Obstructive Sleep Apnea

What is obstructive sleep apnea?

Obstructive sleep apnea occurs when your breathing is interrupted during sleep, for longer than 10 seconds at least 5 times per hour (on average) throughout your sleep period. These periods are called hypopneas when your breathing is reduced and you're not taking in enough oxygen. They're called apneas if your breathing completely stops. Your breathing typically stops because something is blocking your upper airway, such as the muscles, tongue, and other body tissues.

Obstructive sleep apnea can range from moderate to severe, based on a measurement and rating system called the apnea-hypopnea index (AHI). The AHI measures an average number of apnea and hypopnea episodes that you experience per hour that you sleep.

Obstructive sleep apnea is classified by severity:

  • Severe obstructive sleep apnea means that your AHI is greater than 30 (more than 30 episodes per hour)

  • Moderate obstructive sleep apnea means that your AHI is between 15 and 30

  • Mild obstructive sleep apnea means that your AHI is between 5 and 15

Seminar What’s New in the Surgical Treatment of Obstructive Sleep Apnea

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Learn about the newest medical and surgical options for patients with obstructive sleep apnea who struggle with using a CPAP machine.

What causes obstructive sleep apnea?

When you sleep, your body is completely relaxed — even the muscles that help you breathe. In people with sleep apnea, these relaxed muscles combine with a narrowed airway to interrupt breathing.

Anyone at any age can have obstructive sleep apnea, but it's most common in middle-aged and older adults. Only about 2% of children have obstructive sleep apnea. It's also more common in men than in women.

But what's frightening is that as many as 90% of people who have obstructive sleep apnea don't know that they have it. Untreated, sleep apnea can lead to serious health problems.

Who is at risk for obstructive sleep apnea?

Knowing the risk factors for obstructive sleep apnea can help you get a diagnosis. Risk factors include:

  • Family member with obstructive sleep apnea

  • Large or thick neck (greater than 16 inches for women and 17 inches for men)

  • Chronic nasal congestion

  • Thyroid disorder or other endocrine condition

  • Postmenopause

  • Being overweight

  • Defect of the tissues that support the head and neck

  • Down syndrome

  • Smoking

  • Swollen or large adenoids and tonsils (in children)

What are the symptoms of obstructive sleep apnea?

Some people have obstructive sleep apnea with no symptoms. Others find that they just don't feel rested after a night of sleep and feel sleepy during the day.

Snoring is one of the biggest symptoms of obstructive sleep apnea. Other symptoms include:

  • Snoring that's interrupted with periods of quiet (called an apnea episode)

  • Snoring that resumes with a loud sound as breathing starts again

  • Morning headache

  • Frequently falling asleep during the day

  • Being easily irritated

  • Depression

  • Difficulty remembering things

How is obstructive sleep apnea diagnosed?

Diagnosis of obstructive sleep apnea usually involves participating in a sleep study, in which you're observed as you sleep. You may participate in a test called a polysomnogram at a hospital or sleep center. But you may also use a take-home version of the test. Your doctor may give you a monitor to wear when you sleep that measures your oxygen levels and heart rate, to help diagnose sleep apnea.

Your doctor will also typically do a physical exam, including an exam of the throat, neck, and mouth, and take your medical history. You'll probably also have to answer questions about your sleep and bedtime routine, as well as your symptoms.

How is obstructive sleep apnea treated?

These are common treatments to maintain consistent breathing and stop or reduce apnea episodes:

  • Sleeping with a CPAP (continuous positive airway pressure) machine and mask – this treatment provides a constant flow of air to help keep your airway open

  • Wearing an oral appliance, a custom-fit mouthpiece your dentist or orthodontist can make for you to keep airways open while you sleep

Several types of surgery can be done to treat obstructive sleep apnea:

  • Surgery to repair defects in facial structures

  • Surgery to get rid of extra tissues that can block airways

  • Surgery to repair abnormalities that cause obstructions when you breathe or to create a wider airway

  • Removal of adenoids and tonsils; this is most effective in children

  • Hypoglossal nerve stimulator- an implant device that delivers upper airway stimulation synchronized to your breathing to relieve obstruction during sleep

Making a few changes to your sleep and other behaviors can also help manage obstructive sleep apnea:

  • Shed any excess weight.

  • Sleep on your side instead of on your back.

  • Avoid alcohol.

  • Limit your use of sedatives.

What are the complications of obstructive sleep apnea?

Letting obstructive sleep apnea continue untreated is risky — you can get in a serious accident if you fall asleep while operating machinery or driving a car.

Health problems may develop as a result of obstructive sleep apnea, including:

  • Increased blood pressure

  • Instability of oxygen levels

  • Changes in your body's response to insulin and glucose

  • Changes in mental function and mood

  • Cardiovascular problems like heart failure, stroke, or abnormal heartbeat (arrhythmia)

Can obstructive sleep apnea be prevented?

Avoiding behaviors that relax your muscles can help prevent apnea episodes. Don't drink alcohol or take sedatives to help you sleep, and maintain a healthy weight.

When should I call my healthcare provider?

If your bed partner hears symptoms of apnea episodes or your snoring is problematic, it's a good idea to visit your doctor to talk about your symptoms and ask about a sleep study. Feeling drowsy or falling asleep frequently during the day are also signs that you should call your doctor.

Key points about obstructive sleep apnea

  • Don't risk falling asleep in a dangerous situation, such as while driving.

  • Try to set up an appointment with your doctor if your fatigue continues.

  • If obstructive sleep apnea persists over a long period without treatment, you're at risk for major health problems and serious events. These can include cardiovascular problems like heart failure and increased blood pressure.

Johns Hopkins Center for Snoring and Sleep Surgery

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Johns Hopkins Otolaryngology–Head and Neck Surgery’s experts are now available to implant an FDA-approved hypoglossal nerve stimulator as a new treatment strategy for patients with obstructive sleep apnea (OSA). Find out how you can receive this surgical treatment.

Get a Better, More Restful Night’s Sleep

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More than 60 million Americans suffer from poor sleep quality, and more than 40 million meet the diagnostic criteria for sleep disorders. Sleep is critical to a healthy mind and body – learn how to get a better, more restful night’s sleep in the Johns Hopkins Healthy Sleep portal.

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