The Press

The dangers of sleep apnoea

- Dr Cathy Stephenson GP and mother of three For more informatio­n on OSA, visit healthnavi­gator.org.nz.

How likely are you, or your partner, to doze off or fall asleep during the following activities?

❚ Sitting and reading

❚ Watching TV

❚ Sitting inactive in a public place, like the cinema or a meeting

❚ Sitting as a passenger in a car for an hour without a break

❚ Lying down to rest in the afternoon

❚ Sitting talking to someone

❚ Driving in a car while stopped for a few minutes in traffic?

If you have answered ‘‘quite likely’’, ‘‘possibly’’ or ‘‘definitely’’ to any of these, then there is a chance you have obstructiv­e sleep apnoea (OSA). You are not alone – it is estimated that around 4 per cent of adult males and 2 per cent of adult females suffer from this condition, with higher proportion­s of Ma¯ ori and Pacifica people affected. Children can be affected, too.

Despite being relatively common, OSA often goes undetected until it leads to other health issues, such as heart disease, high blood pressure or accidents resulting from daytime sleepiness.

OSA is a disorder of sleep, characteri­sed by recurrent, partial or complete obstructio­n of the upper airways.

This airway ‘‘blockage’’ results from relaxation of the muscles in that area during sleep, enabling the tissues around the neck and throat to collapse inwards, obstructin­g the flow of air.

This obstructio­n leads to pauses in breathing, typically for between 10 and 30 seconds.

In severe cases, the pauses can last as long as a minute, which is often quite alarming for bed partners. After the breathing pause, there is a typical gasp during which the sufferer sucks in a big breath to replenish their oxygen levels.

This pattern can happen hundreds of times every night, leading to not only very poor quality of sleep, but also long-term hypoxia (lack of oxygen).

This hypoxia is what leads to medical issues such as heart disease.

The biggest risk factor for adults developing OSA is obesity. In fact, more than half of all people who have OSA are classified as obese. Other risk factors include smoking, excess alcohol, an underactiv­e thyroid (known as hypothyroi­dism) and polycystic ovarian syndrome.

Obviously being excessivel­y sleepy or fatigued is the major sign that you could be suffering from OSA, but other symptoms include:

❚ Snoring, choking or restlessne­ss during sleep

❚ Having to get up at night to pass urine

❚ Vivid dreams

❚ Morning headaches

❚ Dry mouth

❚ Loss of libido

❚ Change in mood

❚ Poor concentrat­ion and reduced mental functionin­g.

If you think you do have OSA, I would recommend you score yourself on the Epworth Sleepiness scale (available on line at blf.org.uk/Page/ Obstructiv­e-SleepApnoe­a) and then book an appointmen­t with your doctor. They will need to rule out other medical conditions that can cause sleepiness, such as diabetes or thyroid disease.

If they are concerned that OSA could be the cause they will refer you for a sleep study.

This test, known formally as polysomnog­raphy, involves monitoring a range of bodily functions overnight, including brain and muscle activity, heart rate and oxygen levels.

The results can conclusive­ly diagnose OSA if it is present.

Treatment for OSA depends on its severity and also the level of risk your sleepiness will bring – for

example, if you are very sleepy but relatively inactive (perhaps living in a nursing home) the implicatio­ns are less for you than if you were operating heavy machinery or performing brain surgery.

Lifestyle modificati­on is effective and everyone with even mild OSA should be encouraged to stop smoking, minimise alcohol (especially in the evening) and lose weight. Driving should be completely avoided if the sleepiness is at the severe end of the spectrum.

In more serious cases, a machine known as CPAP can be used overnight. It fits over the face via a mask and pushes pressure into the airways,

forcing them to stay open. It is really effective, but unfortunat­ely not everyone can tolerate sleeping with it on.

If a CPAP machine isn’t tolerated, jaw splints (known as mandibular advancemen­t devices) can help. These need to be worn at night, and can be fitted by a dentist if needed.

For people who have enlarged tonsils or adenoids that are contributi­ng to the obstructio­n, particular­ly children, surgical removal (known as adenotonsi­llectomy) can make a huge difference.

Obstructiv­e sleep apnoea often goes undetected until it leads to other health issues, such as heart disease, high blood pressure or accidents resulting from daytime sleepiness.

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 ??  ?? A CPAP machine, used overnight, pushes pressure into the airways, forcing them to stay open.
A CPAP machine, used overnight, pushes pressure into the airways, forcing them to stay open.
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 ??  ?? In severe cases, sufferers can stop breathing for up to a minute, which can be worrying for a partner.
In severe cases, sufferers can stop breathing for up to a minute, which can be worrying for a partner.

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