Editing Sleep apnea (section)

{{short description|Disorder involving pauses in breathing during sleep}}
{{cs1 config|name-list-style=vanc}}
{{Use dmy dates|date=March 2024}}
{{Infobox medical condition (new)
| name          = Sleep apnea
| image         = Obstruction ventilation apnée sommeil.svg
| caption       = Obstructive sleep apnea: At bottom-center, [[Pharynx|nasopharyngeal]] tissue falls to the back of the throat when in a supine posture, occluding normal breath and causing various complications.
| pronounce     = {{IPAc-en|æ|p|ˈ|n|iː|ə}}, {{IPAc-en|ˈ|æ|p|n|i|ə}}
| synonyms      = Sleep apnoea, sleep apnea syndrome
| field         = [[Otorhinolaryngology]], [[sleep medicine]]
| symptoms      = [[apnea|Pauses breathing]] or periods of [[hypopnea|shallow breathing]] during [[sleep]], [[snoring]], tired during the day<ref name="NIH2012What4">{{cite web |date=10 July 2012 |title=Sleep Apnea: What Is Sleep Apnea? |url=http://www.nhlbi.nih.gov/health/health-topics/topics/sleepapnea/ |url-status=live |archive-url=https://web.archive.org/web/20160819043218/http://www.nhlbi.nih.gov/health/health-topics/topics/sleepapnea/ |archive-date=19 August 2016 |access-date=18 August 2016 |work=NHLBI: Health Information for the Public |publisher=U.S. Department of Health and Human Services}}</ref><ref name="NIH2012Sym">{{cite web |date=10 July 2012 |title=What Are the Signs and Symptoms of Sleep Apnea? |url=http://www.nhlbi.nih.gov/health/health-topics/topics/sleepapnea/signs |url-status=live |archive-url=https://web.archive.org/web/20160826185448/http://www.nhlbi.nih.gov/health/health-topics/topics/sleepapnea/signs |archive-date=26 August 2016 |access-date=18 August 2016 |website=NHLBI}}</ref>
| complications = [[myocardial infarction|Heart attack]], [[Cardiac arrest]],  [[stroke]], [[diabetes]], [[heart failure]], [[irregular heartbeat]], [[obesity]], [[motor vehicle collisions]],<ref name="NIH2012What4"/> [[Alzheimer's disease]],<ref name="Jackson et al 2020" /> and premature death<ref>{{cite journal |last1=Young |first1=Terry |last2=Finn |first2=Laurel |last3=Peppard |first3=Paul E. |last4=Szklo-Coxe |first4=Mariana |last5=Austin |first5=Diane |last6=Nieto |first6=F. Javier |last7=Stubbs |first7=Robin |last8=Hla |first8=K. Mae |title=Sleep Disordered Breathing and Mortality: Eighteen-Year Follow-up of the Wisconsin Sleep Cohort |journal=Sleep |date=1 August 2008 |volume=31 |issue=8 |pages=1071–1078 |pmid=18714778 |pmc=2542952 |url=https://aasm.org/study-shows-that-people-with-sleep-apnea-have-a-high-risk-of-death/ |access-date=27 February 2021 |archive-date=23 January 2021 |archive-url=https://web.archive.org/web/20210123171810/https://aasm.org/study-shows-that-people-with-sleep-apnea-have-a-high-risk-of-death/ |url-status=live }}</ref>
| onset         = Varies; up to 50% of women age 20–70<ref name="ReferenceC">{{cite journal|pmc = 4561280|year = 2015|last1 = Franklin|first1 = K. A.|last2 = Lindberg|first2 = E.|title = Obstructive sleep apnea is a common disorder in the population—a review on the epidemiology of sleep apnea|journal = Journal of Thoracic Disease|volume = 7|issue = 8|pages = 1311–1322|doi = 10.3978/j.issn.2072-1439.2015.06.11|pmid = 26380759}}</ref>
| duration      =
| causes        =
| risks         = [[Overweight]], family history, [[allergies]], enlarged [[tonsils]],<ref name="NIH2012Cau2" /> [[asthma]]<ref name="asthma_Ref">{{cite journal |last1=Dixit |last2=Ramakant |year=2018 |title=Asthma and obstructive sleep apnea: More than an association! |journal=Lung India |volume=35 |issue=3 |pages=191–192 |doi=10.4103/lungindia.lungindia_241_17 |pmc=5946549 |pmid=29697073 |doi-access=free }}</ref>
| diagnosis     = Overnight [[Polysomnography|sleep study]]<ref name=NIH2012Diag>{{cite web|title=How Is Sleep Apnea Diagnosed?|url=http://www.nhlbi.nih.gov/health/health-topics/topics/sleepapnea/diagnosis|website=NHLBI|access-date=18 August 2016|date=10 July 2012|url-status=live|archive-url=https://web.archive.org/web/20160811134644/http://www.nhlbi.nih.gov/health/health-topics/topics/sleepapnea/diagnosis|archive-date=11 August 2016}}</ref>
| differential  =
| prevention    =
| treatment     = Lifestyle changes, mouthpieces, breathing devices, surgery<ref name="NIH2012What4"/>
| medication    =
| prognosis     =
| frequency     = ~ 1 in every 10 people,<ref name="Jackson et al 2020"/><ref name="Owen et al 2020" /> 2:1 ratio of men to women, aging and obesity higher risk<ref name="ReferenceC"/>
| deaths        =
| alt           =
| types         = [[Obstructive sleep apnea]] (OSA), [[central sleep apnea]] (CSA), mixed sleep apnea<ref name="NIH2012What4"/>
}}
<!-- Definition -->

'''Sleep apnea''' ('''sleep apnoea''' or '''sleep apnœa''' in [[British English]]) is a sleep-related breathing disorder in which repetitive [[Apnea|pauses in breathing]], periods of shallow breathing, or collapse of the upper airway during [[sleep]] results in poor ventilation and sleep disruption.<ref name="Chang-2023">{{Cite journal |last1=Chang |first1=Jolie L. |last2=Goldberg |first2=Andrew N. |last3=Alt |first3=Jeremiah A. |last4=Mohammed |first4=Alzoubaidi |last5=Ashbrook |first5=Liza |last6=Auckley |first6=Dennis |last7=Ayappa |first7=Indu |last8=Bakhtiar |first8=Hira |last9=Barrera |first9=José E. |last10=Bartley |first10=Bethany L. |last11=Billings |first11=Martha E. |last12=Boon |first12=Maurits S. |last13=Bosschieter |first13=Pien |last14=Braverman |first14=Itzhak |last15=Brodie |first15=Kara |date=2023-07-13 |title=International Consensus Statement on Obstructive Sleep Apnea |journal=International Forum of Allergy & Rhinology |language=en |volume=13 |issue=7 |pages=1061–1482 |doi=10.1002/alr.23079 |issn=2042-6976 |pmc=10359192 |pmid=36068685}}</ref><ref name="Roberts-2022" /> Each pause in breathing can last for a few seconds to a few minutes and often occurs many times a night.<ref name="NIH2012What4" /> A choking or snorting sound may occur as breathing resumes.<ref name="NIH2012What4" /> Common symptoms include daytime sleepiness, snoring, and non restorative sleep despite adequate sleep time.<ref name="Stansbury-2015">{{Cite journal |last1=Stansbury |first1=Robert C. |last2=Strollo |first2=Patrick J. |date=2015-09-07 |title=Clinical manifestations of sleep apnea |url=https://jtd.amegroups.org/article/view/5253 |journal=Journal of Thoracic Disease |language=en |volume=7 |issue=9 |pages=E298-310 |doi=10.3978/j.issn.2072-1439.2015.09.13 |issn=2077-6624 |pmc=4598518 |pmid=26543619 |access-date=11 March 2024 |archive-date=11 March 2024 |archive-url=https://web.archive.org/web/20240311030519/https://jtd.amegroups.org/article/view/5253 |url-status=live }}</ref> Because the disorder disrupts normal sleep, those affected may experience sleepiness or feel tired during the day.<ref name="NIH2012What4" /> It is often a chronic condition.<ref>{{cite journal |last1=Punjabi |first1=Naresh M. |date=15 February 2008 |title=The Epidemiology of Adult Obstructive Sleep Apnea |journal=Proceedings of the American Thoracic Society |volume=5 |issue=2 |pages=136–143 |doi=10.1513/pats.200709-155MG |issn=1546-3222 |pmc=2645248 |pmid=18250205}}</ref><!--Cause and diagnosis-->

Sleep apnea may be categorized as [[obstructive sleep apnea]] (OSA), in which breathing is interrupted by a blockage of air flow, [[central sleep apnea]] (CSA), in which regular unconscious breath simply stops, or a combination of the two.<ref name="NIH2012What4" /> OSA is the most common form.<ref name="NIH2012What4" /> OSA has four key contributors; these include a narrow, crowded, or collapsible upper airway, an ineffective pharyngeal dilator muscle function during sleep, airway narrowing during sleep, and unstable control of breathing (high loop gain).<ref name="Dolgin3">{{cite journal |last1=Dolgin |first1=Elie |date=29 April 2020 |title=Treating sleep apnea with pills instead of machines |url=https://knowablemagazine.org/article/health-disease/2020/treating-sleep-apnea-pills-instead-machines |journal=Knowable Magazine |doi=10.1146/knowable-042820-1 |access-date=9 May 2022 |doi-access=free |archive-date=30 May 2022 |archive-url=https://web.archive.org/web/20220530121424/https://knowablemagazine.org/article/health-disease/2020/treating-sleep-apnea-pills-instead-machines |url-status=live }}</ref><ref name="Osman-2018">{{cite journal |last1=Osman |first1=A. M. |last2=Carter |first2=S. G. |last3=Carberry |first3=J. C. |last4=Eckert |first4=D. J. |year=2018 |title=Obstructive sleep apnea: Current perspectives |journal=Nature and Science of Sleep |volume=10 |pages=21–34 |doi=10.2147/NSS.S124657 |pmc=5789079 |pmid=29416383 |doi-access=free}}</ref> In CSA, the basic neurological controls for breathing rate malfunction and fail to give the signal to inhale, causing the individual to miss one or more cycles of breathing. If the pause in breathing is long enough, the percentage of oxygen in the circulation can drop to a lower than normal level ([[hypoxemia]]) and the concentration of carbon dioxide can build to a higher than normal level ([[hypercapnia]]).<ref>{{cite book |last1=Majmundar |first1=Sapan H. |url=https://www.ncbi.nlm.nih.gov/books/NBK482456/ |title=Physiology, Carbon Dioxide Retention |last2=Patel |first2=Shivani |date=27 October 2018 |publisher=StatPearls Publishing |pmid=29494063 |access-date=23 January 2019 |archive-date=20 May 2020 |archive-url=https://web.archive.org/web/20200520051103/https://www.ncbi.nlm.nih.gov/books/NBK482456/ |url-status=live }}</ref> In turn, these conditions of [[Hypoxia (medical)|hypoxia]] and hypercapnia will trigger ''additional'' effects on the body such as [[Cheyne-stokes respiration|Cheyne-Stokes Respiration]].<ref>{{cite book |last1=Rudrappa |first1=M. |url=https://www.ncbi.nlm.nih.gov/books/NBK448165/ |title=Cheyne Stokes Respirations |last2=Modi |first2=P. |last3=Bollu |first3=P.C. |date=1 August 2022 |publisher=StatPearls Publishing |isbn= |location=Treasure Island, FL |pmid=28846350 |accessdate= |archive-date=15 June 2023 |archive-url=https://web.archive.org/web/20230615151856/https://www.ncbi.nlm.nih.gov/books/NBK448165/ |url-status=live }}</ref>

Some people with sleep apnea are unaware they have the condition.<ref name="NIH2012What4" /> In many cases it is first observed by a family member.<ref name="NIH2012What4" /> An in-lab sleep study overnight is the preferred method for diagnosing sleep apnea.<ref name="Osman-2018" /> In the case of OSA, the outcome that determines disease severity and guides the treatment plan is the apnea-hypopnea index (AHI).<ref name="Osman-2018" /> This measurement is calculated from totaling all pauses in breathing and periods of shallow breathing lasting greater than 10 seconds and dividing the sum by total hours of recorded sleep.<ref name="Chang-2023" /><ref name="Osman-2018" /> In contrast, for CSA the degree of respiratory effort, measured by esophageal pressure or displacement of the thoracic or abdominal cavity, is an important distinguishing factor between OSA and CSA.<ref name="Badr-2019">{{Cite journal |last1=Badr |first1=M. Safwan |last2=Javaheri |first2=Shahrokh |date=March 2019 |title=Central Sleep Apnea: a Brief Review |journal=Current Pulmonology Reports |language=en |volume=8 |issue=1 |pages=14–21 |doi=10.1007/s13665-019-0221-z |issn=2199-2428 |pmc=6883649 |pmid=31788413}}</ref>

A systemic disorder, sleep apnea is associated with a wide array of effects, including increased risk of [[car accidents]], [[hypertension]], [[cardiovascular disease]], [[myocardial infarction]], [[stroke]], [[atrial fibrillation]], [[insulin resistance]], higher incidence of [[cancer]], and [[neurodegeneration]].<ref name="Lim4">{{cite journal |last1=Lim |first1=Diane C. |last2=Pack |first2=Allan I. |date=14 January 2017 |title=Obstructive Sleep Apnea: Update and Future |url=https://www.annualreviews.org/doi/10.1146/annurev-med-042915-102623 |journal=Annual Review of Medicine |volume=68 |issue=1 |pages=99–112 |doi=10.1146/annurev-med-042915-102623 |issn=0066-4219 |pmid=27732789 |url-access=subscription |access-date=10 May 2022 |archive-date=10 May 2022 |archive-url=https://web.archive.org/web/20220510122636/https://www.annualreviews.org/doi/10.1146/annurev-med-042915-102623 |url-status=live }}</ref> Further research is being conducted on the potential of using biomarkers to understand which chronic diseases are associated with sleep apnea on an individual basis.<ref name="Lim4"/><!--Prevention, treatment, prognosis-->

Treatment may include lifestyle changes, mouthpieces, breathing devices, and surgery.<ref name="NIH2012What4" /> Effective lifestyle changes may include avoiding [[Alcohol (drug)|alcohol]], losing weight, [[smoking]] cessation, and sleeping on one's side.<ref name="Gottlieb&20202">{{cite journal |last1=Gottlieb |first1=Daniel J. |last2=Punjabi |first2=Naresh M. |date=14 April 2020 |title=Diagnosis and Management of Obstructive Sleep Apnea: A Review |url=https://doi.org/10.1001/jama.2020.3514 |journal=JAMA |volume=323 |issue=14 |pages=1389–1400 |doi=10.1001/jama.2020.3514 |issn=0098-7484 |pmid=32286648 |s2cid=215759986 |url-access=subscription |access-date=22 October 2021 |archive-date=8 March 2024 |archive-url=https://web.archive.org/web/20240308031521/https://jamanetwork.com/journals/jama/article-abstract/2764461 |url-status=live }}</ref> Breathing devices include the use of a [[Continuous positive airway pressure|CPAP machine]].<ref name="NIH2012Tx2">{{cite web |date=10 July 2012 |title=How Is Sleep Apnea Treated? |url=http://www.nhlbi.nih.gov/health/health-topics/topics/sleepapnea/treatment |url-status=live |archive-url=https://web.archive.org/web/20160827160600/http://www.nhlbi.nih.gov/health/health-topics/topics/sleepapnea/treatment |archive-date=27 August 2016 |access-date=18 August 2016 |website=NHLBI}}</ref> With proper use, CPAP improves outcomes.<ref name="Spi20152">{{cite journal |vauthors=Spicuzza L, Caruso D, Di Maria G |date=September 2015 |title=Obstructive sleep apnoea syndrome and its management |journal=Therapeutic Advances in Chronic Disease |volume=6 |issue=5 |pages=273–85 |doi=10.1177/2040622315590318 |pmc=4549693 |pmid=26336596}}</ref> Evidence suggests that CPAP may improve sensitivity to insulin, blood pressure, and sleepiness.<ref>{{cite journal |vauthors=Iftikhar IH, Khan MF, Das A, Magalang UJ |date=April 2013 |title=Meta-analysis: continuous positive airway pressure improves insulin resistance in patients with sleep apnea without diabetes |journal=Annals of the American Thoracic Society |volume=10 |issue=2 |pages=115–20 |doi=10.1513/annalsats.201209-081oc |pmc=3960898 |pmid=23607839}}</ref><ref>{{cite journal |vauthors=Haentjens P, Van Meerhaeghe A, Moscariello A, De Weerdt S, Poppe K, Dupont A, Velkeniers B |date=April 2007 |title=The impact of continuous positive airway pressure on blood pressure in patients with obstructive sleep apnea syndrome: evidence from a meta-analysis of placebo-controlled randomized trials |journal=Archives of Internal Medicine |volume=167 |issue=8 |pages=757–64 |doi=10.1001/archinte.167.8.757 |pmid=17452537 |doi-access=}}</ref><ref>{{cite journal |vauthors=Patel SR, White DP, Malhotra A, Stanchina ML, Ayas NT |date=March 2003 |title=Continuous positive airway pressure therapy for treating sleepiness in a diverse population with obstructive sleep apnea: results of a meta-analysis |journal=Archives of Internal Medicine |volume=163 |issue=5 |pages=565–71 |doi=10.1001/archinte.163.5.565 |pmid=12622603 |doi-access=}}</ref> Long term compliance, however, is an issue with more than half of people not appropriately using the device.<ref name="Spi20152" /><ref name="Hsu20032">{{cite journal |vauthors=Hsu AA, Lo C |date=December 2003 |title=Continuous positive airway pressure therapy in sleep apnoea |journal=Respirology |volume=8 |issue=4 |pages=447–54 |doi=10.1046/j.1440-1843.2003.00494.x |pmid=14708553 |doi-access=free}}</ref> In 2017, only 15% of potential patients in developed countries used CPAP machines, while in developing countries well under 1% of potential patients used CPAP.<ref>{{cite web |date=18 November 2017 |title=3 Top Medical Device Stocks to Buy Now |url=https://www.fool.com/investing/2017/11/18/3-top-medical-device-stocks-to-buy-now.aspx |access-date=7 March 2021 |archive-date=7 July 2021 |archive-url=https://web.archive.org/web/20210707012026/https://www.fool.com/investing/2017/11/18/3-top-medical-device-stocks-to-buy-now.aspx |url-status=live }}</ref>{{unreliable source|date=December 2024}} Without treatment, sleep apnea may increase the risk of [[Myocardial infarction|heart attack]], [[stroke]], [[diabetes]], [[heart failure]], [[irregular heartbeat]], [[obesity]], and [[motor vehicle collisions]].<ref name="NIH2012What4" /><!--Epidemiology and culture-->

OSA is a common sleep disorder. A large analysis in 2019 of the estimated prevalence of OSA found that OSA affects 936 million—1 billion people between the ages of 30–69 globally, or roughly every 1 in 10 people, and up to 30% of the elderly.<ref>{{cite journal |last1=Franklin |first1=Karl A. |last2=Lindberg |first2=Eva |date=August 2015 |title=Obstructive sleep apnea is a common disorder in the population—a review on the epidemiology of sleep apnea |journal=Journal of Thoracic Disease |volume=7 |issue=8 |pages=1311–1322 |doi=10.3978/j.issn.2072-1439.2015.06.11 |issn=2072-1439 |pmc=4561280 |pmid=26380759}}</ref> Sleep apnea is somewhat more common in men than women, roughly a 2:1 ratio of men to women, and in general more people are likely to have it with older age and obesity. Other risk factors include being overweight,<ref name="Lim4"/> a family history of the condition, allergies, and enlarged [[tonsils]].<ref name="NIH2012Cau2">{{cite web |date=10 July 2012 |title=Who Is at Risk for Sleep Apnea? |url=http://www.nhlbi.nih.gov/health/health-topics/topics/sleepapnea/atrisk |url-status=live |archive-url=https://web.archive.org/web/20160826160854/http://www.nhlbi.nih.gov/health/health-topics/topics/sleepapnea/atrisk |archive-date=26 August 2016 |access-date=18 August 2016 |website=NHLBI}}</ref>