Obstructive sleep apnea

What happens in sleep apnea

During sleep, the muscle tone of the throat and tongue naturally falls. In predisposed people, the upper airway closes partially (hypopnea) or completely (apnea) for 10 seconds or more, with continued chest effort to breathe. Blood oxygen falls, carbon dioxide rises and the brain briefly “wakes” (arousal), reopening the airway, usually without the person remembering. This repeats dozens of times an hour and fragments sleep, even when total duration seems normal.

Severity is measured by the apnea-hypopnea index (AHI), the number of events per hour of sleep: 5 to 14 is mild, 15 to 30 moderate, over 30 severe. The effects include daytime sleepiness, a higher risk of accidents, poor concentration, and a burden on the cardiovascular system: repeated arousals stimulate the sympathetic nervous system and raise blood pressure.

What the signs are

• Loud, frequent snoring.
• Pauses in breathing noticed by family members.
• Waking with a choking feeling or suddenly gasping.
• Unrefreshing sleep, fatigue or daytime sleepiness.
• Morning headache and difficulty concentrating.

Some people have less obvious symptoms, especially women, in whom fatigue, insomnia and low mood may predominate. Absence of sleepiness does not exclude the condition.

Who is at higher risk

Overweight (especially a larger neck circumference), anatomical features of the upper airway (large tonsils, small jaw), age, male sex and family history affect the risk. Alcohol and some sedatives worsen breathing during sleep by lowering muscle tone. Apnea can also be present in people who are not obese. It is linked with arterial hypertension, arrhythmias (particularly atrial fibrillation), heart failure and type 2 diabetes, and can contribute to difficulty controlling blood pressure, especially when it stays high despite treatment with several drugs.

How it is diagnosed

The doctor reviews symptoms and risk factors and examines the upper airway. Questionnaires (for example a sleepiness scale) help the initial assessment but do not establish the diagnosis alone.

A sleep study, or sleep monitoring, is performed at the clinic as indicated: the device records breathing, airflow, chest effort, oxygen saturation and heart rate overnight and reports the AHI. The type of monitoring is decided during the consultation. In some cases, for example when symptoms are marked but the test is normal, or other serious disease is present, additional testing with full polysomnography at a suitable service may be recommended.

A normal oxygen reading in the daytime or the data from a smartwatch do not exclude apnea.

How it is treated

Treatment is tailored to severity and to the patient’s condition. It includes weight control, avoiding alcohol and sedatives before sleep, positional measures (avoiding sleeping on the back when apnea occurs mainly in that position) and CPAP, a device that delivers air at continuous positive pressure through a mask and keeps the airway open. CPAP is the most effective treatment for moderate and severe apnea, improves sleep, sleepiness and often blood pressure, but must be used every night.

In selected patients, oral appliances (which advance the jaw) or specialized procedures are used. Selection and fitting are done at the relevant service. If the device is uncomfortable, ask for the mask or pressure to be reviewed and do not abandon it without discussion.

Safety and follow-up

Do not drive if you are drowsy or fall asleep at the wheel; seek prompt assessment. Tell the anesthetist about apnea and CPAP use before any procedure. Do not take sleeping pills without medical advice. Follow-up checks symptoms, device use and the effect of treatment; reviews take place every 6 months to a year, or sooner when the doctor considers it reasonable, as well as after major weight changes.

Care at Tirana Polyclinic: we offer pulmonology consultation, sleep study and monitoring at the clinic, interpretation of results and guidance on treatment. As needed, care is coordinated with cardiology and endocrinology.