What is Sleep Apnea? 

Sleep disorders are common health issues among urban populations, manifesting in conditions such as insomnia, nocturia, and bruxism. Sleep apnea is a specific type of sleep disorder characterized by repeated interruptions in breathing during sleep, lasting from a few seconds to several minutes, which can lead to oxygen deprivation and negatively impact sleep quality. Although sleep apnea itself is not fatal, the resultant hypoxia during sleep forces the heart to pump more vigorously, thereby increasing the cardiovascular load, particularly in individuals with pre-existing hypertension or heart disease, thus raising their health risks. 

 

While sleep apnea and snoring are not identical, there is a relationship between the two. Snoring occurs due to the partial obstruction of the airway during sleep, producing noise as air passes through narrowed or obstructed passages, causing soft tissues (such as the tongue and soft palate) to vibrate. Snoring, in itself, typically does not lead to serious health issues but may be a symptom of sleep apnea. 

 

Therefore, snoring can serve as an indicator of sleep apnea, particularly in cases of obstructive sleep apnea. However, sleep apnea encompasses a range of symptoms beyond snoring, including interrupted sleep, hypoxemia, and decreased sleep quality, all of which can adversely affect health and lead to issues such as daytime sleepiness, fatigue, hypertension, heart disease, reduced concentration, memory decline, and emotional instability. 

 

Types of Sleep Apnea 

Obstructive Sleep Apnea (OSA): This type is caused by physical blockage of the upper airway, which may result from excess fatty tissue around the neck, enlarged tonsils, enlarged uvula, or a large tongue. 

 

Central Sleep Apnea (CSA): This occurs when the brain fails to send appropriate signals to the muscles responsible for breathing, often due to conditions such as stroke or traumatic brain injury, leading to intermittent cessation of breathing during sleep. 

Mixed Sleep Apnea: This type consists of features of both obstructive and central sleep apnea. 

 

According to research and statistics in Hong Kong, the prevalence of sleep apnea is relatively high. A study indicates that approximately 11.4% of adults in Hong Kong experience moderate to severe sleep apnea (including both obstructive and central types). With the aging population and rising obesity rates, the prevalence of sleep apnea may continue to increase. 

 

Risk Factors for Sleep Apnea  

• Obesity: Obesity is one of the most common risk factors for sleep apnea. Excess fatty tissue around the neck increases the likelihood of airway obstruction. 
• Neck Structure: Certain anatomical features of the neck can increase the risk of airway narrowing or obstruction, such as a larger tongue, a small jaw, or a narrow upper airway. 
• Age: As individuals age, muscle tone decreases, and soft tissues may become more relaxed, increasing the risk of airway obstruction. 
• Gender: Males are more likely than females to suffer from sleep apnea; however, the risk for females may increase post-menopause. 
• Genetic Factors: A family history of sleep apnea can elevate an individual's risk. Genetic predisposition may play a role in the condition's development. 
• Other Health Issues: Chronic conditions such as hypertension, heart disease, diabetes, and fatty liver are associated with sleep apnea. 
• Smoking and Alcohol Consumption: Smoking and excessive alcohol intake can increase the risk of sleep apnea, as tobacco and alcohol may relax the muscles of the airway, heightening the likelihood of obstruction. 
• Nasal and Throat Issues: Conditions such as nasal obstruction, deviated septum, allergic rhinitis, or enlarged tonsils can increase the risk of sleep apnea. 
• Medications and Anesthetics: Certain medications and anesthetics may cause muscle relaxation, thereby increasing the risk of airway obstruction. 

 

Symptoms of Sleep Apnea  

The primary symptom of sleep apnea is recurrent episodes of breathing cessation (apnea) or diminished breathing (hypopnea) during sleep. These interruptions can lead to sleep fragmentation and inadequate oxygen supply, adversely affecting overall sleep quality and health.

 

 

Common Symptoms includes  

• Loud Snoring: Patients with sleep apnea often exhibit loud snoring, which may be interrupted by periods of silence when breathing stops. 
• Breathing Pauses: Individuals may experience episodes of breathing cessation during sleep, lasting from several seconds to minutes and potentially occurring multiple times. 
• Frequent Nocturnal Awakenings: Sleep apnea can lead to frequent awakenings during the night, which are typically brief but may contribute to impaired sleep quality. 
• Shortness of Breath: Patients may experience sensations of breathing difficulty or choking during sleep, potentially leading to awakening or feelings of anxiety. 
• Headaches and Fatigue: Due to poor sleep quality, individuals may wake up with headaches and fatigue, experiencing excessive daytime sleepiness. 
• Concentration and Memory Issues: Sleep apnea can impair focus, memory, and cognitive function. 
• Nocturia: Some patients may frequently awaken during the night to urinate, a condition known as nocturia. 

 

Diagnosis and Assessment of Sleep Apnea 

Healthcare institutions and sleep medicine centers in Hong Kong offer diagnostic and treatment services for sleep apnea. Individuals with concerns or symptoms should consult a physician for evaluation and potential sleep studies. The common diagnostic approach includes polysomnography (PSG) or home sleep apnea testing. 

 

Patients may also complete the Epworth Sleepiness Scale to assess their levels of daytime sleepiness during specific activities: 

 

The total score can indicate the degree of daytime sleepiness: 

0–7 points: Normal sleepiness 

8–11 points: Mild sleepiness 

12–15 points: Moderate sleepiness 

16–24 points: Severe sleepiness 

 

Individuals with sleep apnea generally score above 16 points; however, a comprehensive assessment of the patient's medical history is essential for accurate diagnosis. 

 

Physicians may recommend patients undergo Polysomnography (PSG), a comprehensive sleep study that employs sensors connected to various parts of the body to monitor sleep patterns and collect relevant physiological data for analysis and diagnosis. PSG is a widely used method for assessing and diagnosing sleep disorders and is typically conducted in a hospital or sleep diagnostic center. 

 

During the examination, patients are placed in a bed, and various instruments and sensors are attached to their bodies to record different physiological parameters. These instruments may include: 

 

• Electroencephalogram (EEG): Measures the depth of sleep. 
• Electrocardiogram (ECG): Monitors cardiac activity during sleep. 
• Electromyogram (EMG): Assesses muscle tone and sleep state. 
• Electrooculogram (EOG): Evaluates eye movements to determine dream states. 
• Snoring Monitoring: Records the volume and frequency of snoring episodes. 
• Airflow Measurement: Monitors airflow through the mouth and nose to assess breathing patterns. 
• Chest and Abdominal Movement: Evaluates respiratory movement in the thoracic and abdominal regions. 
• Leg Movement Monitoring: Assesses activity of the legs during sleep. 
• Body Position: Records the patient's sleeping posture. 
• Blood Oxygen Saturation (SpO2): Measures the level of oxygen in the blood to evaluate hypoxemia. 

 

These data will be analyzed and evaluated by trained professionals to determine the presence of sleep disorders, such as obstructive sleep apnea (OSA), periodic limb movement disorder, or other sleep-related conditions. 

 

​​​​​​​Sleep Endoscopy 

Sleep endoscopy, also known as drug-induced sleep endoscopy (DISE), is a procedure used to evaluate the dynamic airway of patients with obstructive sleep apnea. This examination is conducted while the patient is under sedation, allowing the endoscope to be inserted through the nostrils into the airway to observe any areas of obstruction or narrowing. 

 

Home Sleep Testing

In certain cases, physicians may recommend home sleep testing. This involves a simplified sleep assessment conducted in the patient's home using portable monitoring devices, such as pulse oximeters and airflow monitors, to evaluate sleep patterns. 

 

Once sleep apnea is suspected, it is crucial to seek medical attention promptly. A comprehensive sleep study can confirm the diagnosis of sleep apnea. The use of electronic instruments to collect data on brain activity (EEG), heart rhythm (ECG), blood oxygen levels, and eye movements during sleep provides a risk-free, painless, non-invasive, and accurate analysis of sleep. 

 

​​​​​​​Treatment Options of Sleep Apnea 

Treatment methods for sleep apnea include non-surgical and surgical interventions, with specific approaches depending on the severity of the condition and individual patient circumstances.

 

Common treatment options include: 

• Continuous Positive Airway Pressure (CPAP): This is the most widely used non-surgical treatment for sleep apnea. It delivers continuous positive pressure through a mask or nasal pillow, keeping the airway open and preventing collapse and breathing cessation. CPAP effectively alleviates sleep apnea symptoms and improves sleep quality. 
• Oral Appliances: Custom-fitted oral devices created by dental professionals are typically used for mild to moderate sleep apnea. These devices reposition the lower jaw and tongue to maintain an open airway. 
• Lifestyle Modifications: Changes in lifestyle can help manage mild sleep apnea. For example, weight loss can decrease fat accumulation around the neck, improving airway patency. Avoiding alcohol and sleep medications can also reduce sleep apnea symptoms. 
• Surgical Options: In severe cases, surgical intervention may be considered. Surgical options include uvulopalatopharyngoplasty (UPPP), expansion pharyngoplasty, and mandibular advancement surgery, which can alleviate airway obstruction or narrowing and improve sleep apnea. 
• Sleep Hygiene and Environment Management: Maintaining good sleep hygiene and an optimal sleep environment is essential for managing sleep apnea. Establishing a regular sleep schedule, ensuring a quiet, dark, and cool sleeping environment, and reducing caffeine and other stimulants can enhance sleep quality and alleviate sleep apnea symptoms. 

 

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Additional Strategies to Alleviate Symptoms

• Optimize Sleep Position: Certain sleeping positions may exacerbate sleep apnea symptoms. Adopting a lateral (side) sleeping position can help keep the airway open, while avoiding supine (back) sleeping can reduce airway obstruction. 
• Weight Management: If overweight or obese, losing weight can significantly alleviate sleep apnea symptoms. Excess fat around the neck contributes to airway obstruction. Collaborate with a healthcare provider to develop a suitable weight loss plan. 
• Avoid Alcohol and Sedatives: Alcohol and sedative medications can depress the respiratory system and muscle function, worsening sleep apnea symptoms. It is advisable to avoid these substances, particularly in the hours leading up to bedtime. 
• Establish a Consistent Sleep Schedule: Creating a regular sleep routine and maintaining consistent sleep times each night can help regulate sleep patterns and improve sleep quality. 
• Enhance Sleep Environment: Ensure the sleep environment is comfortable, quiet, dark, and cool. Utilize appropriate pillows and mattresses to provide adequate support for the neck and body. 
• Limit Caffeine Intake: Caffeine is a stimulant that can negatively affect sleep quality. Reducing caffeine consumption, especially in the hours before sleep, can help improve sleep. 
• Supportive Therapies: Consider incorporating supportive therapies such as yoga, meditation, or deep breathing exercises, which can promote relaxation, reduce stress and anxiety, and enhance sleep quality. 

   

 

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References 

Harvard Medical School. Division of Sleep Medicine. Education & Training. Available at : https://sleep.hms.harvard.edu/education-training/public-education/sleep-and-health-education-program/sleep-health-education-0 

香港政府衛生署. 《睡眠障礙》. Available at : https://www.chp.gov.hk/en/healthtopics/content/25/59.html 

 

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