The following signs and symptoms are associated with either obstructive or central sleep apnea:

• Hypersomnia or excessive daytime sleepiness
• Periodic breathing cessation during sleeping
• Vascular headache in the morning
• Loud snoring
• Periods of awakening during sleep coupled with shortness of breath
• Insomnia (difficulty in staying asleep)
• Difficulty in focusing and maintaining attention

• Fatigue

  Respiratory disturbances causing sleep fragmentation and repetitive nocturnal hypoxia are responsible for a variety of nocturnal and daytime complaints of sleep apnea patients, such as snoring, daytime sleepiness, fatigue, or impaired cognitive functions [ncbi.nlm.nih.gov]

  People with sleep apnea often have daytime sleepiness or fatigue. [sleepeducation.org]

  Complications can include: Daytime fatigue. The repeated awakenings associated with sleep apnea make normal, restorative sleep impossible, making severe daytime drowsiness, fatigue and irritability likely. [mayoclinic.org]

  Recurrent hypoxia may cause increased respiratory effort and this can induce respiratory muscle fatigue in patients with OSAS [ 2 ]. [esciencecentral.org]

• Weight Gain

  These inflammatory chemicals also contribute to weight gain and obesity, which further worsens asthma. Since airflow is decreased during sleep apnea, this leads to low oxygen levels in the bloodstream and strain on the heart. [verywellhealth.com]

  Observational studies showed that lack of sleep is correlated with weight gain and an increased risk of obesity; this relationship was confirmed by mutually reinforcing pathophysiological mechanisms. [ncbi.nlm.nih.gov]

  Weight gain also can contribute to snoring. This may simply amplify an existing anatomic problem previously causing mild obstruction. The most common cause is an anatomic abnormality leading to obstruction. [calsleep.com]

  Try not to gain weight. Weight gain can worsen sleep apnea and require adjustments to your CPAP device. In contrast, weight loss may relieve your sleep apnea. [web.archive.org]

  Aging and minor weight gain did not appear to have a significant adverse effect on the long-term results; however, major weight gain did seem to have a significant negative impact on the long-term outcomes. [doi.org]

• Hypersomnia

  Abstract Hypersomnia is a significant problem in about 5% of the general population. We discussed clinical aspects in 3 patients with hypersomnia diagnosed in our sleep laboratory. [ncbi.nlm.nih.gov]

  Hypersomnia types Primary hypersomnia • Hypersomnia-bulimia syndrome of Klein-Levine Characterized by semiannual bouts of hyperphagia followed by a 2-5 day 'sleep-off', seen in young ♂. • II. [medical-dictionary.thefreedictionary.com]

  Excessive daytime drowsiness (hypersomnia) may be due to sleep apnea or to other disorders, such as narcolepsy. Treatment can ease your symptoms and may help prevent heart problems and other complications. [newsnetwork.mayoclinic.org]

  Sleep Hypopneas — Apnea, Sleep — Apneas, Sleep — Sleep Apnea — Sleep Apneas — Sleep Apnea, Mixed Central and Obstructive — Mixed Central and Obstructive Sleep Apnea — Sleep Apnea, Mixed — Mixed Sleep Apnea — Mixed Sleep Apneas — Sleep Apneas, Mixed — Hypersomnia [mesh.kib.ki.se]

  In 1972, a conference organized by Lugaresi and his Bologna (Italy) group entitled “Hypersomnia and Periodic Breathing,” served as a springboard for the growth of interest and research in SDB. 7 Guilleminault et al. 8 coined the terms sleep apnea syndrome [accessmedicine.mhmedical.com]

• Asymptomatic

  RESULTS: Asymptomatic OSAS patients already presented altered swallowing pattern before surgery. [ncbi.nlm.nih.gov]

  An HSAT should not be used for general screening of asymptomatic populations. [aasm.org]

  The clinical spectrum thus varies from the asymptomatic patient, to one with chronic cardiac and respiratory failure who is at risk of sudden death. Most patients are disabled by varying degrees of pathologic sleepiness. [clinicaltrials.gov]

  According to recent US Preventive Services Task Force guidance on screening for OSA, there is no clear evidence to support population screening of asymptomatic individuals at low risk of OSA using sleep diagnostic testing. 48 Polysomnography The gold [doi.org]

• Nocturnal Awakening

  The inclusion criteria were age ≥ 18 years, the presence of diagnostic criteria A (complaint of difficulty initiating [defined as sleep latency ≥30 min at least 3×/week] or maintaining sleep [defined as 3 or more nocturnal awakenings or a long nighttime [respiratory-research.biomedcentral.com]

• Sleep Apnea

  The cardinal symptoms of sleep apnea include the "3 S ’s": S noring, S leepiness, and S ignificant-other report of sleep apnea episodes. [emedicine.medscape.com]

  See Answer What are the types of sleep apnea? There are three types of sleep apnea: central sleep apnea (CSA), obstructive sleep apnea (OSA), and mixed sleep apnea (both central sleep apnea and obstructive sleep apnea). [medicinenet.com]

  sleep apnea is different than that of central sleep apnea. [en.wikipedia.org]

• Snoring

  Snoring Studies have shown that up to 50% of adults snore. It is not very common in children, but it does occur. Snoring, when mild or infrequent, may not be a significant issue. [calsleep.com]

  Conclusions: Serum leptin levels are affected by adiposity but not by OSAS severity among children with habitual snoring. [ncbi.nlm.nih.gov]

  The snoring usually is loudest when you sleep on your back; it might be less noisy when you turn on your side. You might not snore every night. Over time, however, the snoring can happen more often and get louder. [web.archive.org]

  Abstract Objective It is unclear whether all snoring patients require polysomnography, and there are no highly sensitive clinical predictors of sleep apnea. Our objective was to develop a simple clinical screening test for OSA in snoring patients. [doi.org]

• Loud Snoring

  Loud snoring is a telltale symptom of OSA. Snoring is caused by air squeezing through the narrowed or blocked airway. Not everyone who snores has sleep apnea though. [nlm.nih.gov]

  But be sure to talk to your doctor if you experience loud snoring, especially snoring that's punctuated by periods of silence. Ask your doctor about any sleep problem that leaves you chronically fatigued, sleepy and irritable. [newsnetwork.mayoclinic.org]

  Common sleep apnea symptoms include: Waking up with a very sore or dry throat Loud snoring Occasionally waking up with a choking or gasping sensation Sleepiness or lack of energy during the day Sleepiness while driving Morning headaches Restless sleep [webmd.com]

• Abdominal Pain

  In the carbocysteine group, two subjects were withdrawn because they did not show up after three reminders, and one subject was excluded because he reported adverse effects (abdominal pain). [journals.plos.org]

• Hypersalivation

  Major signs and symptoms on physical examination include fever, hypersalivation, odynophagia, reduced oral intake, sore throat, swelling on the neck, torticollis, limitation in neck mobility, and voice changes. [ncbi.nlm.nih.gov]

• Hypertension

  It was found: 36% of daytime hypertension, 52% nocturnal hypertension, 40% non-dipper profile, 16% of white coat hypertension and 28% masked hypertension. The prevalence of sleep apnea syndrome was 16%. [ncbi.nlm.nih.gov]

  Cardiovascular Effects of OSA Hypertension The causal link between OSA and systemic hypertension has been clearly established. [medscape.com]

  Treating Obstructive Sleep Apnea Improves Essential Hypertension and Quality of Life DONALD S. [web.archive.org]

  TABLE 1 Evidence That OSA Causes Hypertension and Contributes to Essential Hypertension About 50% (range 30 to 80%) of patients with EH have OSA. About 50% of patients with OSA have EH. [aafp.org]

• Heart Failure

  […] bidirectional relation between heart failure and sleep apnea (Fig 5). [web.archive.org]

  heart failure overlap, as they do between OSA and CAD. [medscape.com]

  For example, if central sleep apnea is due to heart failure, the goal is to treat the heart failure itself. Devices used during sleep to aid breathing may be recommended. [nlm.nih.gov]

  Patients with acute myocardial infarction who have apnea and hypoxemia without evident heart failure should be evaluated for sleep disorders. [ncbi.nlm.nih.gov]

• Hypotension

  View Article PubMed Google Scholar Hayreh SS, Zimmerman MB, Podhajsky P, Alward WL: Nocturnal arterial hypotension and its role in optic nerve head and ocular ischemic disorders. Am J Ophthalmol. 1994, 117: 603-624. [bmcophthalmol.biomedcentral.com]

  […] retrospectively illustrated that the patients with OSAS or an ODI 4% > 5 (oxygen desaturation index; number of oxygen desaturation of 4 percent or more per sleeping hour) suffered significantly more from perioperative complications such as bleeding, atelectasis, hypotension [omicsonline.org]

  […] cardiovascular events. 23, 24, 25, 26, 27, 28, 29 The related conditions of non-dippers and risers are as follows: (1) reduced circulating volume (congestive heart failure, chronic kidney disease, etc), (2) autonomic nervous dysfunction (orthostatic hypotension [nature.com]

  Voronin IMBelov AMChuchalin AG Placebo-controlled study of short-term hypotensive effect of intranasal ventilation with continuous positive pressure upper respiratory tract therapy in patients with stage I arterial hypertension [in Russian]. [doi.org]

• Sweating

  […] nighttime awakenings Sudden awakenings with a sensation of gasping or choking Dry mouth or sore throat upon awakening Cognitive impairment, such as trouble concentrating, forgetfulness, or irritability Mood disturbances (depression or anxiety) Night sweats [my.clevelandclinic.org]

  They may include: Bed-wetting Choking or drooling Sweating a lot at night Ribcage moves inward when they breathe out Learning and behavior problems Problems at school Sluggishness or sleepiness (often seen as laziness) Snoring Teeth grinding Restlessness [webmd.com]

• Loss of Libido

  Other symptoms may include headaches, irritability, night sweats, attention deficit, memory loss, decreased libido, and depression [7]. [physio-pedia.com]

  Sleep apnea can even throw a wrench in your sex life, causing erectile dysfunction in men and loss of libido in women. [nytimes.com]

  […] of libido, irritability, and decreased concentration and memory [ 2 ]. [respiratory-research.biomedcentral.com]

• Anxiety Disorder

  Her longstanding fear of dentists stems from an even less common anxiety disorder: claustrophobia. [ifoundmydoctor.com]

• Nocturia

  The presence of nocturia, urinary urgency, and urge incontinence were also evaluated. RESULTS: The mean OABSS was significantly higher in the patient group compared with the control group (p=0.048). [ncbi.nlm.nih.gov]

  Occasionally the nocturia is so severe as to cause enuresis, particularly in younger individuals. [bmb.oxfordjournals.org]

  Nocturia Nocturia is a very common and severe disorder because of the effects it has on patients [ 60 ]. In OSA patients, nocturia is a strong independent predictor of hypertension [ 61 ]. [transbiomedicine.com]

  Common symptoms of sleep apnea include: Loud or frequent snoring Silent pauses in breathing Choking or gasping sounds Daytime sleepiness or fatigue Unrefreshing sleep Insomnia Morning headaches Nocturia (waking during the night to go to the bathroom) [sleepeducation.org]

• Sexual Dysfunction

  There are many sexual dysfunctions in men that seem to be linked such as erectile dysfunction (ED), low dyadic, and solitary sexual desire, which share many risk factors. [transbiomedicine.com]

  dysfunction Headaches People with central sleep apnea more often report recurrent awakenings or insomnia, although they may also experience a choking or gasping sensation upon awakening. [my.clevelandclinic.org]

  Below are other common sleep apnea symptoms: Constant tiredness Poor concentration Night sweats Weight gain Lack of energy Forgetfulness Sexual dysfunction Frequent urination at night In addition, women often show subtler, atypical symptoms such as insomnia [resmed.com]

  Since people with sleep apnea tend to be sleep deprived, they may suffer from sleeplessness and a wide range of other symptoms such as difficulty concentrating, depression, irritability, sexual dysfunction, learning and memory difficulties, and falling [sleepfoundation.org]

• Headache

  We report the case of a 44-year-old man who had episodic headaches, unconsciousness attacks and seizures. Cerebral angiography showed CVT. He was obese and had severe OSAS. [ncbi.nlm.nih.gov]

  Common sleep apnea symptoms include: Waking up with a very sore or dry throat Loud snoring Occasionally waking up with a choking or gasping sensation Sleepiness or lack of energy during the day Sleepiness while driving Morning headaches Restless sleep [webmd.com]

• Morning Headache

  Both patients presented with a long-standing history of snoring, gasping for air while sleeping, excessive daytime sleepiness, and morning headaches. In both patients, the lesions were discovered by fiberoptic nasopharyngoscopy. [ncbi.nlm.nih.gov]

  Common sleep apnea symptoms include: Waking up with a very sore or dry throat Loud snoring Occasionally waking up with a choking or gasping sensation Sleepiness or lack of energy during the day Sleepiness while driving Morning headaches Restless sleep [webmd.com]

  Common symptoms of sleep apnea include: Loud or frequent snoring Silent pauses in breathing Choking or gasping sounds Daytime sleepiness or fatigue Unrefreshing sleep Insomnia Morning headaches Nocturia (waking during the night to go to the bathroom) [sleepeducation.org]

  Other Signs and Symptoms Others signs and symptoms of sleep apnea include: Morning headaches Memory or learning problems and not being able to concentrate Feeling irritable, depressed, or having mood swings or personality changes Waking up frequently [web.archive.org]

• Somnolence

  In epilepsy patients with risk factors (eg, obesity) or markers (eg, habitual snoring, daytime somnolence) for sleep apnea, a careful sleep history should be elicited and a polysomnogram obtained when indicated. [neurology.org]

  Recognition of its relevance in medicine is relatively recent, although clinical reports of SDB were first made in the 19th century. 1 Likely influenced by such observations, descriptions of an entity constituting obesity and extreme somnolence were highlighted [accessmedicine.mhmedical.com]

• Difficulty Concentrating

  concentrating Memory loss Decreased sexual desire Irritability Risk Factors The major risk factor for sleep apnea is excess body weight. [sleepeducation.org]

  They may have difficulty concentrating and find themselves falling asleep at work, while watching TV or even when driving. They may also be at higher risk of work-related accidents. [mayoclinic.org]

  Sleep apnea is a common problem associated with decreased overall health and a higher risk of life-threatening complications, such as motor vehicle accidents, difficulty concentrating, depression, heart attack, and stroke. [medicalnewstoday.com]

  The most common signs of sleep apnea include: Chronic morning headaches or throat discomfort Difficulty concentrating or remembering Fatigue and daytime sleepiness Frequent waking to urinate Irritability, depression or other mood problems Gasping or choking [multicare.org]

• Sleep Disturbance

  Sleep disturbances are common in FMS and patients usually complain about nonrestorative sleep. Obstructive sleep apnea syndrome (OSAS) is characterized by repetitive pharyngeal collapse during sleep. [ncbi.nlm.nih.gov]

  Symptoms may be present for years, even decades without identification, during which time the sufferer may become conditioned to the daytime sleepiness and fatigue associated with significant levels of sleep disturbance. [sciencedaily.com]

  In addition, the partners of participants in the didgeridoo group were much less disturbed in their sleep. [bmj.com]

  Etiology There are many disturbances that can result in a sleeping disorder, refer to Table 1 [ 5 - 11 ]. [transbiomedicine.com]

The diagnosis of sleep apnea may be effectively clinched with a detailed clinical history. Patients may still be subjected to some tests that may ascertain the diagnosis of sleep apnea. The following tests or sleep studies are implored to patients suspected of having sleep apnea:

• Nocturnal polysomnography: This device records the lung, heart, and brain activities during sleep. Breathing patterns are graphed while nocturnal patterns of arm and leg movements are also recorded [8]. The blood oxygen levels are also measured during the test process to assess the presence of sleep apnea.
• Home sleep test kits: These test kits are very similar to the nocturnal polysomnograph, although heart rate, breathing patterns, airflow, and blood oxygen saturation are the only parameters which are being measured.

• Hypercapnia

  Related Testing An arterial blood gas (ABG) is needed to evaluate patients with suspected hypercapnia. Hypercapnia is defined as the PaCO2 being greater than 42 mm Hg. [ncbi.nlm.nih.gov]

  Neural responses to hypoxia and hypercapnia have not been well studied in children with obstructive sleep apnea and underlying syndromes. [emedicine.com]

The milder forms of sleep apnea may only require some lifestyle modifications. However, some forms of sleep apnea like those classified under moderate and severe may need other treatment options for its resolution. The following therapy and treatment modalities are implored in the treatment of sleep apnea:

• Continuous positive airway pressure (CPAP): This is an oxygen delivery system through a mask which is placed over the nose during sleep. The airflow through the mask creates a positive pressure slightly greater than the environmental pressure making the airways continually open during the duration of the sleep [9].
• Adjustable airway pressure device: This system is very similar to CPAP, it only self-adjusts so that the air pressure becomes high during inhalation and subsequently drops during expiration.
• Expiratory Positive Airway Pressure (EPAP) – This device allows airflow to freely go in during inhalation but diverts airflow through a network of smaller holes during expiration making the expiratory phase create a positive pressure to the upper airways.
• Uvulopalatopharyngoplasty: This is a surgical procedure used to remove soft tissue structures like the tonsils and the adenoids to clear the airways and allay the symptoms of sleep apnea [10].
• Tracheostomy: This is a surgical procedure used when all other methods fail. A hole is created through the neck and trachea for easier respiration during sleep. This procedure is indicated for patients with severe sleep apnea, with associated life threatening conditions.

The common symptoms of sleep apnea like daytime sleepiness and snoring are considered to be a benign complication with a very excellent prognosis. A cohort study, implicated severe untreated sleep apnea to increase the mortality rate of myocardial infarction and stroke among Spanish patients [6]. Australian studies on moderate to severe sleep apnea among men have suggested a significant increase in mortality rate among the respondents [7].

The obstructive type of sleep apnea occurs when the posterior muscles of the larynx relaxe and obstruct the airways during sleep. When the airways constrict during inspiration the blood oxygen levels significantly drop during sleep. The most common causes of the central sleep apnea are heart failure and cerebrovascular diseases (stroke). People suffering from central type of apnea are more likely to remember their apneic spells than those with the obstructive type of apnea.

In the United States, an estimated 18 million people are suffering from either forms of sleep apnea. Although a great majority of these people remain underdiagnosed or undiagnosed. The prevalence rate of sleep apnea is estimated to be 4% among the male population and 2% among women [2]. Recent studies have seen an increasing incidence of sleep apnea in the younger age group especially among obese children.

Internationally, sleep apnea occurs infrequently among the English population with only 3 cases per 1000 population. Higher prevalence rates of obstructive sleep apnea are observed among Australians and Israeli population which reach up to 25%. The elderly population beyond the age of 65 years has a two to three fold risk of developing sleep apnea than their middle aged counterpart [3]. The relatively high fat distribution over the neck among males make them more predisposed to sleep apnea compared to women with a prevalence ratio of up to 3:1 internationally [4].

The upper airway is a slender and compliant tube that could collapse inward when the laryngeal muscles relax during sleep [5]. The intraluminal pressure may not be always greater than the transluminal pressure during sleep; thus, the propensity for collapse and narrowing of the airways is a frequent event. The pharyngeal space where the airway constricts is bounded by the soft palate, the back of the tongue, and the parapharyngeal fat pads. Any pathology that decreases this space consequently increases the risk of sleep apnea.

Sleep apnea is closely associated with obesity; thus, efforts to reduce weight through regular exercise and a healthy diet may significantly lower the risk for sleep apnea. Alcohol and certain medications (tranquilizers) must be avoided to prevent the throat muscles from relaxing during sleep. Try to sleep on one side rather than full supine to prevent the tongue and soft palate from falling towards the throat causing obstruction. Smoking must be avoided for this worsens oxygen saturation in the blood.

Sleep apnea or obstructive sleep apnea (OSA) is a potentially serious sleeping disorder where the breathing intermittently stops and starts for a period of time. Patients usually snore and complain of tiredness even after a full night sleep. There are essentially two types of sleep apnea, the obstructive type of sleep apnea, and the central type of sleep apnea. The obstructive type is fairly common and is characterized by the relaxation of the throat muscle during sleep [1]. The central type is evident when the brain fails to transmit the proper signals to the muscles of respiration that gives rise to apnea. Patients suffering from sleep apnea should seek medical attention promptly to avoid untoward complications in the future.

Definition

Sleep apnea is a common clinical condition where the breathing may suddenly stop or become too shallow during sleep.

Cause

The causes of sleep apnea vary, and they might include the internal processes that happen in our body like relaxation of the throat muscles during sleep, any obstruction in the upper airways, and concomitant medical illness like heart problems and stroke.

Symptoms

The symptoms of sleep apnea include snoring, daytime sleepiness, difficulty in maintaining sleep at night, headaches, and difficulty in maintaining focus.

Diagnosis

The diagnosis of sleep apnea is mainly by the use of a nocturnal polysomnography and home sleep test kits.

Treatment

The treatment of sleep apnea has wider options that include CPAP, adjustable airway devices, EPAP, uvulopalatopharyngoplasty, and tracheostomy.

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