Overview

Obstructive sleep apnea is the most common sleep-related breathing disorder. People with obstructive sleep apnea repeatedly stop and start breathing while they sleep.

There are several types of sleep apnea. Obstructive sleep apnea occurs when the throat muscles relax and block the airway. This happens off and on many times during sleep. A sign of obstructive sleep apnea is snoring.

Treatments for obstructive sleep apnea are available. One treatment is a device that uses positive pressure to keep the airway open during sleep. Another option is a mouthpiece to thrust the lower jaw forward during sleep. In some people, surgery might be an option too.

Symptoms

Symptoms of obstructive sleep apnea include:

  • Excessive daytime sleepiness.
  • Loud snoring.
  • Observed episodes of stopped breathing during sleep.
  • Waking during the night and gasping or choking.
  • Awakening in the morning with a dry mouth or sore throat.
  • Morning headaches.
  • Trouble focusing during the day.
  • Mood changes, such as depression or being easily upset.
  • High blood pressure.
  • Decreased interest in sex.

When to see a doctor

Consult a health care professional if you have, or if your partner observes, the following:

  • Snoring loud enough to disturb your sleep or the sleep of others.
  • Waking up gasping or choking.
  • Pausing in your breathing during sleep.
  • Having excessive daytime drowsiness. This may cause you to fall asleep while working, watching television or even driving a vehicle.

Snoring doesn't necessarily indicate something potentially serious, and not everyone who snores has obstructive sleep apnea.

Be sure to talk to a member of your health care team if you snore loudly, especially if your snoring is interrupted by periods of silence. Snoring may be loudest — and breath pauses known as apneas may be more common — when you sleep on your back.

Ask your health care team about any sleep problem that leaves you fatigued, sleepy and irritable on a regular basis. Excessive daytime drowsiness may be due to other disorders, such as narcolepsy.

Causes

Obstructive sleep apnea occurs when the muscles in the back of the throat relax too much to allow for proper breathing. These muscles support the back of the roof of the mouth, known as the soft palate. The muscles also support the tongue and side walls of the throat.

When the muscles relax, the airway narrows or closes as you breathe in. This can lower the level of oxygen in the blood and cause a buildup of carbon dioxide.

Your brain senses this impaired breathing and briefly rouses you from sleep so that you can reopen your airway. This awakening is usually so brief that you don't remember it.

You may awaken with shortness of breath that corrects itself quickly, within one or two deep breaths. Or you might make a snorting, choking or gasping sound.

This pattern can repeat itself 5 to 30 times or more each hour, all night long. These disruptions impair your ability to reach the deep, restful phases of sleep, and you'll probably feel sleepy during your waking hours.

People with obstructive sleep apnea might not be aware of their interrupted sleep. Many people with this type of sleep apnea don't realize they haven't slept well all night.

Risk factors

Anyone can develop obstructive sleep apnea. However, certain factors put you at increased risk, including:

  • Excess weight. Most but not all people with obstructive sleep apnea are overweight. Fat deposits around the upper airway can obstruct breathing. Medical conditions that are associated with obesity, such as hypothyroidism and polycystic ovary syndrome, also can cause obstructive sleep apnea.
  • Older age. The risk of obstructive sleep apnea increases as you age but appears to level off after your 60s and 70s.
  • Narrowed airway. A naturally narrow airway is a trait that can be passed down in your family. Or your tonsils or adenoids might become enlarged and block your airway.
  • High blood pressure, known as hypertension. Obstructive sleep apnea is relatively common in people with hypertension.
  • Chronic nasal congestion. Obstructive sleep apnea occurs twice as often in those who have consistent nasal congestion at night, regardless of the cause.
  • Smoking. People who smoke are more likely to have obstructive sleep apnea.
  • Diabetes. Obstructive sleep apnea might be more common in people with diabetes.
  • Male sex. In general, men are 2 to 3 times more likely as premenopausal women to have obstructive sleep apnea. However, the risk of obstructive sleep apnea increases in women after menopause.
  • A family history of sleep apnea. Having family members with obstructive sleep apnea might increase your risk.
  • Asthma. Research has found an association between asthma and the risk of obstructive sleep apnea.

Complications

Obstructive sleep apnea is considered a serious medical condition. Complications can include:

  • Daytime fatigue and sleepiness. Because of a lack of restorative sleep at night, people with obstructive sleep apnea often have severe daytime drowsiness, fatigue and irritability. They might have difficulty concentrating and find themselves falling asleep at work, while watching TV or even when driving. This can put them at higher risk of work-related accidents.

    Children and young people with obstructive sleep apnea might do poorly in school and commonly have attention or behavior problems.

  • Cardiovascular problems. Sudden drops in blood oxygen levels that occur during obstructive sleep apnea increase blood pressure and strain the cardiovascular system. Many people with obstructive sleep apnea develop high blood pressure, which can increase the risk of heart disease.

    The worse the obstructive sleep apnea, the greater the risk of coronary artery disease, heart attack, heart failure and stroke.

    Obstructive sleep apnea also increases the risk of heart rhythm problems known as arrhythmias. Arrhythmias can lower blood pressure. If there's underlying heart disease, these repeated multiple episodes of arrhythmias could lead to sudden death.

  • Complications with medicines and surgery. Obstructive sleep apnea also is a concern with certain medicines and general anesthesia. Medicines such as sedatives, some prescription painkillers and general anesthetics, relax the upper airway and can make obstructive sleep apnea worse.

    If you have obstructive sleep apnea, having major surgery can worsen breathing problems. This is especially true if you have been sedated and you were lying on your back. People with obstructive sleep apnea might be more prone to complications after surgery.

    Before you have surgery, tell your surgeon if you have obstructive sleep apnea or symptoms related to the condition. You may need to get tested for obstructive sleep apnea before surgery.

  • Eye problems. Some research has found a connection between obstructive sleep apnea and certain eye conditions, such as glaucoma. Eye complications can usually be treated.
  • Sleep-deprived partners. Loud snoring can keep those around you from getting good rest and eventually disrupt your relationships. Some partners choose to sleep in another room.

People with obstructive sleep apnea also may complain of memory problems, morning headaches, and mood swings or depression. They also may need to urinate often at night.

Obstructive sleep apnea might be a risk factor for COVID-19. People with obstructive sleep apnea have been found to be at higher risk for developing a severe form of COVID-19. They may be more likely to need hospital treatment than do those who don't have obstructive sleep apnea.

By Mayo Clinic Staff