Early Signs of Obstructive Sleep Apnea (OSA)



Written By:

Dr. Kavan Shah
B.D.S, M.A.S (Batch of 2025)


Reviewed By:

Dr. Sujit Pradhan
Co-Founder & Mentor, Simpli Boards


Table of Content:

"Sleep is the best meditation." — Dalai Lama

Do you often wake up feeling exhausted despite a full night’s sleep? Or perhaps you struggle to concentrate during the day, battling constant fatigue that seems inexplicable. If so, you might be among the millions silently grappling with a common yet often undiagnosed sleep disorder: sleep apnea. According to estimates, approximately 22 million Americans and Canadians suffer from sleep apnea, with many cases remaining undiagnosed.

What is sleep?

Sleep is a reversible state involving disengagement from the environment, encompassing both physiological and behavioural processes. It is an active process and consists of two states, non-rapid eye movement (NREM) and rapid eye movement (REM), alternating cyclically (total of 4 to 6 cycles are noted during sleep in adults), each cycle lasting on an average from 90 to 110 min. NREM sleep, comprising four stages based on EEG patterns, constitutes 75-80% of sleep time, with increasing depth from stage 1 to stage 4. NREM sleep is associated with minimal mental activity. On the other hand, REM sleep, accounting for 20-25% of total sleep time, is characterized by rapid eye movements, muscle atonia, and cardiorespiratory irregularities.

Sleep Disorders

Sleep disorders are any conditions that impair one’s sleep or prevent one from receiving restful sleep. Common Examples are Snoring, Insomnia, Parasomnia, Narcolepsy, Sleep-related breathing disorders like Obstructive sleep apnea & Central sleep apnea, Sleep-related movement disorders like Restless leg syndrome & Nocturnal bruxism.

Understanding Sleep Apnea

Sleep apnoea is defined as an intermittent cessation of airflow in nose and mouth during sleep. 

Apnoea is defined as cessation of airflow for at least 10 seconds with a drop in oxygen saturation.

Types of Sleep Apnea

Sleep apnoea is of two types: 

  • Obstructive Sleep Apnea (OSA) – Physical obstruction of airflow during sleep.
  • Central Sleep Apnea (CSA) – Altered brain activity causes temporary lack of inspiration during sleep.

Complex Sleep Apnea – Aka Treatment-emergent central sleep apnea. It occurs when someone who is Diagnosed with OSA using sleep study, converts to CSA during treatment for OSA.

Obstructive Sleep Apnea (OSA)

Obstructive Sleep Apnea (OSA) is a common sleep disorder characterized by recurrent pauses in breathing during sleep, caused by the temporary collapse of the upper airway. It is caused due to physical obstruction of airflow during sleep. These interruptions, known as apneas, result in obstructed airflow into the lungs and can occur in various throat areas. OSA poses potential health risks and significantly affects overall well-being.

Severity Index: Classification

The Apnea-Hypopnea Index (AHI) – It is used to determine the severity of sleep apnea. The apnoea hypopnoea index (AHI) is calculated by the average number of apneas and hypopneas per hour of sleep. Diagnosis of sleep apnoea is confirmed if AHI is greater than or equal to 5. 

AHI = (No. of Apneas + No. of Hypopneas)/ Hours of Sleep

*Apnea – Complete cessation of airflow for at least 10s 

*Hypopnea – Reduction of airflow for at least 10s 

A Nightly Workout for the Heart

he repeated cycles of oxygen deprivation and arousal during sleep apnea can strain the cardiovascular system. Over time, this stress may contribute to the development of cardiovascular diseases such as hypertension and an increased risk of stroke.

Symptoms & Risk Factors

  • The most common symptom of sleep apnea is Snoring. However, not everyone who snores has sleep apnea. Snoring is likely to be a sign of sleep apnea when it is followed by silent breathing pauses and choking or gasping sounds. 
  • Some common symptoms are as follows:
    • Nocturnal choking or gasping
    • Loud or irregular snoring
    • Observed apneas during sleep (e.g., by spouse or bed partner)
    • Excessive daytime sleepiness
    • Nocturia
    • Dry mouth on awakening
    • Morning headache
  • Risk factors For OSA 
    • Obesity 
    • Retrognathia 
    • Micrognathia 
    • Large Tongue 
    • High arched palate 
    • Male gender 
    • Enlarged neck circumference 
    • Narrowing of regions of upper airway 
    • Older age 
    • Enlarged tonsils or adenoids
    • Alcohol consumption
    • Nasal obstruction
    • Ethnicity (e.g., African American adults appear to have higher prevalence)

How is OSA diagnosed?

Diagnosis of Obstructive Sleep Apnea (OSA) involves a comprehensive assessment by a physician or sleep specialist, including medical history, physical examination, and diagnostic testing. The reference standard for diagnosis is an overnight polysomnogram, measuring various parameters during sleep like EEG (brain wave activity), ECG (heart activity), EMG (muscle & jaw movement), EOG (eye movement), Nasal airflow, Thoracic movement, Abdominal movement & Oxygen Saturation. Nowadays, home testing kits are accessible on the market. 

Home sleep apnea testing, while less expensive and more convenient, lacks the sensitivity required to rule out a sleep apnea diagnosis because it does not typically record sleep and Wakefulness. A Clinical questionnaire can be used to assist with conducting OSA risk assessment like STOP Bang questionnaire, Berlin questionnaire & Pittsburgh sleep quality index for initial screening purposes.

The Genetic Connection

 There is evidence to suggest a genetic predisposition to sleep apnea. If a family member has been diagnosed with sleep apnea, there may be an increased likelihood of its occurrence in subsequent generations.

Challenges in the identification and management of OSA

According to Frost & Sullivan, The first and most significant challenge is that the public awareness regarding the condition is lacking, with a significant number of individuals failing to recognize its symptoms and the severity of its impact.

Secondly, Primary care physicians, who serve as frontline caregivers, often neglect to inquire about the duration and quality of sleep or screen patients for the condition. Furthermore, Despite being covered by payers for eligible patients, the costs associated with diagnosis and treatment, including testing, appointments, treatment devices, and potential surgery, amount to an average of $2,105 per year.Lastly, there is an ongoing effort among economic stakeholders to develop cost models that incentivize the management of chronic conditions, aiming to financially reward initiatives that mitigate longer-term risks associated with acute events.

Health Consequences of Sleep Apnea (Complications If Left Untreated)

Each episode of breath cessation during sleep, characteristic of untreated sleep apnea, results in a critical deprivation of oxygen to the brain and body, imposing a strain on the cardiovascular system. This chronic oxygen deprivation has been linked to an array of serious health complications, including hypertension, heart disease, and stroke.

Moreover, untreated sleep apnea is associated with an increased risk of developing type 2 diabetes and obesity.

Beyond the individual health implications, the disruptive nature of sleep apnea, with frequent awakenings throughout the night, can lead to excessive daytime sleepiness, impaired cognitive function, and diminished overall quality of life.The repercussions of untreated sleep apnea extend beyond individual health, as the condition’s pervasive impact on sleep quality poses risks not only to the sufferer but also to family members who may share disrupted sleep patterns.

Given the integral role of sleep in overall health, allowing sleep apnea to persist becomes increasingly perilous, emphasizing the urgency of addressing the condition to mitigate potential complications for both individuals and their immediate social environment.

The Silent Intruder

Sleep apnea often goes undiagnosed because its symptoms, such as snoring and interrupted breathing, occur during sleep. Many individuals remain unaware of their condition until it is brought to their attention by a sleep partner or through a diagnostic sleep study.

Treatment Options

1. Behavioral Modification
  • For mild-to-moderate obstructive sleep apnea (OSA), initial treatment involves lifestyle changes like diet, weight loss, and exercise
  • Cutting back on alcohol, especially before bedtime, is recommended.
  • Patients are also educated about the potential impact of alcohol and recreational drugs on OSA therapy.
2. Positional Sleep
  • This approach is for individuals who experience apnea mainly when sleeping on their back.
  • This strategy includes using a device around the waist or back to maintain a side sleeping position or a vibrating device to prompt position change.
3. Positive Airway Pressure (PAP) Therapy
  • Positive airway pressure (PAP) stands out as a primary therapy for managing adult obstructive sleep apnea (OSA). PAP devices, utilizing air pressure, counteract airway narrowing by delivering compressed air through an air-tight attachment, like a mask covering the sleeper’s nose.
  • Continuous positive airway pressure (CPAP): CPAP is considered gold standard treatment for mild to moderate cases. It works by delivering a constant flow of air while sleeping to reduce the chances of airway collapse. Some CPAP devices called auto-adjusting PAP (APAP) machines automatically adjust the air flow to your breathing patterns.
  • Bilevel positive airway pressure (BiPAP): Doctors may prescribe BiPAP if CPAP is not working well for you. It works by delivering two different levels of airflow, one for breathing in and the other for breathing out.
4. Oral Appliances
  • If PAP therapy does not improve your OSA, then oral appliances could be an option. Many patients find oral appliances more comfortable than wearing PAP equipment at night. Appliances work by stabilizing your mouth to improve airflow.
  • Various oral appliances are available, such as mandibular advancement devices and tongue-retaining devices.
  • These custom-fitted devices, placed in the mouth during sleep, stabilize the mandible and prevent the collapse of oropharyngeal tissue and the base of the tongue, reducing upper airway blockage.
5. Surgery
  • For patients unresponsive to non-surgical OSA treatments, surgery may be recommended. Procedures involve adjusting structures to reduce upper airway obstruction or implantation of neurostimulator devices.
  • Surgical options might include:
    • Hypoglossal nerve stimulation, using an implantable device, aids airway patency in individuals by stimulating the tongue to push outwards rhythmically.
    • Removing obstruction 
    • Septoplasty
    • Adenoidectomy
    • Tonsillectomy
    • Uvulectomy
    • Lingual tonsillectomy
    • Mandible and maxillary advancement osteotomy

In conclusion, The profound impact of sleep apnea on overall health cannot be overstated, and the significance of early detection and intervention is paramount. As future dental professionals prepare for their board exams, it is crucial for them to grasp the nuances of sleep apnea, its implications for oral health, and the integral part they can play in its management. 

How Simpli Boards Can Help To Gain Access on Such Subjects?

Our commitment at Simpli Boards, as a leading resource for dental boards preparation, is to empower aspiring dental professionals with comprehensive knowledge and skills to excel in addressing complex issues such as sleep apnea.

By choosing Simpli Boards, future dentists gain access to meticulously curated study materials- Simpli Notes,various practice questions through Core Test, Viital test, Mini mocks or Mastermind Test and expert mentors guidance, ensuring they are well-equipped to navigate the challenges posed by sleep-related disorders on their dental boards. Our innovative approach to exam preparation not only fosters academic success but also cultivates a deep understanding of the broader healthcare landscape, positioning our users as leaders in the field.

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