New recommendations for diagnosing sleep apnea in adults

This article explains new recommendations for diagnosing obstructive sleep apnea in adults.

Doctors should assess the risk factors for and the symptoms of obstructive sleep apnea (OSA) in patients with unexplained daytime sleepiness, according to a new evidence-based clinical practice guideline from the American College of Physicians (ACP) published in Annals of Internal Medicine, ACP's flagship journal.

"Obstructive sleep apnea is a serious health condition that is associated with cardiovascular disease, hypertension, cognitive impairment, and type 2 diabetes," said Dr. David Fleming, president, ACP. "It is important to diagnose individuals with unexplained daytime sleepiness so that they can get the proper treatment."

ACP recommends a full-night, attended, in-laboratory polysomnography (PSG) for diagnostic testing in patients suspected of having OSA. When PSG is not available, ACP recommends using a home-based portable monitor.

Obesity is the best documented risk factor for OSA. Symptoms of OSA include unintentional sleep episodes during wakefulness, daytime sleepiness, unrefreshing sleep, fatigue, insomnia, and snoring.

OSA is caused by repetitive obstruction of the upper airway during sleep, resulting in reduced airflow (hypopnea) or complete airflow cessation (apnea). According to the National Heart, Lung, and Blood Institute, 12 to 18 million adults in the United States have sleep apnea. The incidence of OSA is rising, likely because of the increasing rates of obesity. The incidence of OSA increases with age, particularly in adults over the age of 60.

ACP's guideline, "Diagnosis of Obstructive Sleep Apnea in Adults," includes High Value Care advice to help doctors and patients understand the benefits, harms, and costs of tests and treatment options so they can pursue care together that improves health, avoids harms, and eliminates wasteful practices.

"Diagnosing obstructive sleep apnea is high value care," Dr. Fleming said. "Prior to diagnosis, patients with obstructive sleep apnea have higher rates of health care use, more frequent and longer hospital stays, and greater health care costs than after diagnosis."

Assessing patients for OSA in the absence of daytime sleepiness or treating individuals with low apnea-hypopnea index (AHI) scores is low value care because the evidence indicates that it does not improve clinical outcomes, ACP states in the guideline.

ACP developed the guideline based on a systematic review of the published literature on human subjects in the English language.

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Is sleep apnea harmful for health?

This article describes in what ways sleep apnea is harmful to a person's health.

Sleep apnea is a sleeping disorder that occurs when a person’s breathing is interrupted during sleep. These breathing pauses typically last between 10 to 20 seconds and can occur up to hundreds of times at night. This chronic sleep deprivation results in daytime sleepiness, slow reflexes, poor concentration, and an increased risk of accidents.

Sleep apnea can also lead to serious health problems over time, including diabetes, high blood pressure, heart disease, stroke, and weight gain. But with treatment you can control the symptoms, get your sleep back on track, and start enjoy being refreshed and alert every day.

Sleep apnea Symptoms:

l If pauses occur while you snore, and if choking or gasping follows the pauses, these are major signs that you have sleep apnea.

l Morning headaches

l Memory or learning problems and not being able to concentrate

l Feeling irritable, depressed, or having mood swings or personality changes

l Waking up frequently to urinate

l Dry mouth or sore throat when you wake up

Treatment of sleep apnea:

l Weight loss: People who are overweight have extra tissue in the back of their throat, which can fall down over the airway and block the flow of air into the lungs while they sleep. Losing just 10% of body weight can have a big effect on sleep apnea symptoms. In some cases, losing a significant amount of weight can even cure Sleep Apnoea.

l Quitting smoking.

l Avoiding alcohol, sleeping pills, and sedatives,

l Avoiding caffeine and heavy meals within two hours of going to bed.

l Maintaining regular sleep hours.

l Bariatric Surgery: Choosing Surgery is not a simple decision and it is not for everyone who struggles with sleep apnea. It is for individuals who have exhausted other options for treatment and have got excess weight.

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When you should get checked for sleep apnea

This article outlines what sleep apnea is and the process by which diagnosis and treatment occur.

Eighteen million Americans are estimated to suffer from sleep apnea, according to the National Sleep Foundation.

Sleep apnea is a common disorder, with a person having one or more pauses in breathing or experiencing shallow breaths while sleeping. The pauses can last a few seconds to several minutes. Thirty or more such pauses are possible in a single hour.

The result is a poor quality of sleep and daytime fatigue. The condition is usually noted by a family member, not the person with the disorder.

Dr. Anne Magauran at the Center for Sleep Disorders at Exeter Hospital said sleep apnea is treatable and she enjoys helping patients get a better night's sleep. She said anyone who is constantly tired during the day should discuss the problem with their primary care physician because a sleep disorder can be the cause and sometimes people are not aware they have sleep apnea issues.

"Sleep apnea is possible at any age," Magauran said. "When a person is referred to us, we have a list of questions called the Stop Bang questionnaire. If they answer yes to three or more of the questions, we suspect a sleep disorder and may do a sleep study."

Among the questions are whether the person snores, feels tired during the day, has high blood pressure or is overweight. Also, patients are asked whether anyone has ever observed them stop breathing while they are asleep.

"Sleep apnea is more common in people over the age of 50 and it is more common in men than in women," Magauran said. "We get referrals from primary care doctors or from specialists like pulmonary or cardiology because this increases the risk of heart attacks or strokes."

Once a referral is made, Magauran will conduct a detailed interview with the patient for a complete medical history, which includes lifestyle, medications, intake of caffeine and alcohol, exercise, weight and neck size — all factors in sleep disorders. Her questions also include the length of time a person has had sleep problems. She said people who say they are suffering from insomnia are often surprised to learn sleep apnea can be a cause.

Once diagnosed, sleep apnea requires long-term management and possibly surgery to correct airway issues. The best way to diagnose sleep apnea is for medical experts to conduct a sleep study. During the overnight study, doctors observe a patient and measure brain waves, eye and chin movements, heart rate and rhythms, respiration, levels of oxygen and carbon dioxide in the blood, and leg movements.

A sleep study can be done in a medical setting or at home. Magauran said a home study has less monitoring but does use an apparatus that the patient wears to bed. The device records the way the person sleeps and it is returned to the sleep center to be analyzed. Then a treatment plan is developed if necessary.

"Sleep apnea has defined criteria," Magauran said. "We look at how many times per hour the airway narrows or closes for 10 seconds or more, associated with a drop in oxygen and patient arousal."

Untreated sleep apnea can increase the risk of high blood pressure, heart attacks and stroke. It can worsen arrhythmias and diabetes. People suffering from poor sleep are more likely to be involved in car crashes and to have job performance issues.

There are three types of sleep apnea. Obstructive apnea comes from a blockage of the airway, usually the result of soft tissue that collapses and closes the rear of the throat during sleep. In central apnea, the airway is not blocked but the brain fails to signal the muscles to breathe. Mixed apnea is a combination of the first two conditions.

In mild cases, treatment may involve the use of decongestants and positional therapy. Some people snore when lying on their back and teaching them to sleep in a different position can help.

"There are devices, like an anti-snore belt that helps patients stay off of their back, if they can tolerate them," Magauran said. "It's not for everyone."

Oral devices such as a continuous positive airway pressure (CPAP) device can be used successfully in some patients.

Surgical methods can be used in adults to open a compromised airway. In children, tonsils and adenoids may be the culprit and surgery can resolve apnea completely.

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Study: Sleep Apnea Symptoms Vary by Race

This new study adds to our knowledge of the effect of race/ethnicity on sleep disorders and the PERCEPTION of sleep problems. 

We have known for some time that certain groups are more susceptible. 

Sleep apnea is another possible element of the study of the prevalence of hypertension and vascular disorders in certain ethnic groups. - JR

From the Huffington Post.....

"Risk factors for obstructive sleep apnea -- the sleep disorder in which breathing repeatedly stops and starts -- run the gamut, from smoking and high blood pressure, to the most common, high body mass index (BMI). But a recent study by researchers at Wayne State University School of Medicine reveals that even with BMI accounted for, one key risk factor remains -- race.

In the study of 512 patients observed at the Detroit Receiving Hospital Sleep Disorders Center between July 1996 and February 1999, the severity of sleep apnea was shown to be higher among African-American men under 40 years old and between 50 and 59 years old. No difference was found between African-American and white women, however.

Lead researcher, James Rowley, PhD, professor of medicine at Wayne State Medical Director of the sleep disorders center, says that the mechanism for a racial difference in sleep apnea severity is unclear, but potential mechanisms include anatomic differences that affect the way the upper airway open and close, as well as differences in the neurochemical control of breathing.

According to the Mayo Clinic, there are two main types of sleep apnea:

Obstructive sleep apnea, the more common form that occurs when throat muscles relax

Central sleep apnea, which occurs when your brain doesn't send proper signals to the muscles that control breathing

Rowley's research isn't the first to identify differences in how race affects the quality of sleep.

In two presentations at the annual meeting of the Associated Professional Sleep Societies in Boston last year, scientists reported that the amount and quality of sleep people get each night vary across racial and ethnic lines, with one study showing that blacks and Asians don’t sleep as much as whites do, and another study showing thatforeign-born Americans are less likely to report having sleep problems than those born in the U.S.

Unlike Rowley's study, however, the authors of last year's research surmise that the majority of the differences in sleep patterns between races can be chalked up to environmental or even geographical factors — rather than genes or physical characteristics like variations in facial structure that could interfere with breathing and sleep, TIME's Alice Park noted.

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