REVIEW PAPER
Symptoms, complications and treatment of obstructive sleep apnea
 
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Katedra i Zakład Stomatologii Wieku Rozwojowego, Uniwersytet Medyczny w Lublinie
2
Katedra i Zakład Ortopedii Szczękowej, Uniwersytet Medyczny w Lublinie
CORRESPONDING AUTHOR
Jolanta Szymańska
Katedra i Zakład Stomatologii Wieku Rozwojowego, Uniwersytet Medyczny w Lublinie
 
Med Og Nauk Zdr. 2013;19(4):391–396
 
KEYWORDS
ABSTRACT
Introduction:
Obstructive sleep apnea (OSA) is a disease characterized by the occurrence of at least five 10-second pauses in breathing (apnea) or abnormally low breathing events (hypopnea) accompanied with a decrease in blood oxygen saturation by 2–4% per hour of sleep, despite continued, or even intensified, movements of respiratory muscles. The objective of this study was to present the current knowledge of symptoms, complications and methods of treatment of obstructive sleep apnea. OSA is a gradually developing disease; its onset is often imperceptible to patients and their families. OSA symptoms occur both at night and during the day. The most characteristic night symptoms are: snoring, observable apneas, hiccups, choking, “air swallowing” and frequent awakenings. The day symptoms include: morning fatigue, personality changes and cognitive functions disorders, impotence and a decreased libido. Events of sleep apnea causing saturation decrease are a great stress on the organism and lead to severe systemic disorders. The most serious are: cardiac dysrhythmia, arterial hypertension, pulmonary hypertension, blood vessel endothelial dysfunction and metabolic disorders. Increased accident risk is one of the dangerous complications of obstructive sleep apnea. Treatment methods for OSA patients depend on the causative factors, intensity of the disease and the related risk of life-threatening complications. Present-day knowledge of OSA is interdisciplinary and offers possibilities for application both in prophylaxis and in effective OSA therapy. Keywords: obstructive sleep apnea, symptoms, complications, treatment

 
REFERENCES (66)
1.
McNicolas WT. Diagnosis of obstructive sleep apnea in adults. Proc Am Thorac Soc. 2008; 5: 154–160.
 
2.
Whyte KF, Allen MB, Jeffrey AA, Gould GA, Douglas NJ. Clinical feature of the sleep apnea/hypopnea syndrome. Q J Med 1989; 72: 659-666.
 
3.
Flemons WW, Whitelaw WA, Brant R, Remmers JE. Likelihood ratios for a sleep apnea clinical prediction rule. Am J Respir Crit Care Med. 1994; 150: 1279–1285.
 
4.
Jones TM, Swift AC. Snoring: recent developments. Hosp Med. 2000; 61: 330–335.
 
5.
Larsson LG, Lindberg A, Franklin KA, Lundbäck B. Gender differences in symptoms related to sleep apnea in general population and in relation to referral o sleep clinic. Chest 2003; 124: 204–211.
 
6.
Hoffstein V, Szalai JP. Predictive value of clinical features in diagnosing obstructive sleep apnea. Sleep 1993; 6: 118–122.
 
7.
Buda AJ, Schroeder JS, Guilleminault C. Abnormalities of pulmonary artery wedge pressure in sleep-induced apnea. Int J Cardiol. 1981; 1: 67–74.
 
8.
Mańkowski M, Koziej M, Cieślicki JK, Śliwiński P, Gorzelak K, Zieliński J. Obraz kliniczny i wyniki leczenia zachowawczego obturacyjnego bezdechu sennego. Pol Arch Med. Wewn. 1995; 93: 234–241.
 
9.
Greenberg GD, Watson RK, Deptula D. Neuropsychological dysfunction in sleep apnea. Sleep 1987: 10: 254–262.
 
10.
Borak J., Cieślicki J.K., Szelenberger W, Wilczak-Szadkowska H, Koziej M, Zieliński J. Wpływ leczenia za pomocą CPAP na psychopatologiczne następstwa obturacyjnego bezdechu sennego. Pneumonol Alergol Pol. 1993; 61(suppl 1): 116–126.
 
11.
Hirshkowitz M, Karacan I, Gurakar A, Williams RL. Hypertension, erectile dysfunction and occult sleep apnea. Sleep 1989; 12: 223–232.
 
12.
Gillis AM, Stoohs R, Guilleminault C. Changes in the QT interval during obstructive sleep apnea. Sleep 1991; 14: 346–350.
 
13.
Gami AS, Rader S, Svatikova A, Wolk R, Herold DL, Huyber C i wsp. Familial premature coronary artery disease mortality and obstructive sleep apnea. Chest 2007; 131: 118–121.
 
14.
Somers VK, White DP, Amin R, Abraham WT, Costa F, Culebras A i wsp. Sleep apnea and cardiovascular disease: An American Heart Association/American College of Cardiology Foundation Scientific Statement from the American Heart Association Council for High Blood Pressure Research Professional Education Committee, Council on Clinical Cardiology, Stroke Council and Council on Cardiovascular Nursing. In collaboration with the National Heart, Lung, and Blood Institute National Center on Sleep Disorders Research (National Institutes of Health). Circulation 2008; 118: 1080–1111.
 
15.
Millman RP, Redline S, Carlisle CC, Assaf AR, Levinson PD. Daytime hypertension in a obstructive sleep apnea. Prevalence contributing risk factors Chest 1991; 99: 861–866.
 
16.
Hla KM, Young TB, Bidwell T, Palta M, Skatrud JB, Dempsey J. Sleep apnea and hypertension. A population-based study. Ann Intern Med. 1994; 120: 382–388.
 
17.
Gjorup PH., Sadauskiene L, Wessels J, Nyvad O, Strunge B, Pedresen EB. Abnormally increased endothelin-1 in plasma during the night in obstructive sleep apnea: relation to blood pressure and severity of disease. Am J Hypertens. 2007; 20: 44–52.
 
18.
Phillips BG, Narkiewicz K, Pesek CA, Haynes WG, Dyken ME, Somers VK. Effects of obstructive sleep apnea on endothelin-1 and blood pressure. J Hypertens. 1999; 17: 61–66.
 
19.
Moller DS, Lind P, Strunge B, Pedersen EB. Abnormal vasoactive hormones and 24-hour blood pressure in obstructive sleep apnea. Am J Hypertens. 2003; 16: 274–280.
 
20.
Pratt-Ubunama MN, Nishizaka MK, Boedefeld RL, Cofield SS, Harding SM, Calhoun DA. Plasma aldosterone is related to severity of obstructive sleep apnea in subject with resistant hypertension. Chest 2007; 131: 453–459.
 
21.
Podszus T, Bauer W, Mayer J, Penzel T, Peter JH, von Wichert P. Sleep apnea and pulmonary hypertension. Klin Wochenschr. 1986; 64: 131–134.
 
22.
Ip MS, Tse HF, Lam B, Tsang KW, Lam WK. Endothelial function in obstructive sleep apnea and response to treatment. Am J Respir Crit Care Med. 2004; 169: 348–353.
 
23.
Kato M, Roberts-Thomson P, Philips BG, Haynes WG, Winnicki M, Accurso V i wsp. Impairment of endothelium-dependent vasodilation of resistance vessels in patients with obstructive sleep apnea. Circulation 2000; 102: 2607–2610.
 
24.
Yamauchi M, Nakano H, Maekawa J, Okamoto Y, Ohnishi Y, Suzuki T i wsp. Oxidative stress in obstructive sleep apnea. Chest 2005; 127: 1674–1679.
 
25.
Ryan S, Taylor CT, McNicolas WT. Systemic inflammation: a key factor in the pathogenesis of cardiovascular complications in obstructive sleep apnea syndrome? Thorax 2009; 64: 631–636.
 
26.
Jelic S, Padeletti M, Kawut SM, Higgins C, Canfield SM, Onat D i wsp. Inflammation, oxidative stress and repair capacity of the vascular endothelium in obstructive sleep apnea. Circulation 2008; 117: 2270– 2278.
 
27.
Levy P, Bonsignore MR, Eckel J. Sleep, sleep-disordered breathing and meta-bolic consequences. Eur Respir J. 2009; 34: 243–260.
 
28.
Tasali E, Ip MS. Obstructive sleep apnea and metabolic syndrome: Alteration in glucose metabolism and inflammation. Proceedings of the ATS 2008; 5: 207–217.
 
29.
Vgontzas AN, Papanicolaou DA, Bixler EO, Hopper K, Lotsikas H, Lin HM i wsp. Sleep apnea and daytime sleepiness and fatigue: relation to visceral obesity, insulin resistance and hypercytokinemia. J Clin Endocrinol Metab. 2000; 85: 1151–1158.
 
30.
Horne JA, Reyner LA. Sleep related vehicle accidents. BMJ 1995; 310: 565–567.
 
31.
Leger D. The cost of sleep-related accidents: a report for the National Commission on Sleep Disorders Research. Sleep 1994; 17: 84–93.
 
32.
Cartwright RD. Effect of position on sleep apnea therapy. Sleep 1984; 7: 110–114.
 
33.
Cartwright RD, Ristanovic R, Diaz F, Caldarelli D, Alder G. A comparative study of treatments for positional sleep apnea. Sleep 1991; 14: 546–552.
 
34.
Issa FG, Sullivan CE. Alcohol, snoring and sleep apnea. J Neurol Neurosurg Psychiatry 1982; 45: 353–359.
 
35.
Taasan VC, Block AJ, Boysen PG, Wynne JW. Alcohol increases sleep apnea and oxygen dasaturation in asymptomatic men. Am J Med. 1981; 71: 240–245.
 
36.
Wetter DW, Smith SS, Kenford SL, Jorenby DE, Fiore MC, Hurt RD, i wsp. Smoking outcome expectancies: factor structure, predictive validity, and discriminant validity. J Abnorm Psychol. 1994; 103: 801–811.
 
37.
Browman CP, Sampson MG, Yolles SF, Guyavarty KS, Weiler SJ, Walsleben JA i wsp. Obstructive sleep apnea and body weight. Chest 1984; 85: 435–438.
 
38.
Loube DI, Gay PC, Strohl KP, Pack AI, White DP, Collop NA. Indications for positive airway pressure treatment of adult obstructive sleep apnea patients: a consensus statement. Chest 1999; 115: 863–866.
 
39.
Sullivan CE, Issa FG, Berthon-Jones M, Eves L. Reversal of obstructive sleep apnoea by continuous positive airway pressure applied through the nares. Lancet 1981; 1: 862–865.
 
40.
Popper RA, Leidinger MJ, Williams AJ. Endosopic observations of the pharyngeal airway during treatment of obstructive sleep apnea with nasal continuous positive airway pressure – a pneumatic splint. West J Med. 1986; 144: 83–85.
 
41.
Pevernagie DA, Shepard JW Jr. Relation between sleep stage, posture and effective nasal CPAP levels in OSA. Sleep 1992; 15: 162–167.
 
42.
Ryan CF, Lowe AA, Li D, Fleetham JA. Magnetic resonance imaging of the upper airway in obstructive sleep apnea before and after chronic nasal continuous positive airway pressure therapy. Am Rev Respir Dis. 1991; 144: 939–944.
 
43.
McArdle N, Douglas NJ. Effect of continuous positive airway pressure on sleep architecture in the sleep apnea-hypopnea syndrome: a randomized controlled trial. Am J Respir Crit Care Med. 2001; 164: 1459–1463.
 
44.
Flemons WW. Measuring quality of life in patients with sleep apnea: whose life it is anyway? Thorax 2004; 59: 457–458.
 
45.
Kribbs NB, Pack AI, Kline LR, Smith PL, Schwartz AR, Schubert NM i wsp. Objective measurement of patterns of nasal CPAP use by patients with obstructive sleep apnea. Am Rev Respir Dis. 1993; 147: 887–895.
 
46.
McArdle N, Devereux G, Heidarnejad H, Engleman HM, Mackay TV, Douglas NJ. Lond-term use of CPAP therapy for sleep apnea/hypopnea syndrome. Am J Respir Crit Care Med. 1999; 159: 1108–1114.
 
47.
Pépin JL, Leger P, Veale D, Langevin B, Robert D, Lévy P. Side effect of nasal continuous positive airway pressure in sleep apnea syndrome. Study of 193 patients in two French sleep centers. Chest 1995; 107: 375–381.
 
48.
Przybyłowski T, Balcerzak J, Korczyński P, Broczek K, Bielicki P, Chazan R. Efekty kliniczne chirurgicznego leczenia obturacyjnego bezdechu podczas snu. Pol Arch Med Wewn. 2002; 107: 263–268.
 
49.
Olsen KD, Kern EB, Westbrook PR. Sleep and breathing disturbance secondary to nasal obstruction. Otolaryngol Head Neck Surg. 1981; 89: 804–810.
 
50.
Friedman M, Tanyeri H, Lim JW, Landsberg R, Vaidyanathan K, Caldarelli D. Effect of improved nasal breathing on obstructive sleep apnea. Otolaryngol Head Neck Surg. 2000; 122: 71–74.
 
51.
Fujita S, Conway W, Zorick F, Roth T. Surgical correction of anatomic abnormalities in obstructive sleep apnea syndrome: uvulopalatopharyngoplast. Otolaryngol. Head Neck Surg. 1981; 89: 923–934.
 
52.
Kamami YV. Laser CO2 for soring. Preliminary results. Acta Otorhinolaryngol Belg. 1990; 44: 451–56.
 
53.
Li KK, Guilleminault C, Riley RW, Powell NB. Obstructive sleep apnea and maxil-lomandibular advancement: an assessment of airway changes using radiographic and nasopharyngoscopic examinations. J Oral Maxillofac Surg. 2002; 60: 526–530.
 
54.
Bettega G, Pépin JL, Veale D, Deschaux C, Raphaël B, Lévy P. Obstructive sleep apnea syndrome. Fifty-one consecutive patients treated by maxillofacial surgery. Am J Respir Crit Care Med. 2000; 162: 641–649.
 
55.
Li KK, Powell NB, Riley RW, Troell RJ, Guilleminault C. Long-term results of maxillomandibular advancement surgery. Sleep Breath 2000; 4: 137–140.
 
56.
Li KK, Riley RW, Powell NB, Guilleminault C. Patient’s perception of the facial appearance after maxillomandibular advancement for obstructive sleep apnea syndrome. J Oral Maxillofac Surg. 2001; 59: 377–380.
 
57.
Kuhlo W, Doll E, Franck MC. Successful management of Pickwickian syndrome using long-term tracheostomy. Dtsch Med Wochenschr. 1969; 94: 1286–1290.
 
58.
Scheuller M, Weider D. Bariatric surgery for treatment of sleep apnea syndrome in 15 morbidly obese patients: long-term results. Otolaryngol Head Neck Surg. 2001; 125: 299–301.
 
59.
Tsuiki S, Lowe AA, Almeida FR, Fleetham JA. Effects of mandibular advancement on airway curvature and obstructive sleep apnea severity. Eur Respir J. 2004; 23: 263–268.
 
60.
Lowe AA, Sjöholm TT, Ryan CF, Fleetham JA, Ferguson KA, Remmers JE. Treatment, airway and compliance effects of a titratable oral appliance. Sleep 2000; 23: 172–178.
 
61.
Pancer J, Al-Faifi S, Al-Faifi M, Hoffstein V. Evaluation of two mandibular advancement appliance for treatment of snoring and sleep apnea. Chest 1999; 116: 1511–1518.
 
62.
Schmidt-Nowara W, Lowe A, Wiegand L, Cartwrihgt R, Perez-Guerra S, Menn S. Oral appliances for the treatment of snoring and obstructive sleep apnea: a review. Sleep 1995; 18: 501–510.
 
63.
Schmidt-Nowara W. Recent developments in oral appliance therapy of sleep disordered breathing. Sleep Breath 1999; 3: 103–106.
 
64.
Clark GT, Blumenfeld I, Yoffe N, Peled E, Lavie P. A crossover study comparing the efficacy of continuous positive airway pressure with anterior mandibular positioning devices on patients with obstructive sleep apnea. Chest 1996; 109: 1477–1483.
 
65.
Ferguson KA, Ono T, Lowe AA, al-Majed S, Love LL, Fleetham JA. A short-term controlled trial of an adjustable oral appliance for the treatment of mild to moderate obstructive sleep apnea. Thorax 1997; 52: 362–368.
 
66.
Tan YK, L’Estrange PR, Luo YM, Smith C, Grant HR, Simons AK i wsp. Mandibular advancement splints and continuous positive airway pressure in patients with obstructive sleep apnoea: a randomized cross-over trial. Europ J Orthod. 2002; 24: 239–249.
 
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