Do you wake up in the morning feeling as if you haven’t slept at all? Are you cranky, irritable, or depressed? Do you find yourself dozing off during movies or while performing routine tasks, including driving? Are you suddenly having difficulty with short-term memory or complex cognitive tasks?

If any of these are the case, you may have sleep apnea, and if even minor surgery is in your future, you need to determine whether you have sleep apnea or you could be putting your life at risk.

What Is Sleep Apnea?

Sleep apnea is a common condition in which breathing stops during sleep. As your body realizes it is suffocating, it wakens partially, which restores airflow, but disrupts sleep. Both parts of sleep apnea are harmful–reduced oxygen supply can lead to high blood pressure and increased risk of heart failure as the heart tries to compensate for low oxygen saturation. Sleep disruption decreases the amount of rest a person receives, reducing the level of rest a person receives during sleep.

Sleep Apnea Surgical Risks

According to studies, surgical patients with sleep apnea face highly increased risks. These risks are described as being periopoerative, meaning that they occur not only during surgery, but also following surgery and throughout recovery.

Surgical Risks include

· Difficulty in mask ventilation tracheal intubation, or laryngoscopic view

· Adverse response to anesthesia including apneic events where the waking response is inhibited, which can lead to dangerously low oxygen levels

Immediate Postsurgical Risks include

· Low blood oxygen levels

· High or low blood pressure

· Irregular heartbeat

· Pneumonia

· Collapsed lung

· Mental confusion

· Wound breakdown

· Oxygen starvation of the heart

· Stroke

· Death

· Brain damage

Recovery Period Risks include

· Shortness of breath

· Chest pain

· Abnormal post-surgical chest x-ray

· Transfer to ICU

· Necessity of mechanical ventilation

· Cardiac arrest

· Congestive heart failure

· Coma

· Death

In all, people with untreated sleep apnea have double the risk of perioperative complications and triple the risk of serious complications. And patients with untreated sleep apnea have, on average, 33 % longer hospital stays than other patients.

Get Tested

Although the rate for sleep apnea in the general population is only 2-4 %, studies found that as many as 19 % of the adult surgical population suffer from sleep apnea. The increase is due to the serious health complications resulting from sleep apnea, making sufferers disproportionately represented in the surgical population. Although many hospitals now pre-screen all surgical patients for sleep apnea, the screening tools are cursory and may not catch you. If you suffer from any of the symptoms of sleep apnea, such as daytime sleepiness, wake feeling poorly rested, experience excessive moodiness, or have difficulty with memory or cognitive tasks, you should consider being screened for sleep apnea before any surgery.

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Sleep apnea is the temporary stoppage of breathing during sleep. Technically, a person is said to have sleep apnea if breathing stops for at least ten seconds, five times an hour. Your body responds to the stoppage of breathing by waking you, which leads to sleep apnea sufferers experiencing very poor sleep. In addition, sleep apnea sufferers tend to experience serious health complications including an increased risk for:

· High blood pressure

· Heart attack

· Stroke

· Arrhythmia

In addition, sleep apnea sufferers are liable to experience a number of psychological effects, including:

· Loss of short-term memory

· Poor work performance

· Severe anxiety

· Mood swings

· Depression

· Impotence

Finally, sleep apnea sufferers can suffer serious complications following surgery and are at an increased risk of dying in an automobile accident. Obviously, this is a very serious condition, and discovering whether you have it is very important.

See the Signs

Anyone can suffer from sleep apnea, but the people most at risk for sleep apnea are overweight men over the age of 50. In addition, anyone who has suffered a traumatic brain injury is at an increased risk for sleep apnea.

Although sleep apnea occurs when you are sleeping, it has a number of daytime manifestations. First, if you are experiencing any of the above psychological effects, consider the possibility that you are suffering sleep apnea. In addition, consider your level of daytime sleepiness. You may take a quick test like the Epworth Sleepiness Test which can help you determine whether you have an excessive level of daytime sleepiness. In addition, if you have a cosleeper, ask him or her about snoring, which is commonly associated with obstructive sleep apnea. More important, ask if they notice you gasping or suffering a stoppage of breathing during the night.

Once you begin to suspect sleep apnea, you might begin a sleep journal. A sleep journal should include at least the time you went to bed, the time you woke up, any waking events you have, insomnia, and note days when you feel sleepy, unrested, or irritable during the day. Also, have your cosleeper record any events he or she notes during the night. With this journal, you can develop a comprehensive picture of your sleep habits.

Definite Diagnosis

Once you begin to suspect that you have sleep apnea, you should seek positive diagnosis. Diagnosis of sleep apnea is the first stage in treatment of this completely remediable disease. Diagnosis of sleep apnea is performed by the use of a polysomnogram. A polysomnogram is a comprehensive test of the way you sleep. It monitors:

· Brain activity (via an electroencephalogram (EEG))

· Air flow, chest and abdomen movement

· Continuous oxygen saturation

· Chin and leg movements

· Eye movements and the onset of Rapid Eye Movement (REM) sleep

· Heart rate and rhythm

By monitoring all these elements simultaneously, the polysomnogram can definitively establish whether you suffer from sleep apnea or not by identifying the number of breathing interruptions you suffer during your sleep. It can tell the amount of time you spend in stage 1, 2,3, and 4 sleep, as well as the amount of time you spend in REM sleep. For diagnosing all sleep problems, the polysomnogram is the gold standard of tests, but it does require an overnight stay in the laboratory.

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Sleep apnea is a disorder characterized by a reduction or cessation of breathing and air flow during sleep. It is much more common in adults than in children. An “apnea” is a period of time w breathing stops or is significantly reduced. Apnea occurs when a person stops breathing for ten seconds or more. When an apnea occurs, sleep is disrupted. Sometimes this means the person wakes up completely, but sometimes this can mean the person comes out of a deep level of sleep. Apneas are usually measured during sleep over a two-hour period. Sleep apnea affects as much as 26% of the general population.

The three types of sleep apnea are central sleep apnea (CSA), obstructive sleep apnea (OSA), and mixed sleep apnea (a combination CSA and OSA).

During sleep, the brain instructs the muscles of breathing to take a breath. Central sleep apnea occurs when the brain does not send the signal to the muscle to take a breath, and there is no muscular effort to take a breath. Obstructive sleep apnea occurs when the brain sends the signal to the muscles and the muscles make an effort to take a breath but are unsuccessful because the airway becomes obstructed and prevents the flow of air. The third type of sleep apnea, mixed sleep apnea, occurs when there is both central and obstructive sleep apnea.

Sleep Apnea and Surgery

People undergoing surgery who have sleep apnea face a whole new set of risks when going under the knife. If a patient is having surgery and suffers from undiagnosed OSA, he will have a greater risk for difficult intubation; will have the chance for more post-operative complications; increased intensive care admissions; and a lengthier hospital stay. For these reasons, it is very important that sleep apnea be diagnosed prior to having any type of surgery.

A very simple, self-administered test has been developed by a team of Canadian anesthesiologists. It’s a questionnaire called “STOP” and involves the following simple questions: “Do you snore loudly? Do you often feel tired, fatigued or sleepy during the daytime? Has anyone observed you stop breathing during sleep? Do you have or are you being treated for high blood pressure?”

If a patient answers “yes” to two or more of those four questions, then he is considered to be at high risk for OSA. When other risk factors were also considered such as high BMI (body mass index), large neck circumference and an age over 50, then the likelihood of correctly diagnosing OSA increased even more.

An overnight study by a highly trained sleep apnea specialist is the best way to diagnose this disorder, but sometimes this is too time-consuming for the patient.

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