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The most common treatment for obstructive sleep apnea is nasal continuous positive airway pressure, which the patient uses during sleep; the positive pressure exerted prevents the airway from obstructing. Another method that may be tried is a dental appliance to move the jaw forward during sleep. In the most refractory cases, such as when an anatomical airway obstruction can be demonstrated, surgery to remove it may be performed after consultation with a surgeon experienced in evaluating and treating such obstructions. Another treatment that is occasionally used is insertion of a special type of tracheostomy tube that can be plugged during the day for normal use of the upper airway and opened at night to bypass upper airway obstruction
apnea(ap-ne'a, ap'ne-) [ ¹an- + -pnea]
obstructive sleep apneaAbbreviation: OSA
positional sleep apnea
apnea of prematurityAbbreviation: AOP
There is no specific treatment. Initial efforts should begin with the least-invasive method. Tactile stimulation is often successful with early recognition. When gentle stimulation does not produce a response, bag and mask ventilation is initiated. Methylxanthines such as caffeine, theophylline, and aminophylline are helpful.
Care includes maintenance of a neutral thermal environment, avoidance of prolonged oral feedings, use of tactile stimulation early in the apneic episode, and ventilatory support as needed. The infant who has experienced and survived an episode of apnea is maintained on cardiac and respiratory monitoring devices. Before discharge, parents are taught cardiopulmonary resuscitation, use of monitoring equipment, and how to recognize signs of medication toxicity if medications are used.
In obstructive sleep apnea, vigorous respiratory efforts are present during sleep but the flow of air in and out of the airways is blocked by upper airway obstruction. Patients with obstructive apnea are usually middle-aged, obese men who make loud snorting, snoring, and gasping sounds during sleep. By contrast, central sleep apnea is marked by absence of respiratory muscle activity. Patients with central apnea may exhibit excessive daytime sleepiness, but snorting and gasping during sleep are absent. Occasionally life-threatening central apneas occur as a result of strokes.
Mixed apnea begins with absence of respiratory effort, followed by upper airway obstruction. Whenever apneas are prolonged, oxygenation drops and carbon dioxide blood levels rise. Patients often awaken many times during the night or have fragmented sleep architecture. In the morning, many patients complain of headache, fatigue, drowsiness, or an unsatisfying night's rest. In addition, these individuals often have hypertension, arrhythmias, type 2 diabetes mellitus, or signs and symptoms of right-sided heart failure. Although these findings may suggest the diagnosis, formal sleep studies in a laboratory are needed to document the disorder and to measure the effects of apneas on oxygenation and other physical parameters.
Partners of patients with sleep apnea are often the first to notice the patient's disordered breathing during sleep. Occasionally patients see their health care providers because of hypersomnolence: they may report falling asleep during the daytime in unusual circumstances, e.g., at traffic lights or whenever seated in a quiet room.
Optimal therapy of obstructive sleep apnea is to assist breathing with continuous positive airway pressure (CPAP) if the patient cannot correct the condition by losing weight. CPAP provides a pneumatic splint that maintains airway patency during sleep. Palatal obstruction, a finding in a small number of patients, can be surgically corrected. Medroxyprogesterone may be of some benefit but is clearly less effective than CPAP.