Friday, August 18, 2006

Sleep Apnea

I suffer from mild sleep apnea which means that my breathing gets interrupted frequently during sleep. Despite being married for 14 years, it was after sharing a room with a stranger at a conference in Portugal, that this was pointed out to me. It is a progressive condition that gets worse with age. Frequently, particularly in the winter, I also find my airways severely congested in the mornings and a strong cuppa is required to get me started for the day. This new paper in the Monaldi chest archive explains the link:

Obstructive sleep apnea (OSA) is characterised by repetitive episodes of upper airway occlusion during sleep. OSA has been shown to be associated with a variable degree of nasal inflammation, uvula mucosal congestion and airway hyperreactivity. The upper airway inflammation, whose clinical importance is uncertain, is characterised by leukocytes infiltration and interstitial oedema. In addition, recent data has shown the presence of neutrophilic inflammation in the lower airways. The current opinion is that airway inflammation is caused by the local, repeated mechanical trauma related to the intermittent airway occlusion typical of the disease. Another potential mechanism involves the intermittent nocturnal hypoxemia that through the phenomenon of the ischemia-reperfusion injury may induce the production of oxygen free radicals and therefore cause local and systemic inflammation. Finally, a state of low-grade systemic inflammation may be related to obesity per se with the pro-inflammatory mediators synthesised in the visceral adipose cells. Several authors stress the role of circulating and local inflammatory mediators, such as pro-inflammatory cytokines, exhaled nitric oxide, pentane and 8-isoprostane as the determinants of inflammation in OSA.

Airway inflammation in patients affected by obstructive sleep apnea. Sabato R, Guido P, Salerno FG, Resta O, Spanevello A, Barbaro MP. Monaldi Arch Chest Dis. 2006 Jun;65(2):102-5.

In the USA, the FDA have approved a new treatment called radiofrequency volumetric reduction of the tongue. This involves piercing the tongue, throat or soft palate with a special needle connected to a radio frequency generator. The inner tissue is then heated to around 170 degrees and shrinks, but the outer tissues are left intact. I haven't seen any results, but I pictured a large man with a very small tongue and a squeaky voice when I read about it.


Blogger ion said...

Don't let any surgeon fry your upper airway- they've been nipping and tucking there for years and the results are not impressive (see Cochrane review or the SIGN guideline on treatment for OSA). In the good old days, they'd just bypass your upper airway with a tracheostomy.

I'm not well informed on this, but I suspect that OSA partly results from the narrowing and shortening of the upper airway during human evolution. Bipedalism put a kink in the airway, and speech moved the larynx and hyoid around. Humans, unlike most other vertebrates, can't vocalise or breathe while eating/drinking.

Two of the best ways to induce temporary OSA are through the ingestion of alcohol (reduced drive for breathing and relaxed musculature) or by being pregnant (high circulating progesterone and reduced lung volumes). I snore like a bastard under both circumstances. At least you don't have either of those problems, Kebz.

ion xx

8:10 AM  
Blogger Kebz said...

My snoring seems to have improved recently or at least the better half hasn't complained about it. We have a light sleeping baby who insists on sharing the bed rather than going in the cot so he would probably be up all the time if I was going like a pneumatic drill like my dad. Good advice on the treatments. I'm not convinced by any of them and I'm certainly not having the useless ENT people in our local infirmary poke about except in an emergency.


6:04 PM  

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