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Question 3 - OSA without symptoms, what should I do?

From: R. P.

I just went to a sleep clinic that is affiliated with a local hospital. I went because my wife complains of my loud snoring. When I got the report back, the doctor said the "indication for study" was excessive daytime sleepiness, fatigue, and malaise. Nothing could be further from the truth. I filled out papers indicating that I had none of this. I feel find during the day, and am not sleepy in the daytime. I have plenty of energy and am pretty active. I am 60 and a male and weigh about 203 (5' 11"). The study showed 7 central apneas, 28 obstructive, and one mixed. Max. duration of apnea was 10 seconds. Oxygen level 96%. AHI/hour index 32.2. Do I need to do anything at all since I am not tired during the day and the Oxygen is good?

R. P.


Answer Provided by Sandman
August 4, 2007

Self report concerning fatigue, sleepiness, etc., when dealing with OSA and other sleep disorders, does not always coordinate with objective findings. I have been talking to patients during hook-up who stated they were not tired or sleepy and would never sleep with all the wires on. They would be nodding out while they were telling me this. One theory is when a person has been sleep deprived for many years, the state of sleepiness becomes their "normal feeling" which they will not connect to being sleepy. They feel normal. In order to do the study, to determine if it is a wake state misperception, the indications for the study will usually be daytime somnolence or fatigue. Without a problem there would be no need for the study. From what you have stated your snoring appears to be your wife's problem.

Looking at the results of the study you reported, you have OSA and an AHI index of 32 is significant. However, if you truly do not have any daytime symptoms, you wouldn't be diagnosed with OSAS (obstructive sleep apnea syndrome) because there must be a consequence to be a syndrome.

However, there are many things missing from this picture to discount OSAS. The consequence from OSA does not have to be sleepiness, fatigue, etc., it can be high blood pressure, morning headaches, the need for excessive caffeine intake, stress on the heart, symptoms of ADD, loss of memory, daytime stress and the list goes on. Also, if you have any other medical issues in your history, OSA will usually make them worse.

So deciding whether to try treatment now depends on what, if any, other medical issues you may have. We do know that as we age OSA gets worse. We may start with just snoring and at some point it will move into hypopneas, next it will come short obstructions then we go into long obstructions. The entire time we go through this our body is paying consequences which may not be apparent until it is severe.

So the question is, how do I know if I need treatment for OSA? I am not a doctor and I am just speaking from my experience in the sleep field and this is my personal best case scenario.

1. Try CPAP and see if you feel even better than you feel now. You may decide you are more alert after CPAP and it will get rid of the snoring your wife is having problems with.

2. If you can't tolerate CPAP there are options. You can try oral appliances, success rate not as good as cpap, which may reduce the snoring, or somnoplasty which has a little better success rate and can be done as an outpatient.

3. You could talk to a sleep surgeon and after a good evaluation they would discuss the surgery options. Some surgeries for mild apnea with snoring are not very drastic.

I'm sure there are other options but these are my top 3 to try.

Best wishes and Sweet dreams,

Sandman

Disclaimer, I am not an MD and my opinions should not be taken as medical advice. If you feel that you need assistance with medications and/or diagnosis, you should seek medical advice from a qualified physician.




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