Sleep Apnea: Causes, Symptoms, Diagnosis, and Treatment
Also known as: Obstructive Sleep Apnea, OSA
A common, underdiagnosed breathing disorder
Sleep apnea, or obstructive sleep apnea (OSA), is a breathing disorder marked by repeated pauses in breathing during sleep. In the United States, an estimated 25 to 30 million adults are affected, according to the American Academy of Sleep Medicine (AASM), and the majority remain undiagnosed. This condition significantly disrupts sleep quality and can lead to serious cardiovascular and metabolic complications if left untreated.
Causes and risk factors
Several factors contribute to the development of sleep apnea:
- Obesity and excess weight (BMI over 30), the leading risk factor
- Anatomical features: an enlarged tongue, a receding jaw, enlarged tonsils
- Being male (more common in men)
- Older age (risk increases as you get older)
- Sleeping on your back
- Use of alcohol, tobacco, and sedatives (benzodiazepines)
- Family history and certain conditions: hypothyroidism, acromegaly, chronic nasal obstruction
Symptoms
Clinical signs of sleep apnea are varied and affect both daytime and nighttime life:
- Loud, irregular snoring (often reported by a bed partner)
- Breathing pauses observed during sleep
- Excessive daytime sleepiness (with a risk of falling asleep while driving)
- Frequent nighttime awakenings with a choking sensation
- Morning headaches
- Difficulty concentrating and memory problems
- Irritability and mood changes
- Nocturia (needing to urinate at night)
Diagnosis
Diagnosis relies on a medical history (including the Epworth Sleepiness Scale), a clinical exam, and a sleep study. A home sleep apnea test or in-lab polysomnography measures the apnea-hypopnea index (AHI): an AHI above 15 events per hour confirms moderate to severe OSA. An ENT evaluation and nasal endoscopy may round out the assessment.
Treatments
Treatment for sleep apnea is tailored to the severity of the condition:
- Continuous positive airway pressure (CPAP): the standard treatment for moderate to severe forms (AHI over 15). A nasal mask delivers a steady flow of air that keeps the airway open
- Mandibular advancement device: a dental device recommended for people who cannot tolerate CPAP or for mild to moderate forms
- ENT surgery (tonsillectomy, uvulopalatopharyngoplasty, maxillofacial surgery): indicated when a specific anatomical obstruction is identified
- Weight loss: an essential measure for patients who are overweight, which can reduce the severity of the condition
- Sleep positioning (avoiding sleeping on your back)
- Cutting out alcohol, tobacco, and sedatives
- Treating related conditions: high blood pressure, diabetes, hypothyroidism
Prevention
Certain lifestyle measures can reduce the risk or severity of sleep apnea:
- Maintain a healthy body weight through a balanced diet and regular exercise
- Avoid alcohol in the evening and sleep medications
- Quit smoking
- Sleep on your side rather than your back
- Effectively treat nasal obstructions (rhinitis, deviated septum)
- See a doctor promptly if loud snoring is reported by those around you
When should you see a doctor?
See a doctor if you have marked daytime sleepiness, severe snoring, or nighttime breathing pauses noticed by others. Prompt care is essential if you have recurring morning headaches, trouble concentrating, or a risk of falling asleep while driving. Untreated sleep apnea significantly raises the risk of high blood pressure, cardiovascular events, and car accidents.
Sources
- National Heart, Lung, and Blood Institute (NHLBI), definition, snoring and daytime sleepiness, and complications (stroke, heart attack)
- NHLBI: Sleep Apnea Causes and Risk Factors, risk factors including obesity, male sex, older age, family history, hypothyroidism, alcohol, smoking, and large tonsils or tongue
- American Academy of Sleep Medicine (AASM): rising prevalence, at least 25 million U.S. adults affected
- AASM: economic burden of undiagnosed sleep apnea, 29.4 million U.S. adults with OSA, most undiagnosed
- StatPearls: Obstructive Sleep Apnea (NCBI Bookshelf), AHI severity thresholds (moderate at over 15/hour), CPAP as most effective treatment, oral appliances for CPAP-intolerant patients, Epworth Sleepiness Scale, and risk factors (retrognathia, acromegaly, sedatives, supine position, nasal obstruction)
- MedlinePlus: Sleep Apnea, U.S. National Library of Medicine overview
- MedlinePlus: Obstructive sleep apnea - adults, symptoms including irritability, forgetfulness, morning headaches, falling asleep while driving, and high blood pressure