Obstructive sleep-disordered breathing (SDB)

Sleep disordered breathing is a prevalent yet often overlooked condition. Understanding its various forms can encourage lifestyle adjustments that improve overall well-being. This disorder encompasses a range of breathing irregularities during sleep, from mild snoring to severe conditions such as obstructive sleep apnea. Left untreated, it can lead to complications, including cardiovascular issues, cognitive impairment, and excessive daytime fatigue - making its impact more significant than it may initially seem. This article explores the different types of sleep disordered breathing, common symptoms, and available treatment options.

What is sleep disordered breathing?

Obstructive sleep-disordered breathing (SDB) is not a single disease but a syndrome caused by upper airway dysfunction during sleep. It is marked by snoring and increased breathing effort due to airway resistance and throat collapsibility. Obstructive Sleep Apnea (OSA), also known as obstructive sleep apnea-hypopnea, occurs when airflow significantly decreases or stops despite ongoing breathing effort.

The main feature of OSA is increased airway collapsibility during sleep, leading to reduced (hypopnea) or absent (apnea) airflow at the nose or mouth. This often results in low oxygen levels (oxyhemoglobin desaturation) and brief sleep interruptions (micro-arousals).

Repeated apnea episodes cause ongoing oxygen deprivation and sleep fragmentation, reducing the amount of deep sleep (slow-wave) and REM sleep, which are essential for overall health.

Child with sleep-disordered breathing (SDB)

When a child's breathing is disrupted during sleep, the body reacts as if they are choking. This triggers an increase in heart attack and high blood pressure, disrupts sleep, and can lower oxygen levels in the blood.

Around 10% of children snore loudly, while 2–4% experience obstructive sleep apnea (OSA). Research suggests that even mild sleep-disordered breathing (SDB) or frequent snoring can lead to similar health concerns as OSA in children.

Risks of sleep disordered breathing

Excess body weight is the leading risk factor for sleep apnea, with studies estimating that obesity accounts for 58% of moderate to severe OSA cases. The condition arises from both structural and nonstructural factors, including genetics.

Structural Risk Factors

Certain anatomical features can increase the likelihood of airway collapse during sleep, such as:

• Retrognathia and Micrognathia – Small or recessed jaw structures

• Maxillo-Mandibular Hypoplasia – Underdeveloped upper and lower jaw

• Adenotonsillar Hypertrophy – Enlarged tonsils and adenoids, particularly in children and young adults

• High, Arched Palate – More common in women, affecting airway space

Nonstructural Risk Factors

Several lifestyle and biological factors contribute to OSA, including:

• Obesity (especially central fat distribution)

• Male sex

• Aging

• Postmenopausal status

• Alcohol and sedative use

• Smoking

Medical Conditions Linked to OSA

Certain health conditions are also associated with a higher risk, including:

• Hypothyroidism

• Stroke

• Acromegaly (excess growth hormone production)

The Impact of Alcohol and Smoking

Though research is limited, alcohol and smoking are often linked to sleep apnea, especially in women. Studies show that:

• Alcohol consumption before bed worsens sleep apnea in men.

• Smoking is associated with increased snoring in both men and women.

• Japanese research found that women consuming more than 23g of alcohol per day experienced worsened oxygen desaturation and snoring.
  

How to Diagnose Sleep Disordered Breathing?

If you have symptoms of sleep-disordered breathing (SDB), such as loud snoring, restless sleep, daytime airway obstruction, mouth breathing, bedwetting, excessive daytime sleepiness, or difficulty concentrating. It is important to consult an ENT specialist or sleep expert.

Doctors may diagnose SDB based on medical, family members history and a physical exam. However, if severe obstructive sleep apnea (OSA) is suspected, further testing, such as a sleep study, may be recommended.

A sleep study, or polysomnography (PSG), is a reliable test for diagnosis of obstructive sleep. Sensors are placed on the head and body to monitor brain activity, muscle movement, eye movement, breathing patterns, and blood oxygen levels. The test is painless and is typically conducted in a sleep lab, hospital, or at home.

What is a Sleep study? 5 Steps to Get Tested for Sleep Apnoea

Treatment for Sleep Disordered Breathing

The choice of treatment depends on the severity of the condition. Mild cases offer more flexibility, while moderate to severe obstructive sleep apnea (OSA) typically requires continuous positive airway pressure (CPAP) therapy.

Primary Treatments

• CPAP Machine – The standard treatment for moderate to severe OSA. Especially for patients with a respiratory disturbance index (RDI) of 30 or more events per hour. CPAP reduces the risk of hypertension, heart failure, and stroke.

• BiPAP machine – Recommended for patients who cannot tolerate CPAP due to discomfort or air leakage.

• Oral Appliances – Mandibular advancement devices (MADs) and tongue-retaining devices help keep the airway open, reducing symptoms and improving sleep quality, particularly in mild to moderate OSA cases.

Lifestyle Modifications

Conservative approaches can help manage SDB, particularly in mild cases:

• Weight Loss – A 10% reduction in weight can decrease the RDI by 26%.

• Avoiding Alcohol – No alcohol consumption 4-6 hours before bedtime.

• Positional Therapy – Avoiding back sleeping using methods like a tennis ball sewn into a nightshirt or specialized vests.

• Sleep Hygiene – Ensuring proper sleep habits, such as:

• Limiting caffeine after lunch

• Avoiding stimulating foods (e.g., chocolate, tea, soda)

• Reducing noise and keeping the bedroom dark

• Proper ventilation for optimal air quality

Surgical Options

Surgery may be considered for patients who do not respond to noninvasive treatments or have anatomical abnormalities contributing to airway obstruction. Procedures include:

• Upper Airway Surgery – Aims to widen the airway and reduce resistance.

• Bariatric Surgery – Recommended for patients with obesity-related OSA.

Medications

Some medications show potential in reducing central apneas and the apnea-hypopnea index (AHI), but more research is needed to confirm their safety and effectiveness. Surgical intervention is an option when other treatments fail or when anatomical factors make it a preferred approach. The goal is to improve airway stability and long-term sleep quality.

The Role of Diet in Sleep Quality

Conclusion

Sleep-disordered breathing is a manageable condition, and early diagnosis plays a crucial role in controlling symptoms and improving sleep quality. With proper management of obstructive sleep apnea in adults, including CPAP therapy and lifestyle adjustments, you can restore restful sleep and safeguard your health. At CPAP Discount, we offer high-quality treatment devices from leading brands like ResMed, Fisher & Paykel, and Philips.