Journalism of Courage
Do you sleep ‘soundly’ yet feel sluggish throughout the day? Do you wake up often during the night?
If the answer to either of the questions is a ‘yes’ then you could be suffering from a condition known as Obstructive Sleep Apnea (OSA), experts suggest.
The word apnea comes from the Greek word ‘apnos’— which means absence of breathing. When a person stops breathing or when breathing becomes shallow during sleep due to throat closure, it is termed as Obstructive Sleep Apnea .
Recent studies have placed the prevalence of OSA at a mean of 22% (range, 9-37%) in men and 17% (range, 4-50%) in women. It has been observed that obesity predisposes us to Obstructive Sleep Apnea. The prevalence of OSA in diabetics can be as much as 50% according to one of the studies. As the muscles around the airway tract relax more, it causes more tissue vibration than normal. This produces an abnormal loud sound, which we often refer to as ‘snore’.
The ENT Department of PGI will be carrying out a public awareness program at Sukhna Lake World Sleep Day on March 17 at 6.30 am, followed by a street play.
One of the most common myths is that snoring means deep and good sleep. This myth effectively also leads people to possibly ignore their snoring under the belief that they’re getting a ‘sound sleep’. It’s only in the later stages of the condition — when one experiences fragmented sleep or increased daytime sleepiness — that they decide to seek the help of a doctor.
Obstructive Sleep Apnea affects an individual’s productivity and studies show that it can increase the chances of road accidents. This is because people with the condition do not get enough sleep and can become drowsy while driving. Even, the drop in oxygen level while sleeping can cause the body to release adrenaline to such a level that it can cause a sudden cardiac arrest. About 19 per cent of people with severe sleep apnea have died, recent studies have found.
Professor Sandeep Bansal, in charge of the sleep services of ENT Department, PGI, said that they see about 35 to 40 new patients of OSA every month and undertake about 20 to 25 sleep studies a month.
Obesity/being overweight is the one of the primary treatable causes of OSA
In children
OSA: 1% to 3%
Obesity and high-risk children: 20-50%
Enlargement of the tonsils and adenoids is the most common cause of OSA in children and 85% of the children can be cured by adenotonsillectomy.
During sleep, signs and symptoms of pediatric sleep apnea might include snoring, pauses in breathing, restless sleep, snorting, coughing or choking, mouth breathing, bed wetting, sleep terrors. Infants and young children with obstructive sleep apnea don’t always snore. They may just have disturbed sleep.
Signs and symptoms (adults)
Treatment
Prof Bansal said that Obstructive Sleep Apnea can be treated, with both medical as well as surgical options available for patients. For most, however, he said, mere lifestyle modifications, like losing weight, is enough.
CPAP/ APAP devices: It is the first line treatment before surgery. The CPAP delivers air with a force which helps in opening the airway, so it acts as a pneumatic splint. Although CPAP is the most consistently successful and most used method of treating obstructive sleep apnea, some people find the mask cumbersome, uncomfortable or loud.
Surgical treatment
Those patients who are unable to tolerate CPAP or are not compliant to CPAP and a few who don’t want to use CPAP can be considered for various types of surgical procedures after evaluation. With improvement in understanding the disease pathology and with the usage of Drug Induced Sleep Endoscopy (DISE) to evaluate the different levels of obstructions in the airway, the ENT surgeons are able to offer much better surgical treatment plans for Obstructive Sleep Apnea patients.
New research carried out in the department shows that DISE used with CPAP titration may help in improving the compliance of the CPAP. The Institute has carried out many research projects to improve surgical treatment options for Obstructive Sleep Apnea under the guidance of Prof Naresh Panda, head of the Department of Otolaryngology and Head Neck surge.
