Scott Webb (Host): Sleep apnea is very common, and if undiagnosed and untreated, it can lead to kids being hyperactive, adults being exhausted, and more. I'm joined today by Dr. Salim Abou-Jaoude. He's board-certified in Pulmonary and Critical Care and Sleep Medicine, practicing at Franciscan Health.

This is the Franciscan Health Doc Pod. I'm Scott Webb. Doctor, thanks so much for your time today. We're going to talk about sleep apnea, which I know is a fairly common condition, maybe is the right way to say it. A lot of folks suffer from it, or maybe haven't been diagnosed yet and need to be diagnosed. So, let's just start there. What is sleep apnea?

Dr. Salim Semaan Abou-Jaoude: Sleep apnea is a condition when the airway is kind of narrow and many things can cause these narrowing. So, the body uses muscles to open up the airway during the day when you're awake. And as you fall asleep, these muscles relax and tend to occlude the airway. Many conditions can cause this. Usually, the most common cause of this sleep apnea is being a little bit overweight. There are some conditions such as maxillofacial abnormalities like bone structures, especially like small jaws, retrognathia can cause that, and sometimes genetic factors play a role by causing a narrowing inside the airway, and many congenital diseases also can cause that.

Host: Yeah. So, there can be a variety of factors, a variety of causes. It may not be one-size-fits-all for everybody. How would someone know if they were sort of self-diagnosing anyway? How would they know if they have sleep apnea? And then, how do you diagnose sleep apnea?

Dr. Salim Semaan Abou-Jaoude: Sleep apnea usually is present when people tell you that you snore at night. Many times people tell you that you stop breathing at night. These are the most common things. Other things include feeling tired during the day, not being able to sleep and staying asleep during the night, having headaches in the morning.

Sometimes some of the symptoms of sleep apnea is refractory hypertension, blood pressure that is very difficult to control, even sometimes with three or four or five medications. Many times treating sleep apnea will help the blood pressure. Many patients I see are referred by Cardiology just because they have atrial fibrillation, which is irregular rhythm of the heart.

Host: So, that gives listeners a sense then anyway of what they may be experiencing, what maybe their sleep partners are telling them about snoring or whatever it might be. How do you actually diagnose sleep apnea? Is it done through a sleep study? Do we have to do that in the office? How does that work?

Dr. Salim Semaan Abou-Jaoude: To diagnose sleep apnea, do a sleep study. There are mostly three different kinds of sleep studies that can be done. One is done at home. One is a sleep study that's done in the sleep lab, and the whole night is done looking for sleep apnea and recording sleep apnea. The other kind of a sleep study is being done in the hospital, but this is called split night polysomnography, meaning the first half of the night we do the diagnosis for sleep apnea, and the second half of the night we try to find a CPAP pressure that is appropriate to resolve sleep apnea.

Sleep apnea or the apneas of sleep apnea are divided into three different categories. There is something called hypopnea. There's something called obstructive apnea. And the third thing is called the central apnea. The most common thing that we really like to treat is the obstructive sleep apnea when the air will completely occlude and the flow to the lungs are decreased by 90%, essentially complete cessation of our airflow. And the complete cessation of this airflow should be 10 seconds or longer to count as a sleep apnea. Hypopnea is a decrease in the airflow, but not to the 90%. Decreased by 30% or more for 10 seconds or more, we call it hypopnea. If it reaches 90%, then it becomes obstructive apnea at that point.

Central apnea is with hypopnea and obstructive apnea. There is effort with the chest trying to move air into the lungs, but there is an obstruction in the upper airway that will not allow the air to go to the lung. With central apnea, there is no order from the brain for the person to breathe. So, we can tell the difference on the sleep study when there is no effort in the chest, but there is cessation of flow. This is called central apnea. And again, the criteria is for it to be more than 10 seconds to be counted as a central apnea.

Host: Gotcha. So then, let's assume that's either someone sort of self-diagnosed and speaks with the provider and/or they go through a sleep study and are diagnosed, the different types of apnea that you mentioned there. What are the options then for folks who are suffering from sleep apnea?

Dr. Salim Semaan Abou-Jaoude: It depends on the severity of the sleep apnea and the age group of the sleep apnea. Believe it or not, there are kids that have sleep apnea and mostly it is due to enlarged tonsils. If patients are before puberty, usually we don't try to give them extensive treatment. Usually, we refer to ear, nose and throat specialists for possible tonsillectomy and adenoidectomy.

Patients after puberty, the most common treatment and the most effective treatment is CPAP machine. A CPAP machine is a machine that fits over the nose and mouth, and will push air to act like an air bridge or a pneumatic splint to prevent the airway from collapsing during sleep.

Some other options could be physical options, like a mandibular advancement device. It's kind of a dental appliance or a mouth guard that moves the lower jaw forward. Most of the time, we refer to a dentist. There are several local dentists that will provide and fit the patient with a dental appliance that moves the jaw forward. And this hopefully will open up the airway. And usually, there is a titration form where they advance the lower jaw a couple of clicks every week until the snoring and the stopping breathing has significantly improved. And this will work for people who have mild sleep apnea or sometimes for moderate sleep apnea.

There are other techniques, exercises for the back of the tongue that will make the tongue a little bit stronger and less likely to collapse backwards. It's called electromagnetic stimulation of the tongue and the machine is called eXciteOSA. They have to use this machine about 20 minutes every day. And if the tongue gets stronger, we test them three or four months later to see if the sleep apnea is getting better.

Sometimes treating other conditions such as nasal septal deviation, nasal congestion, some airway inflammation and swelling by using nasal steroids such as Flonase, Nasonex, or other form of the inhaled nasal steroids can help decrease the airway, or resistance in the airway, and help alleviate some of the symptoms of the sleep apnea.

Sometimes, in the old days, we used to do surgery, where we used to refer to ENT, where they take the back of the tongue out, the uvula, the soft palate, the tonsils, try to open up the airway. We try to stay away from this at this time. And most recently, I'm sure everybody have heard commercials about the Inspire device, which is a pacemaker that is implanted in surgery. There are several things that needs to be done to qualify for the Inspire device. You have to have a BMI of less than 35, and they have to observe the airway while sleeping. If there is a circumferential collapse, if the person qualified, they can implant a pacemaker or the leads will stimulate the hypoglossal nerve, which is a nerve that goes to the tongue. And this pacemaker will pick up if there is any chest movement when the patient tries to inhale. It will feel that the patient is trying to breathe. It will send a stimulus for the tongue to get out of the way, to move forward, and not to obstruct the airway.

Host: That's very cool. Good to know that there are lots of options for folks, specifically at Franciscan Health, which is great. Just want to finish up here, last question for you. When we think about the ages of people who get sleep apnea, I'm not aware of children having sleep apnea, but maybe some do. Just give us a sense of who generally suffers from sleep apnea.

Dr. Salim Semaan Abou-Jaoude: The older the person, the higher the chance of sleep apnea, but we've had many young people with sleep apnea. The criteria for sleep apnea for children is a little bit different than criteria for adults, and the symptoms of sleep apnea in children is different than adults.

Children with sleep apnea presents with hyperactivity, symptoms that are very similar to ADHD, rather than in adults where they present with sleepiness, tiredness, falling asleep easily, car accidents, and other conditions, and children present with hyperactivity. And the treatment for children is usually the tonsillectomy and adenoidectomy because we try to avoid having them do CPAP at very early age and not to burden them with that at that point.

Some other conditions that can contribute to sleep apnea again is obesity, hypothyroidism, acromegaly, congenital disorders, as I mentioned earlier.

Host: Yeah, it's interesting. It's like a sleep disorder, but there could be a number of things that are bringing it on or causing it. And interesting to know that it sort of presents differently in children, they're more hyper. Adults are tired, exhausted, and you can see why that would be a problem with operating machinery and cars and trying to go to work and all of that. So, really educational today. Appreciate your time. Thank you so much.

Dr. Salim Semaan Abou-Jaoude: Thank you very much. Thank you for having me.

Host: And visit franciscanhealth.org and search sleep apnea for more information. And if you found this podcast helpful, please share it on your social channels and be sure to check out the full podcast library for additional topics of interest. This is the Franciscan Health Doc Pod. I'm Scott Webb. Stay well, and we'll talk again next time.