Obstructive Sleep Apnea

While snoring can be socially disruptive, Obstructive Sleep Apnea is a potentially life-threatening disorder that affects millions of Americans, and many more around the world. If you suffer from sleep apnea in the Charlotte, NC area, please call for a consultation with Dr. Moore, 704.358.8898.

People with obstructive sleep apnea (OSA) have disrupted sleep (ie: leading to a form of sleep deprivation caused by abnormal sleep architecture) and may suffer from intermittent low blood oxygen levels. This leads to chronic fatigue and excessive daytime sleepiness, which places these patients at risk for motor vehicle accidents, slow reaction times, and inefficiencies during employment.

What causes Obstructive Sleep Apnea?

Obstructive sleep apnea is contributed to by tonguebase narrowing (this narrowing resulting in part from genetics [ie: how the airway is shaped as a result of inheritance], and environmental influences (ie: weight gain, smoking, alcohol use). In each of these cases, the normal ability of the airway musculature to expand the airway (as a result of upper airway dilator muscle activity) is compromised. This narrowing causes rapid airflow, which over time stretches the soft palate and causes soft palate elongation (ie: secondary soft palate elongation).

During obstructive events (particularly when the patient lies on their back, and particularly during REM sleep) the tonguebase and lateral pharyngeal walls collapse into the airway, thereby blocking airflow and causing obsruction. In many patients, this obstruction can significantly impair normal oxgenation of the bloodstream, and repeated attempts to ventilate against the closed airway causes tremendous changes in intrathoracic pressures.

These repeated attempts to ventilate against a closed airway, combined with desaturations of the bloodstream, impart significant stress to the heart, endothelium, and lungs- and raises levels of circulating catecholamines and cortisol (contributing to hypertension and endothelial dysfunction). When the barometric sensors in the pharynx are stimulated due to this obstruction, the brain senses these disturbances and awakens the patient’s sleep to a lighter stage of sleep (this event is staged as an "arousal" during the sleep study); the arousal causes the obstruction in the throat to temporarily clear and the flow of air starts again, usually with a loud gasp.

This is a recurrent cycle, and may repeat many times during a given night (thereby forming the basis for scoring of a sleep study based upon the number of events [apneas {cessation of airflow for 10 seconds or longer}+ hypopneas {reduction of respiratory airflow by 30%, associated with a desaturation or arousal}]). Patients with this disorder need not be overweight or obese, as many patients inherit their airway and facial anatomy size and shape from their parents (and may present with a normal body mass index).

Repeated cycles of decreased oxygenation (and negative intra-thoracic pressures) lead to serious cardiovascular problems (hypertension, atrial fibrillation, right sided heart enlargement, pulmonary hypertension, cardiac arrhythmias, sudden cardiac death, stroke). Additionally, these individuals suffer from excessive daytime sleepiness, depression, and loss of concentration.

Upper airway obstruction occurs on a continuum, from a fully patent airway, to more significant narrowing. Slight airway narrowing produces rapid airflow that imparts energy to the soft palate- thereby contributing energy that pulls at the most compliant portions of the upper airway (typically, the soft palate and lateral pharyngeal walls). When the resistance is overcome, the vibration that results is perceived as snoring. When the airway narrows further, Upper Airway Resistance Syndrome (UARS) occurs (most commonly seen in young women). Normal sleep architecture is disrupted in these patients due to high airway resistance, and these individuals suffer many of the same symptoms of sleep-deprived individuals. Further airway narrowing results in frank obstructive sleep apnea- ranked on a scale from mild, moderate, to severe.

« Previous - 1 2 3 - Next »