Obstructive sleep apnea (OSA) is a potentially serious sleep disorder that causes breathing to repeatedly stop and start during sleep. It is caused when the throat muscles intermittently relax and block the airway during sleep. The airway can be blocked for 10 seconds or longer and this causes a reduction in oxygen levels in the blood. The brain then rouses the patient so that the airway can be re-opened, but the awakening is brief and the patient won’t necessarily remember it. This pattern can repeat itself 5 to 30 times or more during the night and impairs restful sleep leading to excessive tiredness in the day. OSA needs to be treated as sufferers are at a higher risk for a cardiovascular event.
The most common symptom is loud snoring.
Other symptoms include
- excessive daytime sleepiness;
- a dry mouth in the morning;
- Abrupt awakenings including gasping or choking
- High blood pressure
- Observed episodes of stopped breathing during sleep
- A morning headache
OSA is common in obese males over the age of 50; type 2 diabetics and patients with resistant hypertension.
Treatment options for mild OSA include treating the obstruction and losing weight. A reduction of 10% of body weight leads to a significant reduction in symptoms.
In moderate to severe cases continuous positive airway pressure (CPAP) is recommended. This involves a machine which delivers air pressure through a mask or nose piece whilst the patient sleeps. CPAP reduces the number of respiratory events that occur during sleep. Some patients do find the mask cumbersome, but there are many different types available and they need to find one that is most comfortable. The benefits of the treatment including the increased daytime energy levels should help with compliance.
Dieticians can help the treatment process by implementing a weight-loss diet as most OSA patients are overweight. One needs to remember that these patients are often exhausted during the day and this will lead to excessive snacking or the seeking out of calorie-dense foods and drinks resulting in more weight gain and a worsening of the apnea. These patients are often too tired to exercise which also make the weight-loss more difficult. The dietician needs to work with the doctor and the patient to ensure that the patient is using the CPAP mask as this will result in the patient feeling more energised during the day leading to better appetite control and improved compliance when it come to exercise and healthy food choices. The initial goal in mild cases should be a ten percent reduction in bodyweight which should reduce the frequency of the apnea attacks, and help improve the patient’s quality of life.
Reference:
Patil S, Ayappa I, Caples et al. Treatment of Adult Obstructive Sleep Apnea with Positive Airway Pressure: An American Academy of Sleep Medicine Systematic Review, Meta-Analysis, and GRADE Assessment. Clin Sleep Med. 2019; 15(2): 301-334