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Sleep Apnea Syndrome

By Dr. Adam S. Mednick, M.D., Ph.D.

Sleep apnea syndrome is one of the most under diagnosed illnesses, not only in the United States, but throughout the world. The word ‘apnea’ is derived from the Greek apnoia, meaning’ ‘want of breath’. Neurologists and other healthcare workers use this term ‘apnea’ to define any cessation of breathing, usually occurring during sleep.

Sleep apnea is further subdivided into central and obstructive; patients with central sleep apnea have an underlying dysfunction (due to brain infection, tumor or stroke, for example) of the lower part of the brain, called the medulla which regulates sleep patterns, whereas obstructive sleep apnea refers to a mechanical obstruction in the larynx (upper part of the airway), through which air must travel from the mouth into the lungs, more often due to obesity and usually associated with excessive snoring during sleep.

Interestingly, central sleep apnea is also colloquially known as ‘Ondine’s curse’; in Greek mythology, Ondine is a water nymph who fell in love with Sir Lawrence, a knight. According to this story, as a result of marrying Sir Lawrence, Ondine lost her immortality, following which she unfortunately lost her attractiveness, which led Sir Lawrence into the arms of another woman. Outraged by his infidelity, Ondine placed a curse upon Sir Lawrence that robbed him of the ability to automatically breath while sleeping, i.e., should Sir Lawrence fall asleep, he would stop breathing and, hence, die.

Obstructive sleep apnea syndrome (OSA) is often associated with obesity and tends to more prevalent amongst overweight, middle-aged white males, although this condition does afflict women as well. Obstructive sleep apnea is characterized by daytime fatigue, in association with other symptoms, including headaches, neck and back pains, and depression. Given the enormous epidemic of obesity in the United States, many of these overweight individuals no doubt suffer from OSA.

Like Ondine’s curse (central sleep apnea syndrome), OSA has its place in classic literature. Obstructive sleep apnea is also sometimes referred to as the ‘Pickwickian syndrome’, so-named because of a somnolent (fatigued) overweight character, aptly named Fat Joe, in Charles Dickens’ novel entitled “The Pickwickian Papers”. Obstructive sleep apnea syndrome is sometimes associated with what is called ‘obesity hypoventilation’, however, not all patients with OSA suffer from hypoventilation, which means decreased rate or depth of breathing. The majority of people with OSA suffer from excessive sleep-associated snoring; their bed partners often note pauses (“apnea spells”) in their breathing that may last up to minute, usually in association with loud snoring. Obstructive sleep apnea is more common than its central counterpart. Some people may have a combination of central and obstructive sleep apnea, referred to as mixed apnea syndrome.

If you, or someone you know, are obese and suffer from daytime fatigue, and your bed-partner tells you that you also snore and stop breathing for short periods of time, you may be suffering from sleep apnea syndrome. If so, you should contact your physician as soon as possible so that he/she may arrange for you to be evaluated by an appropriate specialist for sleep apnea syndrome.

In addition to the observations of a bed-partner (if available), sleep apnea syndrome may be diagnosed by a sleep study, in which you are admitted to a sleep laboratory overnight, during which time a trained technician monitors your breathing, heart rate, brain wave activity, oxygen levels, and any abnormal movements; the study is then interpreted by a physician who specializes in sleep-related disorders (usually a neurologist or pulmonologist). If you are diagnosed with sleep apnea syndrome, treatment options include weight loss, the use of a machine (called a CPAP machine) that, using air pressure, forces air through the upper part of your airway, as well as surgery, the latter of which is performed by an otolaryngologist who surgically opens the airway to allow you to breath better. For more information regarding sleep apnea syndrome, you may want to contact the American Sleep Apnea Association (URL is http://www.sleepapnea.org/index.html).

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