수면 무호흡증 (Sleep apnea)
1) Disease description (causes and symptoms)
- Definition and types
- Sleep apnea refers to a condition in which breathing partially or completely stops during sleep. The main types are obstructive, central, and mixed, of which obstructive sleep apnea is the most common. Clinically, it is considered significant when apnea lasting 10 seconds or more occurs at least 5 times per hour or is accompanied by excessive daytime sleepiness.
- Main causes
- Anatomical factors: Structural abnormalities that cause upper-airway narrowing, such as fat accumulation around the neck due to obesity, a large tongue (macroglossia), enlarged tonsils and adenoids, a short or retruded mandible (small jaw), a short and thick neck, and a deviated nasal septum.
- Functional factors: The airway easily collapses because of reduced function of the upper-airway dilator muscles (peripharyngeal muscles) during sleep.
- In children, enlarged tonsils and adenoids are the main causes.
- Central sleep apnea occurs due to dysfunction of the respiratory center in the brain that regulates breathing.
- Summary of pathophysiology
- Repeated upper-airway obstruction or loss of respiratory effort causes decreased oxygen saturation and frequent arousals during sleep. Frequent hypoxia and arousals can lead to sympathetic nervous system activation, increased blood pressure, and cardiovascular, cerebrovascular, and metabolic abnormalities.
- Main symptoms
- Loud snoring, nocturnal apnea (difficulty breathing accompanied by interrupted breathing), excessive daytime sleepiness, fatigue, insomnia, sleepwalking (sleep-related abnormal behavior), decreased sexual function (erectile dysfunction), decreased skin elasticity, and others.
2) Treatment methods and precautions
- Non-surgical treatment (standard treatment)
- Continuous positive airway pressure (CPAP): Recommended as first-line treatment for obstructive and mixed sleep apnea. It prevents airway obstruction by maintaining pressure within the airway.
- Positive airway pressure variants (BiPAP, APAP, etc.): Devices that automatically adjust pressure according to the patient’s breathing pattern or use different inspiratory and expiratory pressures. Used when adapting to CPAP is difficult or in specific situations.
- Oral appliance (mandibular advancement device, MAD): Considered in mild cases or in patients with specific anatomical characteristics, such as mandibular retrusion.
- Surgical treatment
- Uvulopalatopharyngoplasty (UPPP): Partial resection and reconstruction of the soft palate, uvula, and pharynx. Indications are selective, and the success rate varies depending on the patient and lesion (complete cure is not guaranteed).
- Laser-assisted uvulopalatoplasty (LAUP): Reported to be effective for improving snoring, but its effect on improving apnea is limited.
- Nasal surgery (septoplasty, inferior turbinate surgery, etc.): Helps improve CPAP adherence by securing the nasal passage.
- In children, tonsillectomy and adenoidectomy are effective.
- Lifestyle management (non-pharmacological) and behavioral therapy
- Weight loss (correction of obesity) is one of the most important non-surgical treatments.
- Avoid alcohol, sedatives, and sleeping pills before bedtime (they reduce airway muscle tone).
- Positional therapy by lying on one’s side: Useful when airway obstruction worsens depending on sleeping position.
- Quit smoking, maintain regular sleep habits, and improve the sleep environment.
- Drug treatment
- Drug treatment may be considered in specific cases, such as central sleep apnea or cases with complications. In general, medications intended to relieve symptoms are not first-line treatment.
- Precautions and self-management points
- If discomfort occurs while using CPAP (nasal congestion, dryness, air leakage, etc.), device adjustment or mask replacement is necessary.
- If left untreated for a long time, the risk of serious complications such as hypertension, arrhythmia, myocardial infarction, stroke, and traffic accidents increases.
- If daytime sleepiness is severe while driving or operating machinery, consult a medical professional immediately.
- Continuous evaluation, including symptoms, device-use logs, and oxygen saturation, is necessary to improve sleep-related symptoms.
3) Checklist before an outpatient visit (examples of items to bring and records)
- Items and information to prepare
- List of currently used medications and supplements, including doses and administration times.
- Copies of previous test results, if available, such as electrocardiograms, blood tests, and previous polysomnography results.
- Weight and height (recent measurements), neck circumference if possible, and information for calculating BMI.
- Sleep diary (at least 2 weeks recommended): Bedtime, wake-up time, whether you woke during sleep, nighttime symptoms (observed snoring and apnea), and degree of daytime sleepiness.
- Observation records from a partner (such as a spouse): Snoring sounds, the number and duration of observed apneas, and reports of occasional pauses in breathing.
- Sleep-related questionnaires, if possible: Epworth Sleepiness Scale (assessment of daytime sleepiness), etc.
- Information that may be helpful to provide to the doctor during the outpatient visit
- When symptoms began and how they have worsened, nighttime symptoms (frequency and duration), and impairment of daytime functioning (effects on driving and work), etc.
Sample questionnaire (questions that can be used at the hospital)
- "About how many times is apnea observed at night?"
- "Do you experience sleepiness or reduced concentration in daily life during the day?"
- "Have you had any recent changes in your weight?"
4) Examples of general questions to ask the doctor
- "How is the appropriate pressure for my CPAP determined? What are the side effects?"
- "How likely is it that surgery will cure the condition? What is the recurrence rate after surgery?"
- "After starting treatment, when can I expect my symptoms to improve? What is the prognosis?"
- "What should I pay particular attention to in daily life, such as driving, alcohol, and medications?"
- "What complications or long-term risks can be expected if the condition is not treated?"
5) Examples of disease-specific questions
- "How severe are my polysomnography results (AHI, oxygen saturation, etc.), and why do I need CPAP? How is the pressure setting determined?"
- "Based on my anatomical problems (enlarged tonsils, small jaw, etc.), is a surgical approach appropriate? What changes can be expected before and after surgery?"
Reference summary
- Synonyms: sleep apnea syndrome, sleep apnea, sleep apnea syndrome.
- Diagnostic standard: Polysomnography.
- Key treatment: Weight management + CPAP (or BiPAP/APAP), with surgical correction if necessary.
- Main complications: Increased risk of hypertension, cardiovascular disease, cerebrovascular disease, metabolic disorders, and accidents due to daytime sleepiness.