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Sleep Apnoea - Medical Malpractice
Obstructive sleep apnoea or OSA is a condition involving a decrease or cessation in airflow during sleep due to obstruction of some area of the upper airway. People with obstructive sleep apnoea do not sleep well because they are always waking up during sleep in order to catch their breath. There are often many episodes of apnoea during a single night's sleep. There is often a lowering of the oxygen level in the blood during the episodes. Because they don't sleep well, those with OSA often have daytime sleepiness and are at risk of falling asleep on the job or when driving a motor vehicle. About 80 percent of people with this disease are not diagnosed at all.
It is believed that OSA affects 7-18 million people in the US and that the case is severe in 2-4 million individuals. It is becoming increasingly common in developed countries, mostly because obesity is becoming more common. Two percent of women and 4 percent of men have the disease in North America. It is present in children and adults alike but is less common in children. Obese children, on the other hand, are at risk. On the other end of the spectrum, it is 2-3 times greater in those older than age 65. The male to female ratio is about 2-3 to 1. It is more common in blacks than in whites.
The apnoea can occur hundreds of times per night, up to one to two times per minute if the disease is severe. The heart rate often swings wildly from too fast to too slow. Snoring is almost always present and is noted by the person's sleeping partner. It is strongly associated with other medical conditions, such as diabetes type II, coronary artery disease, high blood pressure, depression and sleep-related accidents due to lack of sleep. There is a continuum of sleep disorders from mild snoring to severe sleep apnoea, with prolonged periods of lack of breathing.
Obstructive sleep apnoea usually occurs in clusters. Each cluster of apnoea is associated with a low blood oxygen. The person is then aroused, breathes to the extent necessary to bring up the blood oxygen level and then the cycle repeats itself. It is upper airway obstruction due to obesity or an abnormality in the upper airway that prevents airflow through the nasal and mouth passages during sleep. The upper airway relaxes during sleep so that the tissues fall together and block the airway.
People who have trauma to the nose, a deviated septum or polyps and tumours within the nose are at higher risk of OSA. Those with a small lower jaw, a high arched palate or genetic conditions affecting the shape of the mouth internally can develop OSA more readily. Kids with a large tongue can come down with OSA. Obese people have more tissue within the airway that can easily fall together during the sleep process.
Risk factors for obstructive sleep apnoea include central fat location, obesity, male gender, age, being post menopausal, using alcohol or sedatives, smoking history, habitual snoring, sleeping on your back or being in REM sleep. There seems to be a familial relationship between those who have sleep apnoea and those with conditions like stroke, hypothyroidism, neurological problems or acromegaly are at a greater risk.
The main symptoms of obstructive sleep apnoea include loud snoring on a regular basis, witnessed apnoea episodes, gasping or choking during sleep, getting up to urinate at night, insomnia, sleeping restlessly, waking up tired, morning headache, daytime fatigue or sleepiness, being confused in the morning, having depression or anxiety during the day and having decreased vigilance during the day. Sexual dysfunction can occur with OSA as well as GE reflux and high blood pressure.
The physical examination in an OSA patient can include being obese, having a big neck, having a narrowed airway, having enlarged tonsils, having a small lower jaw, having a high arched palate, having high blood pressure or pulmonary hypertension, having a stroke or metabolic syndrome.
The diagnosis of OSA involves a sleep study done at a sleep center. This can show the episodes of apnoea seen in the disease during a night's stay at the sleep center. The diagnosis can also be made on the basis of a history and physical examination alone along with the knowledge that 30 percent of those with a BMI of 30 or more have OSA.
The treatment of OSA involves using CPAP, which is "continuous positive airway pressure". It is worn at night to keep the airway open. BiPAP is another breathing option. In people who do not respond to such measures, surgery to remove the uvula and upper soft palate could be attempted.LEGAL HELPLINE: ☎ 855 804 7125
The author of the substantive medical writing on this website is Dr. Christine Traxler MD whose biography can be read here