So what exactly is sleep apnea? Obstructive sleep apnea is defined as a partial or complete collapse of the upper airway during sleep. When the muscles around the neck relax during sleep, it puts pressure of the airway and causes it to collapse. As it partially collapses, the air in and out causes a vibration noise against the airway. This is otherwise known as snoring. As the airway further collapses, oxygen levels begin to drop. This is known as a hypopnea (this is treated the same as apnea. In fact, most people who are diagnosed with sleep apnea actually have hypopneas). If the airway has a complete collapse, airflow ceases for a few seconds. This is apnea. These apnea/hypopnea events will occur over and over during the night and will cause awakenings during the night. The patient may not be aware of these awakenings but may certainly cause sleepiness or fatigue during the day. More important is that sleep apnea can lead to serious health issues including hypertension, diabetes and heart disease.

So who is at risk for having sleep apnea? A common misconception is that sleep apnea is a disorder of obesity and this is simply not true. Let’s be clear. Weight absolutely plays a role in sleep apnea but there are many other factors. Anatomic narrowing of the airway is the biggest risk factor for sleep apnea. This may present as enlarged tonsils or tongue, small or recessed chin, thick neck or others. These findings are generally inherited so there is a significant familial component to sleep apnea. Men are generally at a higher risk than women, though we know that women’s risk increases as they reach menopause. Age is also a factor. As we age, the muscle tone weakens and makes us more susceptible to apnea, though even young children can have sleep apnea.

In order to make a diagnosis of sleep apnea, the patient must have a sleep study (polysomnography). This is generally done in a sleep center. The patient comes in during their normal sleep time. Electrodes are attached to monitor things like brain waves, heart rate and rhythm and oxygenation. The patient is awakened in the morning and allowed to leave once the electrodes are removed. Most people say it is like the Hilton… with wires. Some insurances require a home test. While there is an appropriate use of home testing, lab test results are much more accurate and reliable.