Sleep Apnea Research Paper

Kristie Hodgens

Types of sleep apnea: Central (CSA), Obstructive (OSA) and mixed.

Obstructive sleep apnea is defined as a breathing pattern that has a 0- 10% airflow for at least 10 seconds with continued and increasing respiratory effort that repeats 5 or more times in one hour. This is the most common form of sleep apnea in the US, affecting about 25 million adults. It occurs more often in males over 40. (1) OSA occurs when the soft tissue in the back of the throat relaxes while sleeping causing a blockage to airflow. The effort and impulse to breathe remains but the air is blocked. The resulting hypoxia or hypercapnia induces an increase in ventilatory effort. The pharyngeal muscles open up the airways causing a gasp or snort whereby

It starts out with a central feature but an obstruction feature follows. There may be a proponent of CSA in many people who have been diagnosed with OSA, but it may not become evident until the OSA has been addressed…after CPAP therapy, for instance. (5) CPAP therapy will be discussed in more detail later in this writing.

Signs and symptoms are similar in all forms of sleep apnea with a few distinctions. Typical signs are excessive fatigue and daytime sleepiness, snoring, hypertension, memory problems and weight gain. If the cause stems from a neurologic disorder, the patient may have difficulty with swallowing or may notice a change in his speech. (6)

Self-evaluation questionnaires such as the Epworth sleepiness scores assessment can give a patient a general idea if they are suffering from sleep apnea. Examples of questions asked are” “has anyone observed you not breathing at night…do you snore loudly….have you been treated for high blood pressure? (7) These are highly subjective, but can provide a person with enough information to seek further

The higher IPAP level to the lower EPAP gives support to each breath. This also allows for a back- up rate to be applied for the longer apneic periods. Caution needs to be given to the application of IPAP to EPAP though. Too much of a difference can cause PaO2 levels to drop which would make the CSA worse. (5) Adaptive servo ventilation provides a minimal EPAP support during normal breathing but also provides an IPAP that is servo controlled to coincide with the CSA. If it detects a lengthy pause time or reduction in breathing, enough pressure is delivered to keep the patient breathing at about 90% of his normal. (4) This is a particularly desirable option in patients with mixed or complex apnea syndrome.

A surgical procedure to remove the soft tissue and/or tonsils in the back of the throat is called uvulopalatopharyngoplasty. The laser option is called uvulopalatopasty. Permanent surgeries to move the jaw forward or to move the tongue away from the back of the mouth are also options. These all carry with them the risk of infection.