Obstructive sleep apnea

Clinic

• OSA is the most common sleep-related breathing disorder and is characterized by recurrent episodes of complete or partial obstruction of the upper airway leading to reduced or absent breathing during sleep.
• These episodes are termed "apneas" with complete or near-complete cessation of breathing, or "hypopneas" when the reduction in breathing is partial. In either case, a fall in blood oxygen saturation, a disruption in sleep, or both may result.
• A high frequency of apneas or hypopneas during sleep may interfere with restorative sleep, which – in combination with disturbances in blood oxygenation – is thought to contribute to negative consequences to health and quality of life. The terms obstructive sleep apnea syndrome (OSAS) or obstructive sleep apnea–hypopnea syndrome (OSAHS) may be used to refer to OSA when it is associated with symptoms during the daytime (e.g. excessive daytime sleepiness, decreased cognitive function).
• Most individuals with OSA are unaware of disturbances in breathing while sleeping, even after awakening
• Obstructive sleep apnea has been associated with neurocognitive morbidity, as well as a link between snoring and neurocognitive disorders.

Classification

• OSA is classified amongst the sleep-related breathing disorders and is divided in two categories, namely adult OSA and pediatric OSA.

• OSA is differentiated from central sleep apnea (CSA), which is characterized by episodes of reduction or cessation in breathing attributable to decreased effort, rather than upper airway obstruction.
• The respiratory effort must then be assessed in order to correctly classify the apnea as obstructive given the specificity of the diaphragmatic activity in this condition: the inspiratory effort is continued or increased through the entire episode of absent airflow.
• When hypopneas are present alongside apneas, the term obstructive sleep apnea-hypopnea is used and when it is associated with daytime sleepiness and other daytime symptoms, it is called obstructive sleep apnea-hypopnea syndrome.
• To be categorized as obstructive, the hypopnea must meet one or more of the following symptoms: (1) snoring during the event, (2) increased oronasal flow flattening, or (3) thoraco-abdominal paradoxical respiration during the event. If none of them are present during the event, then it is categorized as central hypopnea.

Signs / Symptoms

• Common symptoms of OSA syndrome include unexplained daytime sleepiness, restless sleep, and loud snoring
• Less common symptoms are morning headaches; insomnia; trouble concentrating; mood changes such as irritability, anxiety, and depression; forgetfulness; increased heart rate or blood pressure; decreased sex drive; unexplained weight gain; increased urinary frequency or nocturia; frequent heartburn or gastroesophageal reflux; and heavy night sweats.
• Many people experience episodes of OSA for only a short period. This can be the result of an upper respiratory infection that causes nasal congestion, along with swelling of the throat, or tonsillitis that temporarily produces very enlarged tonsils.

Adults

• The hallmark symptom of OSA syndrome in adults is excessive daytime sleepiness. Typically, an adult or adolescent with severe long-standing OSA will fall asleep for very brief periods in the course of usual daytime activities if given an opportunity to sit or rest. This behavior may be quite dramatic, sometimes occurring during conversations with others at social gatherings.
• The hypoxia related to OSA may cause changes in the neurons of the hippocampus and the right frontal cortex. Research using neuro-imaging revealed evidence of hippocampal atrophy in people with OSA. They found that OSA can cause problems in mentally manipulating non-verbal information, in executive functions and working memory. This repeated brain hypoxia is also considered to be a cause of Alzheimer's disease.

Children

Although this so-called "hypersomnolence" (excessive sleepiness) may also occur in children, it is not at all typical of young children with sleep apnea. Toddlers and young children with severe OSA instead ordinarily behave as if "over-tired" or "hyperactive"; and usually appear to have behavioral problems like irritability, and a deficit in attention.

Pathophysiology

• The transition from wakefulness to sleep (either REM sleep or NREM sleep) is associated with a reduction in upper-airway muscle tone. This allows the tongue and soft palate/oropharynx to relax, reducing airway patency and potentially impeding or completely obstructing the flow of air into the lungs during inspiration, resulting in reduced respiratory ventilation.
• If reductions in ventilation are associated with sufficiently low blood-oxygen levels or with sufficiently high breathing efforts against an obstructed airway, neurological mechanisms may trigger a sudden interruption of sleep, called a neurological arousal. This arousal can cause an individual to gasp for air and awaken. These arousals (In Stage 3 and REM sleep) rarely result in complete awakening but can have a significant negative effect on the restorative quality of sleep.
• Individuals with decreased muscle tone and structural features that give rise to a narrowed airway are at high risk for OSA.

Remedies

Top remedy	Lach	He wakes up frequently due to obstructed breathing. He may need to sit up and needs to take a deep breath. Fear of going to sleep may also prevail among them. Such subjects also cannot tolerate anything tight around their neck like collars.
Enlarged Adenoids or Tonsils	Am-c	Blocked nose at night, inability to breathe through the nose, Waking with starting from sleep. Excessive sleepiness during the daytime
	Agra	Obstruction of nose Tendency to take cold frequently. Deafness or ear discharge
Nasal Polyps Complaint	Lem-m	Foul smell from the nose, Thick yellow-white discharge from the nose and snoring.
	Sangin-n	Dryness of nostrils Yellow-bloody mucus discharge from the nose Sneezing Burning in nostrils Desire for fresh air Poor/restless sleep Nasal turbinate hypertrophy may be present along with nasal polyps
Asthmatic Individuals	Grind	He stops breathing while sleep and wakes with a start suddenly. There is a need to sit up to breathe as well as Oppression felt in the chest with tough, tenacious white expectoration and wheezing.
Snoring	Op	He tends to snore deeply. The person faces spells of stopped breathing upon going to sleep and may also feel suffocated. Excessive drowsiness and sluggishness during the day may be there.
Children	Samb	He wakes up suddenly during sleep feeling suffocated. He sits up and gasps for breath. The episodes of pauses of breathing are repeated several times during sleep. Increased sweating Nose is dry and obstructed.