Obstructive Sleep Apnea (OSA)

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In adults, the most common cause of obstructive sleep apnea is excess weight and obesity, which is associated with the soft tissue of the mouth and throat. During sleep, when throat and tongue muscles are more relaxed, this soft tissue can cause the airway to become blocked.

More than half of people with obstructive sleep apnea are either overweight (body mass index, or BMI, of 25-29.9) or obese (BMI of 30.0 or above).

A 10% weight gain raises your risk of OSA by six times, though the effect goes down after age 60.

Another marker of obesity is the size of your neck. Men with a neck circumference above 17 inches (43 centimeters) and women with a neck circumference above 15 inches (38 centimeters) have a much higher risk for OSA.

Other possible causes or risk factors for OSA include:

• A narrow throat
• A round head
• Hypothyroidism
• Excess growth due to hormones (acromegaly)
• Allergies
• Deviated septum (problem with nose structure)
• Medical conditions that congest upper airways
• Smoking
• Alcohol or drug abuse

In children, causes of obstructive sleep apnea often include enlarged tonsils or adenoids and dental conditions such as a large overbite. Less common causes include a tumor or growth in the airway, and birth defects such as Down syndrome and Pierre-Robin syndrome. Down syndrome causes enlargement of the tongue, adenoids, and tonsils, and there is less muscle tone in the upper airway. Those who have Pierre-Robin syndrome have a small lower jaw, and the tongue tends to ball up and fall to the back of the throat. Although childhood obesity may cause obstructive sleep apnea, it's much less commonly linked to the condition than adult obesity.

Regardless of age, untreated obstructive sleep apnea can lead to serious complications, including cardiovascular disease, accidents, and premature death. So it's important that anyone with signs and symptoms of obstructive sleep apnea -- especially loud snoring and repeated nighttime awakenings followed by excessive daytime sleepiness -- get the right kind of medical evaluation.

Possible Obstructive Sleep Apnea Treatment include:

Weight loss, if needed. Losing even 10% of your weight can make a difference.

Not drinking alcohol or taking sleeping pills. These make your airway more likely to close during sleep and keep you from breathing like you should for longer periods.

Sleeping on your side. This can help if you get mild sleep apnea only when you sleep on your back.

Nasal sprays. These can help if sinus problems or nasal congestion make it harder to breathe while you sleep.

CPAP machine. This device includes a mask that you wear over your nose, mouth, or both. An air blower forces constant air through your nose or mouth. The air pressure is just enough to keep your upper airway tissues from relaxing too much while you sleep. A similar device is the BPAP, which has two levels of air flow that change when you breathe in and out.

Oral devices. If you have mild sleep apnea, you might get dental appliances or oral "mandibular advancement" devices that keep your tongue from blocking your throat or bring your lower jaw forward. That may help keep your airway open while you sleep. A trained dental expert can decide which type of device may be best for you.

Surgery. This is for people who have extra or uneven tissue that blocks airflow through the nose or throat. For example, if you have a deviated nasal septum, swollen tonsils, and adenoids, or a small lower jaw that causes your throat to be too narrow, surgery might help you. Doctors usually try other treatments first.

Types of surgery for obstructive sleep apnea include:

Upper airway stimulator. This device, called Inspire, has a small pulse generator that your surgeon puts under the skin in your upper chest. A wire leading to your lung tracks your natural breathing pattern. Another wire, leading up to your neck, delivers mild signals to nerves that control your airway muscles, keeping them open. You can use a remote to turn it on before bed and turn it off in the morning.

Somnoplasty. Your doctor uses radiofrequency energy to tighten the tissue at the back of your throat.

UPPP, or UP3. This procedure takes out soft tissue in the back of your throat and palate, making your airway wider at your throat opening. (UPPP stands for uvulopalatopharyngoplasty.)

Nasal surgery. These operations correct obstructions in your nose, such as a deviated septum (when the wall between your nostrils is off-center).

Maxillo Mandibular Advancement Surgery . Your doctor moves your jawbone and face bones forward to make more room in the back of your throat. It’s a complex procedure used only for people who have severe sleep apnea and problems with their head or face.