Medical Facts About Headaches and Sleep Apnea
Macomb Sleep Institute
Approximately 20% of patients with sleep apnea will have headaches and 25% of patients with other sleep disorders will also experience headaches. The headaches associated with sleep apnea may be difficult to differentiate from musculoskeletal headaches also referred to as tension headaches.
Do you or your patients have obstructive sleep apnea (OSAS)?
It is estimated that approximately 2% of women and 4% of men between the ages of 30 and 60 years have OSAS. These numbers probably underestimate the actual number of people with this condition, as the condition is under-diagnosed.
What is OSAS?
OSAS occurs when there is partial or complete pharyngeal closure during sleep producing frequent arousals and sleep fragmentation which leads to excessive daytime somnolence as a sequela. An apnea is a polysomnographic diagnosis that is defined as a cessation of airflow for at least ten seconds despite continuous respiratory effort. The definition for a hypopnea is less precise but most agree that it is characterized by continuous respiratory effort in the presence of a reduction of airflow with a concomitant drop in the oxygen saturation ranging from 2-4%. An apnea-hypopnea index (AHI) is calculated to assess the presence and severity of OSAS. An AHI equal to or greater than 5/hr is the minimal criteria for OSAS.
Middle-aged men who snore loudly, who have witnessed apneic events, and excessive daytime sleepiness are at an increased risk for the development of OSAS. Persons with neck circumferences over 17 in and a body mass index (BMI) >28, post-menopausal women, and those with acromegaly, hypothyroidism and craniofacial abnormalities are also at risk.Children who are hyperactive may also have OSAS secondary to enlarged tonsils. It is important to note that these children do not have to be obese.
What should be done if OSAS is suspected?
If OSAS is suspected, a clinical polysomnogram (CPSG) should be ordered. A CPSG consists of monitoring the patient in a quite room simulatinga typical home bedroom environment. Leads are placed to assess sleep stages, limb/chest/abdominal movements, respirations,and cardiac rhythms. Prior to the CPSG, the patient should be evaluated by a sleep specialist in order to determine whether other sleep abnormalities are present and to provide appropriate counseling and screening studies.
Nasal continuous positive airway pressure (nCPAP) is the most common method for the treatment of OSAS. NCPAP provides a pneumatic splint which prevents the airway from closing; hence, hypoxemia is eliminated and the number of arousal eliminated or greatly reduced. Excessive daytime sleepiness does not occur because there is alleviation of sleep fragmentation.Tracheotomy is the only other treatment option with a high success rate. However, a tracheostomy is not very aesthetically pleasing and is reserved for those who fail all other treatment options. Uvulopalatopharyngeoplasty (UPPP) is considered to be effective if it reduces the AHI by 50%; hence, a person with an AHI of 100 (severe OSAS) who has UPPP is considered to have had a successful surgery if the AHI drop to or below 50 (however, this is still severe OSAS). Therefore, UPPP may be indicated in patients with mild OSAS. Maxillofacial surgery and complete facial reconstruction are reserved for those with craniofacial abnormalities or for those who have failed other treatment modalities. Weight reduction is also very important in the treatment of OSAS.
Why should OSAS be treated?
Untreated OSAS has been linked with hypertension and cardiac dysrhythmias. Heart attack, stroke, sudden cardiac arrest and cognitive/personality abnormalities are all considered to be somehow linked to OSAS as well. Hence, it is very important to recognize and to treat these patients.
I hope that I have shed some light on the pathophysiology, assessment, and treatment of OSAS. If you have any questions, please feel free to contact us.
Medical Director of Macomb Sleep Institute
Schedule an appointment or sleep evaluation by calling 586-778-3478.