Q&A: Management of Sleep Apnoea

The most common sleep disorder is insomnia. Others are sleep apnea, narcolepsy and hypersomnia (excessive sleepiness at inappropriate times), sleeping sickness (disruption of sleep cycle due to infection), sleepwalking, and night terrors.

In this article:
Sleep Apnoea
MCQ exam: clinical scenario
MCQ exam: answer
MCQ exam: explanation

Sleep Apnoea

Sleep apnea is a common sleep disorder characterized by brief interruptions of breathing during sleep. These episodes usually last 10 seconds or more and occur repeatedly throughout the night. People with sleep apnea will partially awaken as they struggle to breathe, but in the morning they will not be aware of the disturbances in their sleep.

The most common type of sleep apnea is obstructive sleep apnea (OSA), caused by relaxation of soft tissue in the back of the throat that blocks the passage of air. Central sleep apnea (CSA) is caused by irregularities in the brain’s normal signals to breathe. Most people with sleep apnea will have a combination of both types.

The hallmark symptom of the disorder is excessive daytime sleepiness. Additional symptoms of sleep apnea include restless sleep, loud snoring (with periods of silence followed by gasps), falling asleep during the day, morning headaches, trouble concentrating, irritability, forgetfulness, mood or behavior changes, anxiety, and depression. Sleep apnea is more likely to occur in men than women, and in people who are overweight or obese.

MCQ exam: clinical scenario

An obese 40 year old woman was brought to the general practitioner by her husband. The husband explained that the patient's snoring at night was disturbing him.

On questioning, the GP found that the problem was distinct from being merely annoying because the husband noted that she was also gasping for air throughout the night - and this repeatedly roused her out of her refreshing, deep sleep. On further questioning the physician identified the tell-tale signs of sleep apnoea: excessive daytime sleepiness and difficulty functioning.

What treatment did the physician most likely recommend?

a) adenoidectomy
b) removal of the uvula
c) night time low dose of diazepam
d) tracheostomy
e) nasal continuous positive airway pressure

MCQ exam: answer

The correct answer is E.
Continuous positive airway pressure (CPAP) will often be recommended.

MCQ exam: explanation

Sleep apnoea is among the most common and most dangerous types of sleep disorder. The condition is marked by repeated episodes of cessation of breathing during sleep that over time can lead to high blood pressure, cardiac disease, and disordered thinking.

The most common effective treatment for obstructive sleep apnea is nasal continuous positive airway pressure, or CPAP. The patient wears a soft plastic mask over his or her nose while sleeping.

Surgery to increase the size of the airway is another possible option for sleep apnea treatment. The removal of adenoids and tonsils, especially in children, or other growths or tissue in the airway is sometimes effective, as are other, relatively more risky surgical procedures, including uvulopalatopharyngoplasty (shaving of the excess soft tissues in the mouth and throat) and tracheotomy (creating an opening in the neck through the windpipe) for the most severe cases.

The newest device for this condition is Somnoplasty, used to treat mild cases of sleep apnea. It is a radio frequency surgical device that shrinks the soft palate in a half-hour outpatient procedure. FDA approved the Somnoplasty device in July 1997.