Obstructive sleep apnea syndrome (OSAS)

Obstructive sleep apnea syndrome (OSAS) is the term used to describe a condition in which breathing interruptions during sleep lead to symptoms. Breathing stops several times during an hour, the pauses last longer than ten seconds. This is where the term apnea (Greek) comes from, which translates as respiratory arrest.

Obstructive sleep apnea syndrome, which is associated with loud snoring, is a serious condition that should not be taken lightly. It can lead to long-term incapacity for work, a number of secondary diseases such as high blood pressure, heart attacks or strokes and should therefore be treated medically.

Overview: What is Obstructive Sleep Apnea Syndrome?

Sleep apnea is a form of breathing disorder that typically occurs during sleep. Those affected usually snore very loudly while they sleep. Periodically, a relaxation of the muscles of the throat and tongue leads to a collapse of the upper airways. As a result, breathing stops for a few seconds to a minute until it starts again audibly. Afterwards, those affected continue to breathe and snore again. The phase of reduced oxygen supply during the breathing cessation leads to a brief alarm reaction of the body, which is usually perceived unconsciously by the person affected. She wakes up briefly, gasps for air with increased breaths and goes back to sleep. If this process takes place countless times during the night, restful sleep cannot take place. Those affected are not rested the next morning. This is because the frequent nocturnal stress reactions with an increased heart rate and the release of stress hormones prevent normal regeneration during sleep, and the deep sleep phases that are part of the nocturnal sleep rhythm do not take place.

Obstructive sleep apnea syndrome - causes and risk factors

In obstructive sleep apnea syndrome, the muscles of the upper airways slacken, causing them to collapse and producing snoring noises. A partial or complete blockage (obstruction) of the flaccid airways is responsible for the interruptions. As a result, the body is no longer supplied with sufficient oxygen, the carbon dioxide content in the blood rises and the pulse slows down. Finally, the respiratory center in the brain reacts and sounds the alarm, so to speak. The body reacts to stress:

  1. The airways open up again due to the tension
  2. Breathing resumes with rapid, deep breaths
  3. The affected person briefly switches to a light waking state,
  4. Heart rate and blood pressure increase and the body is supplied with sufficient oxygen again.

The brief waking moments are usually not consciously noticed, but they prevent restful deep sleep from taking place. The unconscious awakening is also called arousal. So if you feel constantly tired during the day and your environment tells you that you snore heavily at night, then you may have obstructive sleep apnea syndrome. To be sure, your relatives can observe the frequency of the interruptions. The cessation of breathing in sleep apnea occurs at least five times within an hour and lasts at least ten seconds each time.

It is estimated that around two to five percent of middle-aged people are affected by this disease, with the number of sufferers increasing with age. There are a few risk factors that can contribute to obstructive sleep apnea syndrome. These include:

  • Overweight(adipostas)
  • Congenital predisposition
  • Malposition of the lower jaw
  • enlarged adenoids, nasal polyps
  • Alcohol, nicotine, drug consumption, sleeping pills

Diabetes mellitus, heart failure or sleeping on your back can also contribute to obstructive sleep apnea syndrome. Sleep apnea is more common in people with cardiovascular disease than in otherwise healthy people.

Symptoms: Obstructive sleep apnea syndrome

As a rule, people with obstructive sleep apnea syndrome are unmistakably loud snorers. Light snoring in itself is harmless and can be described as a normal sleep event. However, if the relatives notice the typical breathing interruptions during sleep, then sleep apnea is suspected. Those affected complain of tiredness during the day and sometimes have difficulty concentrating. Other symptoms may occur:

  • Headache in the morning
  • Dry mouth
  • Waking up in the night with shortness of breath and palpitations
  • Sweating at night
  • Potency problems

Even if those affected do not consciously experience the waking phases, many complain of restless sleep. Sleep disorders can cause depressive moods and even depression. It is usually relatives who urge the person concerned to see a doctor or hospital because of their own disturbed sleep. In the case of mild sleep apnea, sufferers nod off quickly during the day when resting; in severe cases, chronic respiratory insufficiency can lead to high blood pressure or cardiac insufficiency in addition to severe daytime sleepiness.

Sleep apnea can also be a hindrance at work, because in Switzerland, for example, all driving license categories require that no illnesses with increased daytime sleepiness are present. This is another reason not to take nightly breathing interruptions lightly, but to have a thorough medical examination.

Illustration of a man sleeping to illustrate snoring

Diagnosis of obstructive sleep apnea syndrome

For the initial diagnosis, we will take the patient’s medical history and the observations of the relatives (anamnesis). During the physical examination, the patient’s weight, height, blood pressure, heart and lungs are examined. A blood test can show whether there is a thyroid dysfunction and whether the number of red blood cells has increased due to the lack of oxygen in a longstanding sleep apnea. An arterial blood gas analysis provides information about the oxygen and carbon dioxide content. The physical diagnosis can be followed by an examination of breathing and sleep.

Obstructive sleep apnea syndrome – Portable measuring device

There are various ways of examining breathing during sleep. Various parameters can be checked using a portable measuring device that you can take home with you. Put the probes on before you go to bed. While you sleep, your breathing, heart rate and blood oxygen saturation are measured. The probes also register the body position and snoring sounds. If the suspicion of OSAS is confirmed, treatment or further examination in a sleep laboratory may be advisable.

Obstructive sleep apnea syndrome – Sleep laboratory

During an examination in the sleep laboratory, your sleep can be observed in detail and recorded using various measuring devices. For one or more nights, you move into a special room equipped with a video camera and recording devices. In addition to pulse rate and oxygen content, sensors also record breathing movements, limb and eye movements and brain waves. The frequency of apneas and hypopneas per hour is calculated from the number of complete and partial pauses in breathing as the apnea-hypopnea index (AHI). The AHI is a measure of the severity of obstructive sleep apnea syndrome.

Obstructive sleep apnea syndrome - prevention, early detection, progression

To a certain extent, you can try to prevent sleep apnea. First of all, this includes checking the weight. Excessive obesity promotes breathing stops, partly because too much abdominal fat and fat on the neck makes breathing more difficult. Make sure you eat a balanced, healthy diet with plenty of fruit, vegetables and fiber. Go easy on sugar, control the fats you consume – plant-based are better than animal-based – and be a little stingy with carbohydrates. Exercise also helps to achieve a healthy normal weight: leave the car at home and take the bike, don’t take the elevator, take the stairs instead. If you stop smoking and avoid alcohol and sleeping pills before going to bed, this also reduces the risk of sleep apnea.

Obstructive sleep apnea syndrome – progression

React soon if your partner complains about your loud snoring at night. Do not accept daytime tiredness as an annoying evil, but visit us to find out the cause. A diagnosis of obstructive sleep apnea syndrome and treatment can help you regain a better quality of life and avert possible consequences such as heart attacks and strokes.

If left untreated, the hundreds of breathing interruptions during the night can

  • Hypertension
  • Heart failure
  • Heart attack
  • Stroke
  • Cardiac arrhythmias

cause. Daytime tiredness makes driving risky, which is particularly dangerous for professional drivers. Drowsiness during the day can lead to incapacity to work. In people with dementia, untreated sleep apnea increases cognitive decline.

Self-help groups

The exchange with people who are affected by the same disease can be a great support in coping with the disease. Advice on finding a suitable self-help group is available from Selbsthilfe Zürich. Self-Help Zurich and the University Hospital Zurich are cooperation partners in the national project “Health literacy thanks to self-help-friendly hospitals”.

Obstructive sleep apnea syndrome - treatment

You may have already been able to achieve a certain improvement in your sleep quality with the measures mentioned above, such as weight reduction and abstaining from alcohol and nicotine. The sleeping position (preferably lying on your side and not on your back) can also help to reduce sleep apnea. If these measures have not helped to reduce your breathing stops at night, there are various options available:

  • Respiratory therapy devices – CPAP
  • Technical aids – lower jaw splint, snoring splint, etc.
  • Surgical interventions – in the presence of nasal polyps, enlarged palatine tonsils