TODAY’S COLUMN - Kami Whitney, PA-C, talks about Obstructive Sleep Apnea (OSA)

Many patients in our office complain of fatigue. While there are many causes of fatigue, one common, treatable cause is Obstructive Sleep Apnea (OSA).

Patients with OSA often snore, wake up in the morning still feeling tired, may have restless sleep with many awakenings, insomnia, may fall asleep easily when sitting quietly or more dangerously, while driving. Bed partners will likely complain of loud snoring and may report that they “stop breathing” during sleep, or wake up choking.

When patents with OSA sleep, the soft tissues in the back of the throat collapses–closing off the patient’s airway, causing an obstruction. This obstruction causes the patient to stop breathing, known as an “apnea.” In response the blood oxygen level decreases and the brain briefly wakes the patient so they begin breathing again. These brief awakening may not be noticed by the patient, but can happen many times an hour, interrupting the normal sleep cycles that would result in restful sleep.
 
The most prominent risk factors for OSA is being overweight. It is estimated that in patients with a BMI greater than 30, 30% have OSA. For those with a BMI greater than 40, 50% may have OSA. Other risk factors include large tonsils and certain jaw misalignments.

OSA is also a risk factor for other diseases including high blood pressure, Type II Diabetes, congestive heart failure, coronary artery disease, stroke, and may contribute to the development of Metabolic Syndrome. Treatment of OSA can help to reduce high blood pressure and help reverse some of the metabolic derangements found in Metabolic Syndrome, including insulin resistance.

OSA is fairly easy to diagnose and can often be done with a simple at home test. The patient wears a monitor which records breathing, oxygen saturation, and heart rate for 1-3 nights, then returns the device for interpretation. More in-depth testing, called Polysomnography can also be done but requires patients to sleep in the office and includes brain wave, eye and limb movement monitoring, and more in-depth cardiac monitoring.
 
While weight loss can reduce or eliminate OSA for some patients, the most common treatment is the Continuous Positive Airway Pressure, commonly known as the CPAP.

This device provides a constant stream of air through a face or nasal mask keeping the airway open while sleeping thereby preventing obstruction. The treatment may take some time and experimentations with different masks but once patients are comfortable with treatment, we often hear that they cannot live without their CPAP.

For those unable to tolerate the CPAP, variable airflow devices may be more tolerable. Other options include oral appliances which realign the jaw to prevent obstruction and surgery which removes excess tissue from the back of the throat.

For more information visit: http://www.sleepapnea.org/

Kami Whitney is a certified Physician Assistant at Arjun Medical Center in Gainesville, Virginia. Arjun Medical Center, headed by Alok Gupta, MD, an Internal Medicine practice.

Visit them on the web at http://www.alokguptamd.com follo,w us on Facebook at Arjun Medical Center, PC, or call (571) 248-6666.