what is sleep apnea and body position in patients

(I-Newswire) December 17, 2005 - Obstructive sleep apnea is an illness characterized by snoring, partial or complete cessation of breathing during sleep, reductions in blood oxygen levels, severe sleep fragmentation, and excessive daytime sleepiness. Researchers and clinicians have recognized sleep apnea as one of the most common sleep disorders and with perhaps the greatest medical and social impact on society in terms of morbidity and mortality. The syndrome strikes both sexes and all races, ages, socioeconomic strata, and ethnic groups, though it is less common in women prior to menopause, and may be more common in blacks than in whites.

The potential consequences of obstructive sleep apnea are significant and include hypertension, coronary heart disease, myocardial infarction, pulmonary hypertension, congestive hear failure, stroke, neuropsychiatric problems, cognitive impairment, sexual disfunction, and injury due to accidents. It is estimated that cardiovascular deaths attributable to obstructive sleep apnea alone may be as high as 38,000 annually.

In the United States, 11,845,000 people between the ages of 30-60 are estimated to have obstructive sleep apnea; nearly one-quarter of them (3,029,000) experience the disorder at a moderate or severe level. The prevalence of obstructive sleep apnea may be much higher in specific subgroups. ... For the approximately 31 million Americans who are age 65 and older, the best estimate of obstructive sleep apnea is 7,440,000, with 46 percent at the moderate or severe level.

Recent studies show that among employed people 30 to 60 years old, at least 2 percent of the women and 4 percent of the men may have treatable sleep apnea syndrome, while 24 percent of the men and 9 percent of the women showed disturbed breathing during sleep. An issue of NEJM proclaimed sleep apnea as "a major public health problem."

Diagnosis and treatment for apnea and snoring

Diagnosis is made on the basis of the clinical picture, patient and spouse reports, and an overnight polysomonogram done in the laboratory or even at home. Effective treatment eliminates snoring and apnea. The success of treatment is measured by the reduction of respiratory disturbance to normal levels, by the elimination of symptoms like fatigue and depression, and the patient's subjective feeling of well-being. The standard treatment accepted by physicians and others trained in sleep disorders medicine is the continuous application of positive air pressure through a mask during sleep (Continuous Positive Airway Pressure--CPAP). The additional air pressure keeps the airway from collapsing. Since this permits normal breathing to continue during sleep, normal sleep patterns emerge, sleep becomes restorative, and the patient feels better. The impact is often immediate and dramatic although the patient may need to continue therapy permanently. Weight loss, surgery and other interventions may also have their place in treatment.

Obstructive sleep apnea syndrome is a serious medical problem affecting an estimated half a million children per year in the United States, according to background information in the article. Pediatric OSAS is most commonly caused by enlarged tonsils and adenoids. It is characterized by episodes of partial or complete upper airway obstruction that occur during sleep, including snoring, cyanosis (a bluish color of the skin and mucous membranes), and poor quality of sleep. Symptoms during the day can include mouth breathing, behavior problems, hyperactivity, and excessive daytime sleepiness. While research among adults has shown a significant decrease in OSAS episodes when patients avoid sleeping on their backs (the supine position), the issue of sleep position is not as well understood among children with OSAS.

Apneic events occurring in the supine position proved to be more severe by all measures than apneic events in the lateral position. The measures of severity included: apnea duration, blood oxygen desaturation, duration of consequent arousal, loudness of snoring, and extent of change in heart rate. Moreover, apneas in the supine position were more likely to cause arousals (lightening of sleep, short of awakening) and outright awakenings, than apneas in the lateral position.
Specialists say millions of Americans have undiagnosed sleep disorders-and millions more have bad habits that are keeping them from a good night's rest


People with sleep apnea are at a higher risk of having a stroke than those without the condition.

Evidence going back to the early 1970s suggests that sleep apnea, strokes and heart attacks often happen together, but that doesn't mean that there is a cause/effect relationship."

Nevertheless, it strikes me to suggest that, even with CPAP, a person should avoid sleeping on the back. This is especially striking since some people complain that the CPAP mask and hose force them to sleep in this unfamiliar and uncomfortable position! In fact, it does not seem difficult to sleep on one's side without displacing the mask.

Findings on CPAP pressure and sleeping position raise the question in my mind as to which position should best be used to set the CPAP pressure. The pressure needed to suppress apneas and hypopneas in both positions may be higher than necessary for people who sleep mainly on their sides.

They don't usually wake up when they stop breathing; they just feel tired irretable unwell next day. But that could describe a growing number of Americans these days. And it's one reason why, in an increasingly sleep-deprived society, disorders are often misdiagnosed-or not diagnosed at all.


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