Caused by a problem with the nervous system that controls breathing, and the respiratory tissues tamponade the airways at the same time when sleeping.

• And other types of apnea Among them, obstructive sleep apnea is the most common, accounting for more than 80% of cases.

3. TYPICAL SYMPTOMS

Sleep apnea is caused by the pharyngeal muscles relaxing and tamponade the airways. At that time, the patient will snore and this is the most common symptom. But not everyone who snores will have obstructive sleep apnea.
Here are the common symptoms of obstructive sleep apnea. All are related to the lack of oxygen in the body:
 Loud snoring
 Silent pauses in breathing
 The patient woke up gasping for breath
 Daytime Drowsiness
 Not sleeping well or tossing or not sleeping
 Headache, tired the next morning
 Irritability
 Difficulty concentrating
 Memory impairment
 Decreased libido or erectile dysfunction

4. SUBJECTS AT RISK OF OBSTRUCTIVE SLEEP APNEA

Obstructive sleep apnea can occur at any age, including in children. But it will be more common in middle age, and more men than women. The main risk factor for sleep apnea is being overweight or obese. However, sleep apnea can also occur in lean people, but at a lower rate.
Common risk factors for sleep apnea include:

• Overweight – obese: The risk of apnea increases up to 3 times compared to the normal person

• Large Neck Circumference: Greater than 43cm for men and 38cm for women. A large neck has more soft tissue and increases your risk of blocking your airway

• Male

• Pre-menopausal women

• Middle age

• Airway abnormalities: enlarged tonsils, large tongue, small jawbone, deviated nasal septum, …

• Smokers and alcohol addicts

• Using sedatives or narcotics

• Family history of sleep apnea: Certain genetic traits such as obesity, large necklines, large tongues, etc. increase the risk of sleep apnea.

• People have diseases such as Hypertension, Diabetes, Hypothyroidism, Cardiovascular disease, …

• For children, it is often associated with ear-nose-throat problems and overweight and obesity.

5. SERIOUS BUT “SILENCE” EFFECTS

Sleep apnea can make you feel tired, headache, or drowsy the next day. These may be just mild symptoms at first and people often ignore it. But in the long term, it will cause more serious consequences because the body is lack oxygen for a long time:

• Arrhythmia, angina, heart failure and myocardial infarction

• High blood pressure

• Cerebrovascular accident

• Stroke

• Sudden death in sleep

• Diabetes

• Decreased memory, and decreased concentration lead to reduced work productivity

• Mood swings, irritability and depression

• Traffic accident due to drowsiness while driving

• People with sleep apnea if not diagnosed before surgery under anesthesia can be life-threatening because lying on the back makes breathing difficult

• Sleep apnea, often accompanied by loud snoring, can damage the relationship between husband and wife

• Sleep apnea can also cause attention deficit hyperactivity disorder, aggression, fussiness, bedwetting, and decreased school performance in children.

DIAGNOSE OBSTRUCTIVE SLEEP APNEA

People with sleep apnea won’t realize they have trouble breathing, because apnea only occurs when they are deeply asleep. So sleep apnea often goes undetected, even though it can lead to severe consequences.

Before taking these in-depth sleep tests, you can self-assess your risk of sleep apnea with the test below:

6. DIAGNOSE OBSTRUCTIVE SLEEP APNEA

People with sleep apnea won’t realize they have trouble breathing, because apnea only occurs when they are deeply asleep. So sleep apnea often goes undetected, even though it can lead to severe consequences.

Before taking these in-depth sleep tests, you can self-assess your risk of sleep apnea with the test below:

Nowadays, with the development of science and technology, you can be diagnosed with modern equipment.

According to the American Society of Sleep Medicine (AASM), the gold standard for diagnosing sleep apnea is polysomnography. (Find out more)

The device will record the following parameters:

• Electroencephalogram – Electrocardiogram – Electromyography of legs – Electromyography of chin

• Breathing airflow – Respiratory movement – Blood oxygen saturation – Heart rate – Snoring

Then the software will analyze and give the results:

▪️ Sleep indicators: Light sleep, deep sleep, sleep time, lying position

▪️ Respiratory indicators: Apnea; decreased breathing; central apnea; obstructive sleep apnea; …

▪️ Blood oxygen indicators – heart rate: SpO2, heart rate, …

▪️ Other indicators: Snoring frequency, leg movement, breathing rate, …

7. TREATMENT OF OBSTRUCTIVE SLEEP APNEA

• Continuous Positive Airway Pressure CPAP

CPAP is an airway ventilation device that uses a steady and gentle airflow to keep your airways clear throughout the night. You will sleep with a mask attached to the device at the bedside. Masks and devices may vary, depending on your treatment needs and comfort. CPAP is the first-line treatment for sleep apnea and is recommended for most patients.

• Oral appliance therapy

Oral appliance therapy uses an appliance that fits in your mouth over your teeth while you sleep. It can be similar to orthodontic retainers. The device prevents the airway from collapsing by keeping your tongue in place or sliding your jaw forward so you can breathe easier while you sleep. Some patients prefer to sleep with an oral appliance to a CPAP machine. The oral appliances are recommended for patients with mild to moderate apnea who cannot use CPAP or who simply want to try using an oral device instead of a CPAP device.

• Oropharyngeal surgery

Surgery applies when CPAP or Oral appliances are not working for you. The most common options reduce or remove excess tissue in the throat when it collapses and blocks your airway during sleep. More complex procedures that can adjust your bone structure include the jaw, nose, and facial bones. Weight loss surgery may also be an option. Consult your sleep doctor about the type of surgery that is right for you.

• Stimulate the upper airway

It’s a small device implanted in your chest wall, like a pacemaker. The machine will be connected directly to the nerve that stimulates the tongue. When operating, this device will stimulate your tongue to gently move forward during sleep. You can control the machine remotely to turn it on and off. Before you can have this implant, your otolaryngologist will endoscopy with a flexible tube while you sleep to find out why you have sleep apnea. If it’s because your tongue is blocking your airway, you should probably use this method. If your airway is completely collapsed, you shouldn’t use this method.

• Control your weight

Weight loss is an effective support method, helping to improve or eliminate the symptoms of sleep apnea if you are overweight or obese. People who are overweight often have thick necks with a lot of tissue in the throat that can block the airway. You should combine weight loss with other methods to increase the effectiveness of treatment.

• Change the posture

Some people have sleep apnea mainly when they sleep on their back and breathe normally when they sleep on their side. Postural therapy may involve wearing a special device around your waist or back that helps keep you asleep on your side. Another option is a small device worn on the back of the neck. It gently vibrates when you start to sleep on your back and won’t wake you up. Postural therapy may be used alone or along with another sleep apnea treatment.

• Change the lifestyle

Many lifestyle changes can help you reduce snoring and improve sleep apnea symptoms such as quitting smoking, not drinking alcohol, etc. Alcohol relaxes the muscles of your throat, which can make you snore or collapse your airways. If you have allergies, taking a decongestant before bed can help improve airflow through your nose.

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