Those with sleep apnea experience breathing interruptions during sleep. In severe cases, these breathing stoppages can happen hundreds of times a night. The toll this takes on the body is enormous, with health consequences that include depression, chronic fatigue, heart disease, diabetes, and sudden death, according to Mayo Clinic. Here is what you need to know about severe sleep apnea and the available treatment options.
What Makes Sleep Apnea ‘Severe?’
Determining sleep apnea severity starts with a sleep test. "Getting timely treatment for severe sleep apnea is critical because confirming the diagnosis will allow your doctor to recommend and start treatment immediately and decrease the likelihood of grave conditions such as heart disease or stroke,” Paul Schalch Lepe, MD, FACS, and clinical professor of otolaryngology and sleep medicine with UC San Diego Health, tells WebMD Connect to Care.
The most common measure of sleep apnea severity is the apnea-hypopnea index (AHI). The American Academy of Sleep Medicine (AASM) describes an apnea event as a pause in breathing greater than 10 seconds and a hypopnea event as a partial constriction of the airway that causes oxygen levels to drop. The AHI is the average number of apnea and hypopnea events per hour. Here are the different classifications of sleep apnea severity, according to Harvard University:
- None/Minimal: AHI less than 5 per hour
- Mild: AHI between 5 and 15
- Moderate: AHI between 15-30
- Severe: AHI greater than 30
Severe Sleep Apnea Treatment Options
The AASM has established guidelines for the treatment of sleep apnea. Continuous positive airway pressure (CPAP) therapy is considered the treatment of choice for all forms of sleep apnea. The machine works by delivering air to your upper airway through a mask. This keeps the tissues from collapsing and causing obstruction, according to UC San Diego Health.
Surgery is typically considered as a treatment option only when a person cannot tolerate airway pressure devices. The Adult OSA Task Force of the AASM, assembled to create clinical guidelines for the treatment of sleep apnea, notes that upper airway surgeries for sleep apnea include:
- Nasal airway procedures (septoplasty, turbinate reduction)
- Tonsil and adenoid removal (first-line therapy for pediatric cases)
- Palate and uvula reduction (uvulopalatopharyngoplasty)
- Tongue reduction (partial glossectomy, tongue ablation)
- Tongue advancement (hyoid suspension, genioglossus advancement, mandibular advancement)
Obesity is a major cause of obstructive sleep apnea. When sleep apnea occurs in the context of morbid obesity, doctors may consider bariatric surgery as an adjuvant therapy, according to the AASM.
Maxillomandibular advancement is a special type of surgery for people whose lower jaw is set far back from their upper jaw, which is a condition called retrognathia. The AASM considers this to be a global airway procedure.
The final consideration is tracheotomy. “For the most severe cases of sleep apnea, the last resort treatment is a tracheotomy. In this surgery, a tube is placed through the neck into the trachea, below the level of the vocal cords, bypassing the obstruction at the level of the upper airway tissues altogether,” says Schalch Lepe.
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