Sleep Disordered Breathing
a) Definition
The term Sleep Disordered Breathing describes a range of sleep breathing disorders that include: snoring, upper airway resistance syndrome and obstructive sleep apnea. Sleep Disordered Breathing is a continuum of these conditions. Simple snoring represents the mildest disorder that is noticed when breathing during sleep is very loud due to the near collapse of the upper airway. When the snoring becomes worse, due to further airway collapse, more effort is required for breathing and sleep becomes interrupted. This condition is referred to as upper airway resistance syndrome. The most dangerous problem in the continuum is sleep apnea. Sleep apnea describes the condition when oxygen levels in the blood drop as a result of the complete collapse of the airway. During an apnea, breathing cannot occur, and the sleeper is forced to awaken to resume normal breathing.
b) Sleep Apnea
Obstructive Sleep Apnea occurs when the tongue and soft palate collapse onto the back of the throat. This blocks the upper airway, causing air flow to stop, which in turn causes the blood oxygen level to drop. When the blood oxygen levels drop low enough, the brain moves out of deep sleep and the individual partially awakens (an arousal). The airway finally reopens, usually with a loud gasp. The individual then moves back towards deep sleep until the next apnea occurs. This cycle of events may occur many times during the night, sometimes once per minute.
The combination of low oxygen levels and fragmented sleep are the major contributors to most of the ill effects that the sleep apnea patient suffers. In addition to excessive daytime sleepiness, studies show that sleep apnea patients are much more likely to suffer from heart problems (heart attack, congestive heart failure, hypertension, high blood pressure), strokes, metabolic syndrome, weight gain, diabetes, mood swings, acid reflux, and sexual dysfunction as well as having a higher incidence of work related and driving related accidents. The diagnosis of sleep apnea is graded mild, moderate, or severe.
Risk Factors Include:
- Snoring
- Weight gain
- Getting older
- Family history
- Malformation of the orofacial area (misaligned teeth, jaw, palate)
- Bruxism (teeth grinding)
- Polycystic Ovarian Syndrome (PCOS)
- Menopause
- Progesterone/Estrogen deficiency
- Anatomy and physiology of the airway
- Small Jaw, Thick Neck (greater than 17" males, 16" females)
c) Upper Airway Resistance Syndrome (UARS)
The term 'upper airway resistance syndrome' denotes an entity characterized by the presence of daytime fatigue or sleepiness in the presence of a normal respiratory disturbance index and oxygen saturation. Despite some similarities, certain specific clinical and diagnostic features distinguish it from the obstructive sleep apnea syndrome. The essence of diagnosis lies in the documentation of increasing esophageal pressures during sleep with associated transient EEG arousals. Furthermore, the evidence suggests an abnormal blood pressure response to the changes in esophageal pressures and arousals.
d) Gastroesophageal Acid Reflux Disease (GERD)
GERD is a disease that refers to the clinical manifestations of reflux (backflow) of stomach contents into the esophagus. It is the most common disease of the esophagus, affecting up to 40% of adults. Typical symptoms of GERD include heartburn, abdominal discomfort, difficulty swallowing, and acid regurgitation. This acid irritates the esophagus because it doesn't have a special lining to protect it like the stomach does.
GERD that occurs at night is called nocturnal GERD. Although reflux episodes occur less frequently at night than during the day, the esophagus lining is exposed to the stomach's corrosive contents much longer at night. When you lie in bed, the protective effect of gravity is lessened. Researchers also believe that apnea episodes may cause a negative pressure in the esophagus which will then work like a vacuum to bring the acid up from the stomach. Complications of nocturnal GERD include erosive esophagitis and the precancerous condition Barrett's esophagus, as well as esophageal cancer. Sometimes the acid comes all the way up into the mouth where it can cause damage to the teeth. Your dentist should look for this during periodic exams.
Many people who have been successfully treated for apnea have experienced a reduction in GERD symptoms.
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