Obstructive sleep apnea (OSA) is a widespread disorder that causes night-time upper airway blockage which may result in snoring, hypoxia, and arousal.[6] Malta has a relatively high prevalence of Obstructive Sleep Apnea, in a particular randomized study it was found to be 6.6% of the examined population between 40 and 70 years old were found to have OSA[7]. This rate could also be higher since obesity is a risk factor for OSA and unfortunately, Malta has a large percentage of the population that is obese as a study in 2016 reported that; 70% of Maltese are obese.[10]
In addition to affecting alertness and cognitive function, OSA increases the risk of cardiovascular disease and metabolic diseases, as well as road and workplace accidents. OSA is linked to higher cardiovascular and all-cause mortality[6].OSA is linked to older age, male gender, craniofacial anomalies, and, most critically, excess adiposity(obesity)[6].OSA and obesity are often linked, with a high prevalence of OSA in obese individuals and most patients presenting with OSA being obese[6]. Here are key points about OSA:
Symptoms and Causes
Symptoms
Excessive daytime sleepiness
Loud snoring
Observed episodes of stopped breathing during sleep
Waking during the night and gasping or choking
Awakening in the morning with a dry mouth or sore throat
Morning headaches
Trouble focusing during the day
Mood changes, such as depression or being easily upset
High blood pressure
Decreased interest in sex[1][2][3]
Causes
Relaxation of muscles that support the soft tissues in the throat, such as the tongue and soft palate
Narrowed airway due to factors like excess weight, medical conditions, or family history
Snoring, which can be a sign of OSA[1][2][3]
Risk Factors
Excess weight
Medical conditions associated with obesity, such as hypothyroidism and polycystic ovary syndrome
Older age
Narrowed airway
High blood pressure
Chronic nasal congestion
Smoking
Diabetes
Male sex
Family history of sleep apnea
Asthma
Defect of tissues that support the head and neck
Down syndrome
Swollen or large adenoids and tonsils (in children)[1][2][3]
Diagnosis and Complications
Diagnosis is generally done by talking to a healthcare professional which may use of the following to diagnose Obstructive Sleep Apnea (OSA).
Participating in a sleep study, such as a polysomnogram or a home sleep test
Physical exam and medical history
Monitoring oxygen levels and heart rate during sleep[2][3]
Usually the sleep study is suggested tool for diagnosis, this can be with a in-hopsital polysomnogram or a home sleep test. The main difference is that the polysomnogram is a bit more invasive and thus has to be done at hospital. The home sleep test can be attached to the person in the outpatient setting to record sleep and oxygen saturation throughout sleep and is considered a less invasive form than the polysomnogram[9].Through these tests the severity of OSA is determined by an index – Apnea Hypopnea Index (AHI) or Respiratory Disturbance Index (RDI), if the sleep study is performed, or Respiratory Event Index (REI) if OCST(out-of-center sleep testing) is performed. The following are the results and the categorized severity of OSA.[8]
AHI = number of Apneas+Hypopneas/total sleep time
REI = number of Apneas+Hypopneas/monitoring time
AHI or REI <5/hour = normal (for adults); -5–14.9/hour = mild OSA; -15–29.9/hour = moderate OSA; -and ≥30/hour = severe OSA.
One may also opt for using a mobile application to check if he is snoring or not , which may be indicative of OSA even though not as reliable as the sleep monitors. To download the free application ; visit Snore lab by clicking here.
- Complications of Sleep Apnea
Daytime fatigue and sleepiness
Cardiovascular problems like heart failure, high blood pressure, and stroke
Eye problems like glaucoma
Metabolic disorders like type 2 diabetes
Problems with pregnancy like gestational diabetes
Complications with medicines and surgery
Sleep-deprived partners
Increased risk of COVID-19[1][2][3] Treatment Options There are many treatment options available according to your needs and limitations; thus it is always suggested to speak to your doctor or health care provider.
Devices that use positive pressure to keep the airway open during sleep (eg: CPAP)
Mouthpieces that thrust the lower jaw forward during sleep
Surgery, if necessary
Lifestyle changes like weight loss and quitting smoking[1][2][3][6][8] (Click on the words for advice to help you make these lifestyle changes! )
Importance of Diagnosis and Treatment
Obstructive Sleep Apnea is a serious condition that can lead to adverse effects, and health complications and may indirectly lead to death. Thus maintaining a healthy lifestyle with correct Body Mass Index ( check weight loss post), exercising, nasal breathing, and NOT smoking, can help prevent OSA. Early diagnosis and treatment can prevent complications and improve quality of life [1][2][3].We thus encourage those who are experiencing any of the above symptoms to reach out to their doctor or health care professional.
Citations:
[1]“Obstructive Sleep Apnea.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 14 July 2023, www.mayoclinic.org/diseases-conditions/obstructive-sleep-apnea/symptoms-causes/syc-20352090.
[2] “Obstructive Sleep Apnea.” Johns Hopkins Medicine, 21 June 2024, www.hopkinsmedicine.org/health/conditions-and-diseases/obstructive-sleep-apnea.
[3]“Obstructive Sleep Apnea (OSA): Definition, Causes, Symptoms, Diagnosis, and Treatment.” WebMD, WebMD, www.webmd.com/sleep-disorders/sleep-apnea/understanding-obstructive-sleep-apnea-syndrome. Accessed 24 June 2024.
[4]Obstructive Sleep Apnoea (OSA) | NHS INFORM, www.nhsinform.scot/illnesses-and-conditions/lungs-and-airways/obstructive-sleep-apnoea/. Accessed 24 June 2024.
[5]“Sleep Apnea.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 6 Apr. 2023, www.mayoclinic.org/diseases-conditions/sleep-apnea/symptoms-causes/syc-20377631.
[6]Araghi, M.H. et al. (2013) ‘Effectiveness of lifestyle interventions on obstructive sleep apnea (OSA): Systematic review and meta-analysis’, Sleep, 36(10), pp. 1553–1562. doi:10.5665/sleep.3056.
[7]Gauci, J. et al. (2019) ‘Prevalence of obstructive sleep apnoea syndrome in Malta’, Epidemiology [Preprint]. doi:10.1183/13993003.congress-2019.pa4414.
[8] Goyal, Munish, and Jeremy Johnson. “Obstructive Sleep Apnea Diagnosis and Management.” Missouri Medicine, U.S. National Library of Medicine, www.ncbi.nlm.nih.gov/pmc/articles/PMC6140019/#:~:text=The%20severity%20of%20OSA%20is,REI)%20if%20OCST%20is%20performed.&text=AHI%20or%20REI%20%3C5%2Fhour,30%2Fhour%20%3D%20severe%20OSA. Accessed 24 June 2024.
[9] Quan, Stuart F, et al. “Out of Center Sleep Testing in Ostensibly Healthy Middle Aged to Older Adults.” Southwest Journal of Pulmonary & Critical Care, U.S. National Library of Medicine, www.ncbi.nlm.nih.gov/pmc/articles/PMC6528663/#:~:text=Most%20have%20used%20PSG%20recorded,actual%20sleep%20is%20not%20recorded. Accessed 24 June 2024.
[10] Cuschieri, S, et al. “Prevalence of Obesity in Malta.” Obesity Science & Practice, U.S. National Library of Medicine, www.ncbi.nlm.nih.gov/pmc/articles/PMC5192534/#:~:text=Results,)%20(p%20%3D%200.0001). Accessed 24 June 2024.
Comments