Get Treatment For Obstructive Sleep Apnea

Obstructive sleep apnea (OSA) is a serious, sleep-related breathing disorder that involves a partial or total blockage of airflow in the upper airway, which occurs because of collapsing soft tissues in the back of the throat due to relaxed muscles during sleep. OSA most commonly happens when you are lying down on your back. The partial or complete halt in breathing lasts for about 10 seconds during sleep, but at times may persist for 1 minute or longer. This causes a sudden decrease in the blood oxygen saturation level. As a result, your brain responds to this lack of oxygen and alerts your body to awaken you from sleep and restore breathing.

Obesity is one of the most complicating factors that potentiate the development of OSA. Obese people have more thick tissues around the throat, which predisposes them to sleep apnea. The prevalence of OSA in obese individuals is found to be as high as 45%. OSA may occur in people of all ages but affects about 25% of men and 10% of women.

Initially, the treatment for OSA is the adjustment of the sleeping position,  which means lying on your sides rather than on your back. By doing this, the soft tissues of your throat do not recede and thus resolves the breathing difficulty to some extent. If this method is ineffective, a specialized machine that pumps air gently through a mask worn while sleeping is recommended. This maintains the air pressure within the airway sufficiently high to prevent the collapse of the soft palate.

Bariatric Surgical Procedures Performed to Treat Obstructive Sleep Apnea at Cedars-Sinai Marina del Rey Hospital

Weight loss is a most effective treatment option for overweight people with mild or moderate OSA as it resolves sleep-disordered breathing. The American Academy of Sleep Medicine recommends that weight loss should be advised to every patient with OSA even though other treatments are being used. Weight loss achieved through bariatric surgery can decrease the severity of OSA symptoms, and sometimes, may cure OSA completely. Bariatric surgery is indicated in patients with a body mass index (BMI) ≥ 35-40 and other co-morbidities. It can achieve a sustainable weight loss and is used as adjunctive treatment in OSA.

At Cedars-Sinai Marina del Rey Hospital, a weight loss surgery procedure is performed to observe significant improvement in OSA symptoms. As weight-loss or bariatric surgery is a major procedure, it is considered only when all the other conservative treatments for OSA fail to improve the condition.

Bariatric surgery may be performed using one of the following surgical techniques:

• Roux-en-Y gastric bypass
• Adjustable gastric banding
• Sleeve gastrectomy

Our surgeons will decide on the type of procedure that best suits your needs.

Minimally Invasive Techniques

Most often, our surgeons perform weight loss procedures using advanced laparoscopic (minimally invasive) techniques that have benefits such as lesser pain and scarring due to smaller incisions that facilitate quick recovery.

Laparoscopic Roux-en-Y Gastric Bypass

In this procedure, a smaller stomach pouch is created so that you can take in less amount of food. Then, your intestine is rerouted to connect the small stomach pouch to the lowermost segment of your small intestine. Generally, the recovery period is around 3-4 weeks after which you can return to work.

Laparoscopic Adjustable Gastric Banding (LAGB)

This technique involves the placement of an adjustable as well as inflatable band made of silicone material around the upper portion of your stomach. When adjusted in a proper way, it helps you restrict the food intake and control your hunger. The recovery is usually very quick and you can return to work in 1-2 weeks. The drawbacks involved in this procedure include the frequent need to adjust the band postoperatively, slippage of the band, and gastric prolapse, which requires a corrective surgical procedure.

Laparoscopic Sleeve Gastrectomy

This technique is a part of the staged approach followed to achieve surgical weight loss. It restricts the food intake by decreasing the size of your stomach. This approach is useful in patients with extremely high BMI, people with a heart or lung disorder, or individuals who cannot tolerate anesthesia and surgical procedures of longer duration. After the surgery, the recovery requires about 3-4 weeks. No frequent adjustments and postoperative visits are needed, which means the procedure is comparatively more compliant and efficacious.

Drugs and Other Treatment Needed for Obstructive Sleep Apnea

A wide range of treatment strategies is used in OSA to achieve long-term success.

Oral appliances »

Continuous positive
airway pressure »

Medications »

Behavioral changes »

Generally, people who snore loudly or have difficulty in breathing during sleep suffer from Obstructive Sleep Apnea Syndrome (OSAS). This condition involves two basic types that are described below.

Hypopnea »

Apnea »

Signs and Symptoms of Obstructive Sleep Apnea

The problems with sleep quality develop slowly and may progress over some years, particularly when your weight increases at the same time. Most often, you may not recognize any symptoms as you fail to remember the sleep and wake cycles that occur during the night.

The following signs and symptoms indicate the presence of OSA.

• Extremely loud snoring
• Episodes of interrupted breathing and waking up in the night gasping for breath
• Excessive daytime sleepiness (EDS): falling asleep at work or while driving
• Headaches, sore throat or unexplained nausea while you wake up in the morning
• Irritability, mood swings, anxiety or depression
• Trouble in concentrating and forgetfulness
• Appearance of dark circles below the eyes

Diagnosis of Obstructive Sleep Apnea

Your doctor will inquire about your medical history, your behavior during the day and night sleep. During the physical examination, signs such as the presence of upper body obesity (higher BMI>3Okg/m²), wider neck circumference (more than 43 cm in men and 37 cm in women), abnormalities in the upper airways or soft palate, enlargement of the tonsils, and blood pressure will be checked for.

To evaluate your sleep behavior, a study called polysomnography may be advised. Polysomnography is an overnight sleep study performed at a sleep center, during which tiny sensors are attached to specific positions in your body to record brain waves, movements of your arms and legs, heart rhythm, respiratory rate, oxygen level, muscle activity, and other functions during sleep.

Sometimes, an X-ray or direct examination of your airways is performed to rule out any abnormalities in the throat.

Another type of study called Multiple Sleep Latency Test (MSLT) may be done during the day. In this test, you will be monitored through a nap lasting for 20 minutes, taken at every 2-hour intervals. This helps measure daytime sleepiness and other causes of sleepiness such as narcolepsy.

Risk Factors for Obstructive Sleep Apnea

A major risk factor involved in the development of OSA is obesity. OSA is almost twice more common in obese and severely obese patients than individuals with a normal weight. Being overweight (BMI of 25 to 29.9) and obese (BMI of more than 30) can increase your risk of developing OSA.

Both waist and neck measurements are indicators of central obesity and are associated with an increased risk of OSA. Middle-aged or elderly men with central fat deposits and around the neck and postmenopausal women have increased deposits of visceral fat, thereby, are associated with a higher risk of OSA. Several other risk factors involved in the progression of OSA include:

• Racial or ethnic background: African-American people are predominantly at a greater risk of developing sleep disordered breathing.
• Abnormalities in the bone or soft tissues of the head and neck region
• Children with Down syndrome, enlarged tonsils, and adenoids
• Family history of OSA
• Habit of smoking
• Endocrinal diseases such as hypothyroidism and acromegaly

Causes of Obstructive Sleep Apnea

The increased neck circumference and fat deposition surrounding the upper airway that occurs in obese individuals causes the narrowing of the air passages. Central or abdominal obesity is associated with reduced lung volumes, which increase the severity of sleep apnea. Increased collapsibility of the upper airways as a result of fat deposition is the main cause for the development of OSA in obese individuals.

The factors such as inactive lifestyle and increased food intake, especially refined carbohydrates are reasons for weight gain in patients with OSA. On the other hand, a hormone called ghrelin (produced by cells of the stomach lining) can stimulate appetite. The level of this hormone is elevated in obese individuals during the night, and further disturbed/reduced sleep increases the release of ghrelin. Eventually, increased appetite may lead to obesity.

You may also be advised alternative medical therapies as some of these can help in the treatment of sleep apnea caused by allergic conditions.

Alternative Systems of Medicine - Homeopathy

Certain homeopathic remedies that are used as supportive therapy for sleep apnea include Arsenicum album, Lachesis, Opium, Sambucus, Spongia, and Sulphur. The most appropriate remedy for your condition will be determined after evaluation by your homeopath.

Biologically based therapies - nutrition and herbal supplements

• Diet: Add plenty of fruits and vegetables, whole grains, and dairy products with low-fat into your daily diet. Restrict the intake of saturated fats such as butter, meat, and processed food products. Consider using healthier fats, for example, olive oil for cooking. These dietary changes help lose your excess weight. Avoid eating foods that stimulate the production of excess mucus (bananas).
• Chromium supplements: These are commonly used to lose weight and build a more lean muscle mass, but are less effective when compared to lifestyle changes such as regular exercise and healthy dietary modifications.

Acupuncture

There is some evidence that a kind of acupuncture method called auriculotherapy acupoint pressure may be suggested in the treatment of sleep apnea.

The following preventive measures could help an obese person deal with or prevent the worsening of OSA:

• Restriction of body position during sleep: Breathing disorder associated with OSA may be worse in the supine position (lying on your back). Avoiding this position using materials such as a snore ball (a small ball sewn to the backside of your dress) or a gravity-activated position monitor may be helpful in patients with mild OSA. Severely obese people may stay in the upright position while sleeping. The Food and Drug Administration has approved a special pillow called PillowPositive that helps in maintaining upper airway patent by holding your head and neck in position during sleep.
• Smoking cessation: Quitting smoking helps in reducing your risk of snoring and apnea.
• Avoid alcohol: Consumption of alcohol or other sedatives should be avoided as these are known to worsen apnea.

If you are obese and suffering from symptoms of OSA, weight loss surgery could help in the remission of disorderly breathing during sleep. If you need any guidance, our surgeons at Marina Weight Loss can answer your questions and advise appropriate treatment.