N E W S

Vol 13, No. 1        LINCARE is a National Supplier of Home
Fall '00                Oxygen and Respiratory Therapy Services

What is Sleep Apnea?

   Imagine ceasing to breathe for 10-20 seconds, then strenuously gasping in air, then stopping again - hundreds of times during what is supposed to be eight hours of restful slumber.
   For some people with sleep apnea, this happens every night.   Fortunately, the relentless lapses in breathing are not remembered even though up to three-quarters of total sleep time may be spent not breathing!
   Apnea is derived from the Greek work "a + pnoie" meaning "without wind".  In adults the cessation of breathing for 10 seconds or more is considered an apneic event.  There are three types of Sleep Apnea:

1. Obstructive -
   absence of inspiratory flow with inspiratory effort

2. Central -
   absence of inspiratory flow without inspiratory effort

3. Mixed - combination of obstructive and central 

   Obstruction in the airway occurs because of an excessive relaxation in the upper airway muscles, resulting in airway collapse during inhalation.  Obstructive apneic event can last as long as 2 to 3 minutes or even longer.  Some patients will have several hundred events in one night of sleep.  When apneic event are prolonged and/or when they occur at a high rate, oxygen saturations can drop.  Sleep apnea is associated with high blood pressure, heart failure and sudden death.

   Once apnea is documented in a Sleep Disorders Center, several effective treatment approaches may be taken.  Many years ago a tracheotomy was performed, thus bypassing upper airway obstruction.  A tracheostomy can provide dramatic improvement, however many patients associate other psychosocial concerns with this treatment.  Other surgical treatment is also available.  Laser-assisted uvulopalatopharyngoplasty has been introduced as an outpatient treatment.  However, studies have indicated that less than fifty percent of these patients are cured.  Maxillofacial Surgery is another alternative, reserved for the patient with sleep apnea who is either unwilling or unable to be treated with positive airway pressure.  These operations are not uniformly successful, although individual patients have had excellent results.
   Oral appliances, which are currently being regarded as secondline therapy, are also available.
   In the late 1970's and early 80's Nasal CPAP was introduced as a form of treatment for OSA.  Positive airflow pushes and forces the soft tissue from occluding the airway, thus preventing the obstruction.
   Compliance with this group of patients is disappointing, often as high as 50%; however, compliant patients achieve 90% improvement.
   A recent study revealed that a patient group of 352 with a mean age of 39.7 years and 68.4% female resulted in 51.7% responding yes to the question, "Do you have any problem at all with your sleep?"  Another 76.4% complained of sleepiness or a drowsy feeling during their waking hours.  37.2% stated that they do snore.
   Sleep apnea is a significant problem for over one percent of the general population.  While surgery, drugs, oxygen and weight loss all help a limited number of patients, each treatment has its side effects and benefits only a select group.   Nasal CPAP is a safe, effective, immediate solution to reverse the effects of Obstructive Sleep Apnea

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