Compare conditions

Put any two — or three — conditions side by side, adult or pediatric, to spot the look-alike differences fast, row by row.

OSA · Sleep Apnea

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In one line

·Your throat collapses over and over while you sleep, choking off air until your brain wakes you up gasping — CPAP holds it open so you can breathe all night.

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Normal physiology

·Your throat is a soft tube held open by muscles. During the day those muscles stay firm. At night during sleep they relax, but in healthy people the airway stays wide enough for air to flow freely into the lungs.

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What goes wrong

·The pharynx (throat tube) becomes too narrow or too floppy, so when the muscles relax during sleep, the walls collapse inward and block the airway completely.

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Hallmark signs

·Loud snoring that stops and starts
·Gasping or choking during sleep
·Daytime sleepiness that interferes with work or driving
·Morning headache
·Dry mouth or sore throat on waking
·Trouble concentrating or memory problems
·Irritability or mood swings
·Witnessed pauses in breathing during sleep

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Red flags · escalate now

·Falling asleep while driving or during conversations
·New or worsening high blood pressure that does not respond to medicine
·Witnessed breathing pauses longer than ten seconds, especially with turning blue or gray
·Chest pain, irregular heartbeat, or waking up gasping for air with a racing heart
·Severe daytime sleepiness in someone who operates heavy machinery or cares for children

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Workup

·Home sleep pauses in breathing (apnea) test (portable monitor that measures airflow, oxygen, and breathing effort while you sleep at home)
·In-lab polysomnography (overnight sleep study in a hospital that records brain waves, eye movement, oxygen, airflow, heart rhythm, and leg movement)
·Epworth Sleepiness Scale (8-question survey that asks how likely you are to fall asleep in everyday situations)
·Electrocardiogram (ECG or EKG — heart tracing that shows electrical activity)
·Blood pressure measurement (at home or in clinic, ideally multiple readings over several days)
·Hemoglobin A1c (blood test that shows average blood sugar over the past 3 months)

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Treatment

·Continuous positive airway pressure (CPAP) — a bedside machine that blows steady air through a mask into your nose or mouth while you sleep
·Weight loss through calorie reduction and regular physical activity if body mass index (BMI) is ≥ 25
·Oral appliance (custom-fitted mouthpiece worn at night that moves your lower jaw and tongue forward)
·Positional therapy — wearing a device that keeps you sleeping on your side instead of your back
·Uvulopalatopharyngoplasty (UPPP) — surgery that removes extra tissue from the soft palate, uvula, and throat to widen the airway
·Hypoglossal nerve stimulation — an implanted device that sends electrical pulses to the hypoglossal nerve (the nerve that moves your tongue) to keep your tongue from falling back and blocking the airway during sleep
·Avoid alcohol, sedatives, and sleeping pills, especially within 4 hours of bedtime

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NCLEX trap

·Sleepiness in sleep pauses in breathing (apnea) is a symptom, not the disease. The disease is a closed airway. Fix the airway with continuous positive airway pressure (CPAP, a mask that gently blows air to hold the throat open) first. Stimulants are a band-aid that leaves the real danger — low oxygen, high blood pressure, stroke risk — unfixed.
·Losing weight helps sleep pauses in breathing (apnea), but it takes months or years. Meanwhile, the patient has low oxygen at night and high stroke risk. Start CPAP now while weight loss happens. Do both — treat the airway today and the weight over time.
·Sleep pauses in breathing (apnea) causes high blood pressure by stressing the heart and blood vessels 30 to 100 times every night. The repeated oxygen drops trigger the sympathetic nervous system (the body's alarm system), which floods the blood with adrenaline and squeezes vessels tight. Screen for sleep pauses in breathing first in any patient with hard-to-control blood pressure.
·Most people with sleep pauses in breathing (apnea) do not know they have it. They do not remember waking up. Ask every overweight patient, every older patient, and every patient with high blood pressure or irregular heartbeat about snoring and witnessed pauses in breathing (a bed partner sees them stop breathing). Sleep pauses in breathing is silent and dangerous. You have to ask.
·Sleeping pills (benzodiazepines, Z-drugs like zolpidem) relax the muscles in the throat and make the airway close even more in sleep pauses in breathing (apnea). They worsen oxygen drops and are dangerous. Fix the airway first with CPAP. Never add sleeping pills until pauses in breathing is treated.
·Sleep pauses in breathing (apnea) patients stop breathing and their oxygen drops during surgery under anesthesia and after surgery when opioids are given (both relax throat muscles). Screen for sleep pauses in breathing before any surgery using the STOP-BANG questionnaire. If present, bring CPAP to the operating room and recovery room.

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