Obstructive sleep apnea (OSA) is a condition of halted breathing, snoring, and waking from sleep. It is due to airway collapse and worsens in the face-up sleep position. About eighty percent of Americans with OSA haven’t been diagnosed with this condition. Symptoms are present for years before diagnosis and treatment are begun.

Those at risk for OSA include African Americans, Mexican-Americans, Pacific Islanders, and obese people. It is more common in men than women. Additional risk factors include smoking, sleeping face-up, alcohol use, having a relative with OSA, history of stroke, a high arched palate, and low thyroid levels.

Common symptoms include irregular heart rate, short term memory deficit, morning confusion, decreased libido, daytime sleepiness, and gasping or choking during sleep. Halted breathing could occur hundreds of times at night at one or two times per minute. OSA sufferers are unaware that they have this condition. They may regard themselves as “good sleepers" because they "can sleep anytime, anywhere." 

 Enlarged tonsils and a soft palate decrease the upper airway diameter. This causes the airway to collapse, which triggers snoring. People with OSA may develop high blood pressure, coronary artery disease, diabetes, low blood oxygen levels, congestive heart failure, stroke, and depression. They are at risk for heart attack and fatal motor vehicle accidents.

Diagnosis: Polysomnography (overnight sleep study in a sleep laboratory) confirms the diagnosis. Temporary breathing cessation, heart rhythm, sleep arousals, and leg movement are recorded.

Treatment: CPAP (continuous positive airway pressure) home machines reduce symptoms and improve sleep quality. For those who don’t prefer or tolerate CPAP, oral appliances (fixed or adjustable) can help. People with no teeth and those who have jaw (temporomandibular) arthritis should not use oral appliances. If these are prescribed, they must fit accurately, comfortably, and remain in position throughout the night. 

Soft-palate and tongue devices: The Pillar Palatal Implant system was originally developed for the treatment of snoring. It t has some benefit in treating mild to moderate sleep apnea. This involves surgical placement of mesh polyethylene implants into the soft palate muscles. These permanent implants improve snoring by stiffening the palate and decreasing palate movement during inspiration.

          

                               Palate implants

       Questions or comments? Contact Dr. Clem at clementhanson.blogspot.com

Source: Medscape: http://emedicine.medscape.com/article/295807-overview