SLEEP DISORDERED BREATHING

Abstract

Till date breathing abnormalities induced by sleep i.e., sleep disorder breathing (SDB) is not recognized as a medical problem in our part of world. Snoring and daytime sleepiness, is seen as comical, or as a nuisance.

Prevalence of SDB is expected as high as 15 to 18% in urban areas and is in rising trend due to an increase in obesity in new urban generation and increase in life expectancy. A recent Australian study showed that 10 % of Australians suffer from undiagnosed obstructive sleep apnea, which rises to 49 % in the males aged 40–69 years and 62% in males aged >70 years.

The most common form of SDB is obstructive sleep apnea (OSA), characterized by frequent breathing pauses due to sleep-related changes in muscle tone; the increased airway resistance leading to partial (hypopnea) or complete (apnea) upper airway collapse. Symptoms of OSA include excessive daytime sleepiness, fatigue, non-refreshing sleep, nocturia, morning headache, irritability and impairments in vigilance, concentration, cognitive function,social interactions, memory. However, absence of subjective sleepiness does not rule out that the patient is not having sleep-disorder. 50% of people with OSA are not obese and 25% of individuals with moderate OSA have neither subjective nor objective sleepiness. Consequences of untreated OSA are wide and results from the fragmented sleep, intermittent hypoxia and hypercapnia, intrathoracic pressure swings, and increased sympathetic nervous activity that is associated with disordered breathing during sleep Untreated OSA over time is associated with longterm health consequences like impaired daytime function including excessive daytime sleepiness, cardiovascular disease (including difficult-tocontrol blood pressure, coronary artery disease, congestive heart failure, arrhythmias and stroke), metabolic disorders (affecting blood glucose control and risk for diabetes), behavioral change, cognitive impairment and depression.

“Still in our part of world, sleep disorders are mostly diagnosed coincidentally, in patients with serious comorbid conditions. Undiagnosed and untreated OSA has a significant burden on the healthcare system, with increased healthcare utilization later on. So the health care professional should understand importance of early diagnosis and treatment of this common disorder.”