Sleep-Disordered Breathing
An umbrella term for breathing abnormalities during sleep, ranging from simple snoring to severe obstructive sleep apnea.
What is Sleep-Disordered Breathing?
Sleep-disordered breathing (SDB) is a general term encompassing a spectrum of breathing problems that occur during sleep. This spectrum ranges from primary snoring (snoring without other abnormalities) through upper airway resistance syndrome to obstructive sleep apnea. All forms of SDB involve some degree of upper airway narrowing or collapse during sleep, resulting in increased breathing effort, reduced airflow, or complete breathing cessation. The severity and health implications vary widely across this spectrum.
Prevalence
Sleep-disordered breathing in some form affects up to 50% of the adult population when including habitual snoring. More significant SDB (OSA with AHI ≥5) affects approximately 10-17% of men and 3-9% of women. Prevalence increases significantly with age and obesity.
Causes
SDB results from narrowing or collapse of the upper airway during sleep. Contributing factors include anatomical features (small jaw, large tongue, enlarged tonsils), excess soft tissue from obesity, loss of muscle tone during sleep, nasal obstruction, and neuromuscular factors affecting airway patency. Genetic factors, alcohol, sedatives, and sleeping position also play roles.
Types
Primary Snoring
Snoring without apneas, hypopneas, or arousals. Generally considered benign but may progress to more severe SDB over time.
Upper Airway Resistance Syndrome (UARS)
Characterized by increased breathing effort and arousals without meeting criteria for apnea or hypopnea. Causes similar daytime symptoms as OSA.
Obstructive Sleep Apnea Hypopnea Syndrome
The most recognized form of SDB, characterized by repeated episodes of complete or partial airway obstruction during sleep.
Symptoms
Snoring
The hallmark of SDB, caused by vibration of soft tissues as air flows through a narrowed airway. May range from quiet to extremely loud.
Witnessed apneas
Breathing pauses observed by bed partners, typically followed by gasping, choking, or snorting sounds.
Daytime sleepiness
Excessive tiredness during the day despite apparently adequate time in bed, resulting from fragmented sleep.
Non-restorative sleep
Waking feeling unrefreshed even after sleeping for normal duration, indicating poor sleep quality.
Morning headaches
Headaches upon waking related to low oxygen levels and elevated carbon dioxide during sleep.
Cognitive impairment
Difficulty with concentration, memory, and executive function due to sleep fragmentation.
Diagnosis
Self-Assessment Questions
If you answer yes to any of these questions, consider consulting a sleep specialist:
- 1Do you snore regularly?
- 2Has your snoring gotten worse over time?
- 3Do you feel tired during the day despite sleeping enough hours?
- 4Have you gained weight and noticed your sleep has worsened?
- 5Do you wake up with headaches or a dry mouth?
- 6Has anyone observed pauses in your breathing during sleep?
Evaluation involves a detailed sleep history, physical examination of the upper airway, and sleep testing. The severity of SDB is determined by sleep studies measuring respiratory events and their impact on sleep and oxygen levels.
Polysomnography
Comprehensive overnight sleep study that measures all parameters needed to diagnose and classify SDB severity, including respiratory events, oxygen desaturation, arousals, and sleep stages.
Home Sleep Testing
Portable monitoring for patients with high likelihood of moderate to severe OSA. Measures breathing, effort, and oxygen but not sleep stages.
Upper Airway Evaluation
Physical examination and sometimes endoscopy to identify anatomical factors contributing to airway narrowing.
Drug-Induced Sleep Endoscopy (DISE)
Examination of the upper airway during sedation to identify sites of collapse, useful for surgical planning.
Treatment
Treatment is tailored to the severity of SDB and individual patient factors. Options range from conservative measures for mild cases to PAP therapy or surgery for more severe disease.
Lifestyle Modifications
Weight loss, avoiding alcohol before bed, and positional therapy are first-line approaches for mild SDB and adjuncts for more severe disease.
Positive Airway Pressure Therapy
CPAP, BiPAP, or APAP devices deliver pressurized air to maintain airway patency. The gold standard treatment for moderate to severe SDB.
Oral Appliances
Mandibular advancement devices or tongue-retaining devices can be effective for mild to moderate SDB or when PAP is not tolerated.
Surgical Interventions
Various procedures to address specific sites of obstruction, from nasal surgery to multilevel pharyngeal procedures or skeletal advancement.
Lifestyle Adjustments
- •Achieve and maintain a healthy weight
- •Avoid alcohol, especially within 3 hours of bedtime
- •Sleep on your side rather than your back
- •Quit smoking
- •Treat nasal congestion and allergies
- •Maintain regular sleep hours
- •Elevate the head of the bed if reflux is present
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