Sleep Apnoea (or apnea) is a disorder when breathing stops during sleep for a brief time (>10secs) that can affect 2-4% of adults and up to 30% of the elderly, but could be much higher due to unknown mild cases. Those who snore loudly and still feel tired after they have what they think is a full night’s sleep, may have sleep apnoea.
If not treated, there is an increased risk for hypertension, stroke, arrhythmias, cardiomyopathy, heart failure, diabetes, obesity, myocardial infarction, COVID-19.
Those with sleep apnoea are at an increased risk for motor vehicle accidents.
Strongly linked to Alzheimer’s disease.
Two main types:
- Obstructive sleep apnoea (airway is obstructed)
- Central sleep apnoea (loss of sensitivity of central respiratory control mechanisms)
Sometimes elements of both types are present and is diagnosed as complex or mixed sleep apnea. The clinical features and risk factors of the two do overlap and they have similar treatments.
In those with sleep apnoea carbon dioxide will build up in the bloodstream when breathing stops and that increased level will be detected by chemoreceptors. This will signal to awaken the person which will clear the airway and allows normal breathing to resume to restore oxygen levels and then allow sleep to resume.
Obstructive Sleep Apnoea:
The more common type that occurs when breathing is interrupted by a blockage of air flow
The typical symptoms include loud snoring; observation of episodes of stopped breathing during sleep by others; gasping for air during sleep; restless sleep; dry mouth in the morning; morning headache; insomnia; daytime drowsiness; night sweats; frequent nighttime urination; attention difficulties; increased irritability
Risk factors: obesity; thicker necks; narrowed airway; enlarged tonsils; larger tongue volume; male; older; family history; using alcohol and sedatives; smoking; difficulty breathing through the nose; medical conditions (eg congestive heart failure, hypertension, type 2 diabetes, Parkinson’s disease, polycystic ovary syndrome)
Central Sleep Apnoea (CSA):
This occurs when the brain doesn’t send proper signals to the muscles which control breathing as the brain stem fails to properly recognize carbon dioxide levels. Affects less than 1% of the population.
Signs of CSA are similar to obstructive sleep apnoea, but are most commonly: abnormal breathing patterns and rythms; excessive daytime drowsiness; nighttime wakings; a sudden shortness of breath or chest pains at night; morning headaches.
Risk factors: older; male; congestive heart failure; opioid medications, infection or injury of brain stem; stroke, neuromuscular diseases (eg amyotrophic lateral sclerosis); postpolio syndrome; being at high altitude.
Following a history and heath assessment, then often will undergo a sleep study to measure EEG; blood oxygenation; eye movements; sleep position and limb movements; heart rate; breathing; snoring.
Management of Sleep Apnoea:
Lifestyle changes (avoid alcohol, losing weight, stop smoking, sleep on the side).
Mouthpieces (‘mandibular advancement splint’ – a custom-made mouthpiece which that shifts the lower jaw forward to open up the airway)
Breathing devices (continuous positive airway pressure (CPAP) devices; very effective)
Surgery of any obstructions.
For central sleep apnea, address the underlying medical condition in addition to the above.
There are currently no medication recommended for obstructive sleep apnoea, but acetazolamide, zolpidem or triazolam may be trailed for central sleep apnoea, depending on the underlying risk factors.
Relevance to Podiatry:
The prevalence of diabetic foot ulcers is higher in those with sleep apnoea and healing is impaired in those who have diabetic foot ulcers. Those with a diabetic foot ulcer may have undiagnosed sleep apnoea, so appropriate screening questions should be asked and appropriate referral if necessary.
Sleep apnoea and diabetic foot ulceration (Podiatry Arena)
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