on sleep apnea

Received on: 18-01-2021 Revised On : 24-02-2021 Accepted on : 28-02-2021 Obstructive sleep apnea (OSA) is a sleep-related breathing disorder that involves a reduces or complete halt in airflow despite an ongoing effort to breathe. It occurs when the muscles relax during sleep, causing soft tissue in the back of the throat to collapse and block the upper airway. This results in partial reductions (hypopneas) and complete block (apneas) in breathing that lasts a minimum of 10 seconds during sleep. Most pauses last between 10 and 30 seconds, but some may persist for one minute or longer. This can cause abrupt reductions in blood oxygen saturation. The brain responds to the lack of oxygen by alerting the body, causing a brief arousal from sleep that restores normal breathing. This pattern can occur many times in one night. The result is a fragmented quality of sleep that often produces an excessive level of daytime sleepiness. Most people with OSA snore loudly and regullarly, with periods of silence when airflow is reduced or blocked. They then make choking, snorting or gasping sounds when their airway reopens. A common measurement of sleep apnea is the apneahypopnea index (AHI).


Introduction
Sleep apnea is a serious, potential life-threatening condition. It is a breathing disorder characterised by In CSA, the airway is not blocked but the brain fails to signal the muscles to breath due to instability in the  [19,20]. International Journal of Health Care and Biological Sciences

Obstructive sleep apnea
Obstructive apnea have an anatomically small pharyngeal airway like due to either increased soft tissue surrounding the airway or a small bony compartment in which the airway is enclosed [21].
During wakefulness, pharyngeal patency is maintained primarily by reflex-driven, augmented pharyngeal dilator muscle activity, which offsets the positive extraluminal tissue pressure collapsing the airway [22,23]. Normal ventilation is maintained, at sleep onset and/or during REM sleep, reflex muscle activation is reduced as is arousal-modulated excitatory output to the upper airway musculature [24]. Lung volume falls as well [25]. If the airway anatomy is quite deficient, these events alone will likely lead to substantial or complete airflow obstruction, yielding a hypopnea or apnea. As a result, hypoxia and hypercapnia develop, ventilation is stimulated, and often arousal from sleep in response to respiratory activation is required to reestablish airway patency to allow a recovery of ventilation [26,27]. heart rate, and oxygen saturation) and sleep parameters and may be useful in diagnosing sleep apnea [29].

Treatment
The goals of treatment for sleep apnea patients include both physiologic and symptomatic components.  [39]. Although very effective, CPAP may be difficult for some patients to use [40]. Adherence to CPAP treatment varies greatly but tends to be higher in patients with severe symptoms [41]. The most common reasons for discontinuing CPAP are intolerance of the mask, nasal-related complaints, and the inconvenience of being connected to a machine. Oral/ dental appliances Oral or dental appliances could also be an option for patients with mild-to-moderate sleep apnea. However, they are not effective in all patients Appliances have also been used for patients who snore but do not have sleep apnea. There are various devices that displace the tongue forward or move the mandible to an anterior and forward position to improve patency of the airway [43]. Reported side effects of the devices include excessive salivation and temporomandibular joint discomfort. A dentist or orthodontist experienced in the use of these devices should fit the patient, and a sleep study should be done after the device is fitted to evaluate its effectiveness [44].

Surgical procedure
Patients need to understand that no surgical procedure has universal success, and all are invasive and carry risk. Several procedures or a combination of procedures may need to be performed to help sleep apnea patients.
It is important that sleep studies be repeated after each surgical procedure to confirm its effectiveness, once there is evidence of adequate healing. When weighing treatment options, it may be useful to let the patient know that CPAP is highly effective when used properly and is safe and reversible [45,46] Uvulopalatopharyngo plasty (UPPP). During UPPP, an inpatient procedure, the uvula and portions of the soft palate are resected to widen the oropharyngeal airway. Although snoring is temporarily relieved in most cases, apnea may persist.
The overall success rate of UPPP is reported to be about 40 percent (when success is defined as achieving an AHI of less than 20) [47]. It is difficult to predict which patients will benefitfrom this procedure, and long-term side effects and benefits are unknown.

Nasal Surgery
Nasal surgery may be used alone or in conjunction with other procedures. However, it is rarely curative alone.

Tonsillectomy
In children and adolescents adenotonsillectomy may be useful, even curative [48]. Tonsillectomy alone in adults is not usually helpful [49]. but is often done in  [52].

Pharmacological treatment
Currently, there are no safe and effective medications indicated in the routine treatment of sleep apnea.

Oxygen
Administration of supplemental oxygen may improve nocturnal desaturation but is not a satisfactory treatment option by itself because it does not reduce sleep disruption and subsequent daytime sleepiness [53].

Management considerations
The