Transcript
Hello, my name is Anne Cartwright. I'm a physician assistant in the Sleep Medicine Division of National Jewish Health. In the following video, I'll be discussing obstructive sleep apnea.
First, we'll talk about what sleep apnea is. Sleep apnea means that you actually stop breathing during your sleep. As you can imagine, it's a pretty serious health problem that impacts the body in several different ways. So first, we'll talk about the AHI. You may have heard your doctor talk about this. The AHI is a measure of how severe your sleep apnea is. It's actually a measure of how many times per hour you stop breathing. Less than five times per hour is considered normal. Five to fifteen times per hour would be mild sleep apnea. Fifteen to thirty times per hour is moderate sleep apnea. And anything over thirty times per hour is considered severe sleep apnea. And if you think about it, if you stop breathing thirty times per hour, that means you stop breathing on average of every two minutes, so that's fairly significant.
So the AHI is actually made up of two different components, apneas and hypopneas. Apnea means that you actually completely stop breathing for a period of ten seconds or more. Hypopnea means that you haven't stopped breathing completely, but your breathing is actually diminished to the point where your oxygen level decreases. So we add all the apneas, all the hypopneas, and divide them by how long you're sleeping, and that gives us the AHI. Again, how many times per hour you stop breathing.
There are other kinds of sleep apnea, but obstructive sleep apnea is certainly the most common. And when people are talking about sleep apnea, this is usually what they're referring to. So during OSA, your airway actually becomes blocked or obstructed while you're sleeping. You're trying to breathe, you just don't have an airway or a tube to actually breathe through. So why does this happen? Well, when we sleep, our muscles relax, and that includes the muscles of our upper airway and the tongue. Everything gets kind of loose and floppy and falls back, and our airway actually collapses, making it so that we can no longer breathe. Anything that makes your airway smaller to begin with or more floppy to begin with actually puts you at risk for having sleep apnea.
The biggest risk factor for having OSA is being obese. 70% of people with sleep apnea have it because they're obese or overweight, which makes sense when you consider that you have more gravity and more weight literally pressing down on your airway when you're trying to breathe. Also, when you gain weight, you get fatty deposits that grow on the inside around your airway that kind of smoosh it down and make it narrow and smaller to begin with. If you measure the size of your neck, that can give you a good indication as to whether or not you might be at risk for having OSA. In men, having a neck circumference larger than 17 inches, and for women, a neck circumference larger than 16 inches puts you at risk.
Some other risk factors for OSA are any other structural abnormalities that would make your airway again smaller to begin with. If you have large tonsils or large adenoids obstructing your airway, this is usually more of an issue in children with sleep apnea, not so much in adults, but it can sometimes be a factor. If you have a large uvula, the uvula is a little hangy down flappy thing in the back of your throat that you can see when you look in the mirror. If you've got a large tongue, if the palate or the roof of your mouth is really long or narrow, or if you have any craniofacial abnormalities, like if you have a small jaw, if your jaw is pushed back very far into your head. Most people with Down syndrome have OSA because they have very small bone structure and they have very large tongues, so their airways become very crowded.
Besides structural things, there are many other things that can put you at risk for OSA as well. Smoking puts you at risk. When we smoke, you get inflammation in your airway, which makes your airway smaller. Using alcohol, particularly before bed, this relaxes the muscles in your airway, making it more floppy and more likely to collapse. Medications such as muscle relaxants, sedatives, or narcotic pain medications, and patients with a history of heart failure, stroke, or any neuromuscular weakness are also more at risk. Snoring is a big risk factor and is also a sign or symptom of sleep apnea, though not everyone that snores has sleep apnea. Sleep apnea does tend to run in families. As you age, you also become more at risk, and that's because as we age, we lose muscle tone and our muscles get more floppy. Sleep apnea is more common in males, although once females hit menopause and they lose that estrogen drive, they have less muscle tone, and in older adults, we see that males and females have sleep apnea in equal rates.
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