Obstructive Sleep Apnoea Syndrome
Obstructive sleep apnoea syndrome is a common sleep disorder that causes you to stop breathing repeatedly throughout the night, leaving you exhausted during the day and putting your health at serious risk if left untreated.
Table of contents
- What is obstructive sleep apnoea syndrome?
- Symptoms
- Causes and risk factors
- Complications
- Diagnosis
- Treatment options
- Lifestyle changes and self-care
What is obstructive sleep apnoea syndrome?
Obstructive sleep apnoea (OSA) is a sleep disorder where your breathing repeatedly stops and starts while you sleep. This happens when the muscles that support the soft tissues in your throat, such as your tongue and the soft palate at the back of your throat, temporarily relax. When these muscles relax too much, the airway narrows or closes completely, and breathing is momentarily cut off[1]. These breathing pauses are known as apnoeas, which are episodes where you completely stop breathing, or hypopnoeas, which are episodes where your breathing becomes very shallow[3].
OSA is the most common type of sleep-related breathing disorder[1]. The condition causes you to wake up briefly—often without realizing it—so you can start breathing again. While this reflex keeps you alive, it also disrupts your sleep cycle and prevents you from getting restful, healthy sleep[2]. These repeated awakenings can happen many times throughout the night, sometimes hundreds of times, leaving you feeling exhausted the next day even if you don’t remember waking up[3].
Obstructive sleep apnoea affects up to 1 billion people around the world between the ages of 30 and 69[2]. The condition can affect anyone at any age or body size, though certain factors increase your risk[2].
Symptoms
Symptoms of obstructive sleep apnoea occur both at night while you’re sleeping and during the day when you’re awake. Many people with OSA don’t realize they have the condition—often, a bed partner is the first to notice the symptoms[4].
Nighttime symptoms include loud snoring, which is usually habitual and bothersome to others. However, it’s important to note that not everyone who snores has sleep apnoea, and some people with OSA may not snore much at all[4]. Other symptoms during sleep include pauses in breathing that are often noticed by a sleeping partner, waking up gasping or choking, needing to urinate frequently during the night, restless sleep with frequent tossing and turning, and night sweats[1][2].
During the day, people with obstructive sleep apnoea typically experience excessive daytime sleepiness or tiredness, even after what seems like a full night’s sleep. This is sometimes described as “waking up as tired as when they went to bed”[4]. Other daytime symptoms include morning headaches, dry or sore throat upon waking, difficulty concentrating or remembering things, mood changes including depression and anxiety, and sexual dysfunction[1][2][4].
Causes and risk factors
Obstructive sleep apnoea happens when a blockage or narrowing in your upper airway prevents air from moving properly through your windpipe while you’re asleep. During sleep, all your muscles relax, including those that help keep your airway open. Normally, there should still be enough space for air to flow into your lungs. However, with sleep apnoea, the relaxed muscles and tissues in your throat block the airway, stopping airflow and causing you to stop breathing[2].
The collapse of your airway during sleep is influenced by multiple factors. These include sleep-related reductions in how your body controls breathing, problems with how nerves control your muscles, and physical features of your airway that make it more likely to close[3]. Anatomical factors that promote narrowing of the airway include having a large neck circumference or collar size (16-17 inches or 41-43 centimeters), a large tongue, large tonsils or adenoids, and structural features like having an underbite or small lower jaw[2][3].
Several risk factors increase your chances of developing obstructive sleep apnoea. Being overweight or obese is a significant risk factor, as excess body weight, especially around the neck, increases the risk of airway collapse during sleep[2][5]. However, people at a healthy weight can also develop OSA[5].
Other risk factors include being male (men are more likely to be diagnosed before age 50), being middle-aged or older, being a post-menopausal woman, having a biological family history of OSA, having certain genetic conditions that affect how your head and neck develop (like Down syndrome or Prader-Willi syndrome), having heart conditions, high blood pressure, or having had a stroke, drinking alcohol, smoking, and having naturally large adenoids or tonsils[2][5]. Children can also have OSA, usually caused by having large tonsils or adenoids[5].
Complications
Obstructive sleep apnoea can lead to dangerous and sometimes life-threatening complications if left untreated. The repeated drops in oxygen levels during sleep, the fragmented sleep, and the physical stress of repeatedly trying to breathe can damage your organs and blood vessels over time[2][10].
One of the most serious complications is the increased risk of cardiovascular problems. Untreated OSA significantly increases your risk of high blood pressure (hypertension), heart damage, heart failure, irregular heart rhythms (particularly atrial fibrillation), stroke, and sudden cardiac death[2][3]. The condition can also contribute to the development or worsening of Type 2 diabetes and problems with blood sugar control[2].
Daytime drowsiness caused by OSA is particularly dangerous because it increases your risk of accidents at work or while driving. People with untreated sleep apnoea are much more vulnerable to motor vehicle crashes and workplace accidents[2][3][10]. The poor quality sleep also affects your mental health and cognitive function, increasing the likelihood of developing depression, anxiety, problems with attention, memory, and concentration[2][3].
Other complications can include chronic kidney disease, gastroesophageal reflux disease, eye problems such as glaucoma and dry eye, worsening asthma attacks, and increased risk of certain cancers including pancreatic, kidney, and skin cancer[10]. For these reasons, it’s important to seek diagnosis and treatment if you suspect you have sleep apnoea.
Diagnosis
A healthcare provider will diagnose obstructive sleep apnoea by taking your medical history, performing a physical exam, and recommending specific tests. During the exam, your provider will examine your mouth, neck, and throat, looking for physical features that might contribute to airway blockage[2]. They may measure your neck and waist circumference and check your blood pressure[7].
If you share a bedroom with someone, it’s helpful to bring them to your appointment, as they can describe your sleep patterns and whether they’ve noticed snoring, breathing pauses, or other symptoms you might not be aware of[5]. Your doctor may refer you to a sleep specialist for further evaluation[5][7].
The main test used to diagnose OSA is called polysomnography, or a sleep study. This test monitors your breathing and other body functions while you sleep. During polysomnography, you’re connected to equipment that monitors your heart, lung, and brain activity, breathing patterns, arm and leg movements, and blood oxygen levels[7]. The study might be conducted overnight at a sleep center, or in some cases, you may undergo home sleep apnea testing using portable equipment[7].
The sleep study measures how many times per hour your breathing stops or becomes very shallow. This measurement is called the apnoea-hypopnoea index (AHI). A diagnosis of obstructive sleep apnoea is typically made when you have 15 or more events per hour regardless of symptoms, or 5 or more events per hour along with related symptoms like snoring, witnessed apnoeas, gasping during sleep, or excessive daytime sleepiness[11].
Treatment options
Several treatment options are available for obstructive sleep apnoea. The choice of treatment depends on the severity of your condition, your preferences, and whether you have other health conditions.
The most common and effective treatment for moderate to severe OSA is continuous positive airway pressure (CPAP) therapy. CPAP remains the gold standard treatment for obstructive sleep apnoea[11][13]. A CPAP machine provides constant air pressure through a mask you wear over your nose or mouth while you sleep. This airflow acts like a pneumatic splint that keeps your throat open, preventing it from collapsing and allowing you to breathe normally[7][12].
CPAP treatment has proven effectiveness and can significantly improve sleep quality, reduce or eliminate snoring, and decrease daytime sleepiness[10][13]. It may also help reduce the risk of cardiovascular complications and improve overall health outcomes. However, some people find CPAP difficult to tolerate due to side effects like nasal congestion, dry mouth, nosebleeds, or discomfort from wearing the mask[14]. Adherence to CPAP therapy can be as low as 50% in certain populations[10].
Other types of positive airway pressure devices include bilevel positive airway pressure (BiPAP) machines, which deliver different pressure levels when you breathe in versus when you breathe out, and auto-adjusting positive airway pressure (APAP) machines, which automatically adjust the air pressure based on your breathing patterns[14][12].
For people with mild to moderate sleep apnoea who cannot tolerate CPAP, oral appliances are an alternative treatment option. These are specially made mouthpieces, also called mandibular advancement devices, that you wear during sleep. The device shifts your lower jaw slightly forward, which tightens the soft tissues and muscles at the back of your throat to help keep the airway open[8][13]. Oral appliances require a special fitting from a dentist trained in this therapy.
Surgical treatments are available for people who cannot use or do not respond well to CPAP or oral appliances. Several surgical procedures can help by increasing the size of the airway or removing tissue that blocks it[8]. One newer surgical option is hypoglossal nerve stimulation, which involves implanting a device that stimulates the nerve controlling tongue movement, keeping the airway open during sleep. This treatment is appropriate for select patients who cannot use CPAP[11].
Another treatment option is nasal expiratory positive airway pressure, which uses small disposable devices placed over the nostrils. These devices create resistance when you breathe out, which helps keep the airway open[10][13].
In some cases, combining two or more treatments may provide the best results. Your healthcare provider can help you determine which treatment or combination of treatments is most appropriate for your specific situation[10].
Lifestyle changes and self-care
Lifestyle changes play an important role in managing obstructive sleep apnoea. For people with mild symptoms, these changes alone may be enough to improve the condition. For those using CPAP or other treatments, lifestyle modifications can make treatments more effective[14].
Weight loss is one of the most effective lifestyle changes for people with OSA who are overweight or obese. Even a modest weight loss of about 10% of body weight can lead to a 20%-30% reduction in the severity of sleep apnoea symptoms[10]. Losing weight helps reduce excess tissue around the throat that can block the airway. However, it’s important to note that weight loss may not be right for everyone, and some people at a healthy weight also have sleep apnoea.
Sleep position can make a significant difference. Sleeping on your side with your back mostly straight is the best position, as it reduces apnoea severity and snoring[16]. You can prevent yourself from rolling onto your back by placing a body pillow behind you or using other positioning devices. Some people also benefit from elevating the head of their bed slightly[1].
Regular physical activity can help improve sleep apnoea symptoms in several ways. Exercise strengthens the muscles that support your airway, making them less likely to collapse during sleep. It also helps with weight management and improves overall lung capacity and oxygen flow[10][16]. Aim for at least 30 minutes of moderate exercise most days of the week, but consult your doctor before starting any new exercise program.
Avoiding alcohol and sedative medications is important because these substances relax the throat muscles excessively, making airway obstruction more likely[1][10][19]. It’s best to avoid alcohol, especially in the hours before bedtime.
Quitting smoking is crucial, as smoking causes inflammation and swelling in the airways, making breathing more difficult during sleep[1][10][19]. If you smoke, talk to your healthcare provider about strategies and support for quitting.
Treating nasal allergies and congestion can help improve airflow. Allergies cause the tissues in your airways to swell, making them narrower and harder to breathe through[1]. Talk to your doctor about appropriate treatments for allergies or chronic nasal congestion.
Maintaining good sleep hygiene can also help. This includes going to bed and waking up at the same time every day, even on weekends, keeping your bedroom cool, dark, and quiet, avoiding heavy meals close to bedtime, and limiting caffeine intake, especially later in the day[16][19].
Managing stress is also important, as chronic stress can lead to weight gain and inflammation, both of which can worsen sleep apnoea. Relaxation techniques like meditation, deep breathing exercises, and other stress management strategies can help improve sleep quality[16].
If you’re using CPAP therapy, it’s crucial to use your machine consistently for all sleep, including naps. Be patient, as it may take time to adjust to breathing with the device. Talk to your healthcare provider if you have any problems with your CPAP machine, as adjustments can often be made to improve comfort and effectiveness[20].
You will need regular follow-up appointments with your healthcare provider to monitor your condition and ensure your treatment is working effectively. You may need to repeat your sleep study, especially if you gain or lose a significant amount of weight[20].
