Sleep Apnea Syndrome (SAS)

Sleep Apnea Syndrome is a condition in which breathing repeatedly stops or becomes shallow during sleep. It is associated with excessive daytime sleepiness, impaired quality of life, and increased risk of cardiovascular diseases.

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🔬 Epidemiology

• Prevalence:

  • Estimated in 4–7% of adult men and 2–5% of women.

  • Increases with age; prevalence in individuals over 60 can exceed 20%.

  • Much more common in individuals with obesity (especially BMI >25).

• Gender Difference:

  • More common in men, but risk increases in postmenopausal women.

• Pediatric Cases:

  • Seen in 2–3% of children, mainly due to enlarged tonsils or adenoids.

• Undiagnosed Cases:

  • Many remain undiagnosed due to lack of awareness or subtle symptoms.

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🧠 Causes

Sleep apnea can be categorized into two main types:

1. Obstructive Sleep Apnea (OSA) – Most common

• Caused by repetitive collapse of the upper airway during sleep.

• Common causes include:

  • Obesity (especially fat deposition around the neck)

  • Enlarged tonsils/adenoids

  • Micrognathia or retrognathia (small or backward-positioned jaw)

  • Nasal obstruction (e.g., allergic rhinitis)

  • Tongue base collapse (especially in supine position)

2. Central Sleep Apnea (CSA)

• Caused by reduced or absent respiratory drive from the brainstem.

• Often related to:

  • Heart failure (e.g., Cheyne-Stokes respiration)

  • Stroke or brainstem injury

  • Opioid use

  • High-altitude exposure

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⚠️ Aggravating Factors

• Obesity (especially BMI >25)

• Alcohol or sedative use before bedtime

• Smoking (causing airway inflammation)

• Sleeping in supine position

• Nasal congestion (leading to mouth breathing)

• Aging (decreased muscle tone in upper airway)

• Postmenopausal hormonal changes

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💊 Treatment

1. Lifestyle Modification

• Weight loss (5–10% reduction can significantly improve symptoms)

• Avoiding alcohol and sedatives

• Smoking cessation

• Positional therapy (sleeping on the side)

• Improving sleep hygiene

2. Continuous Positive Airway Pressure (CPAP)

• First-line treatment for moderate to severe OSA.

• Delivers pressurized air through a nasal mask to keep airways open.

• Reduces cardiovascular risks when used consistently.

3. Oral Appliance (OA)

• Mandibular advancement device that moves the jaw forward.

• Effective in mild to moderate OSA.

• Requires dental fitting and monitoring.

4. Surgical Treatments

• Tonsillectomy, adenoidectomy (especially effective in children)

• Nasal surgery (e.g., septoplasty), uvulopalatopharyngoplasty (UPPP)

• Maxillomandibular advancement in skeletal abnormalities

5. Treatment for Central Sleep Apnea

• Managing underlying conditions (e.g., heart failure)

• Specialized ventilators such as Adaptive Servo-Ventilation (ASV)

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🫀 Complications and Risks

• Hypertension, heart failure, arrhythmias, myocardial infarction, stroke

• Worsening of diabetes mellitus

• Increased risk of motor vehicle and occupational accidents

• Association with depression and cognitive decline