Nosing Around About Sleep Apnea

Adam Amdur is resting easier knowing that his daughter is not going to suffer from obstructive sleep apnea the way that he did for most of his life. Amdur, 37, who was in ill health for many years, was diagnosed with the condition only recently. But he recognized the symptoms in his now 4-year-old daughter when she was only a toddler, and got her the medical help she needed to be able to breathe properly at night and, therefore, function normally during the day.

Obstructive sleep apnea (OSA) is the decrease or arrest of airflow during sleep because of the narrowing or blockage of the airway. A blockage in the upper airway, or pharynx (the canal between the nose and the back of the throat), affects the collapsibility of the muscles of the throat.

Although all people can have occasional hypopnea (arrested breathing) episodes during sleep, those of us who have many of them on a regular basis have OSA, which can lead to many serious health problems. Often, the condition runs in families. Amdur realized only retrospectively that his ancestors almost surely suffered from OSA. However, thanks to his own diagnosis and his increasing knowledge about the condition, he is doing all he can to improve his health and to change the outlook for future generations of his family.

“Although OSA can occur spontaneously, there are several components that make it run in families,” explained Dr. Nanci Yuan, a pediatric pulmonologist and the medical director of the sleep center at Lucile Packard Children’s Hospital at Stanford University. She told The Jewish Week that the hereditary aspects involve facial structures, weight issues (being heavier set), genetic neuromuscular diseases and allergies.

“I don’t have a typical ‘Jewish’ nose,” Amdur remarked in a phone conversation with The Jewish Week. “I have a small nose, narrow face and recessed chin — and so does my daughter.” Indeed, those are the inherited “cephalometics,” or facial features, that Yuan advises parents to look out for in their children. “People with flat faces, small nasal passages, recessed jaws and overbites are more prone to OSA,” she said.

Often, it is a child’s (or adult’s) dentist or orthodontist who sees the first signs of problems that could cause OSA. According to Dr. Stacey Quo, an orthodontist in Palo Alto, Calif., who serves as clinical professor at Stanford University, teaching at the Stanford Sleep Disorders Clinic, “for many patients with OSA, the problem is at the back of the throat, either behind the palate or at the base of the tongue.” She explained in an e-mail interview, “dentists routinely examine these areas at every dental visit, and can determine if these areas vary from normal.”

Many OSA patients present with malocclusions, or problems with their bites. Amdur recalls having had to have many teeth pulled because of overcrowding in his mouth. “Studies describe [the] risk factors as having jaws that are small in length and narrow in width, long and narrow face, protruded incisors, cross bite, dental crowding, incisors that do not touch (open bite), and high arched and narrow palate,” Quo said. But she cautioned that people can still have OSA, even if they do not possess any of these features.

Undiagnosed and untreated OSA can take a severe toll on a person. Amdur knows from first-hand experience. “I am 37, but I have a 75-year-old man’s body,” he said. “But I am healing now,” he continued, with a sigh of relief. “In hindsight, I realized that all this went back to when I was just 2 years old, when I thankfully had my adenoids taken out. But things really got bad when I hit puberty and started really growing, causing my throat muscles to really constrict.”

Amdur, who recently moved back to his home state of Florida from Northern California to be in a less allergenic environment, recalls his middle school teachers complaining of his eyes wandering and his being tired in class. “I was drinking coffee in seventh grade because I was so tired,” Amdur remembered. “My mom thought I was the boy who cried wolf and was lazy, but I was exhausted all the time.”

As he became an adult, his immune system wasn’t working properly, he was having problems in school, and he ended up experimenting with illegal substances. The constant sleep deprivation was taking a toll on his personality, causing him severe anxiety, and making it hard for him to work up to his full potential. “As I got older, the effects started to show more and more,” he said.

The most dramatic and dangerous result of his OSA was his falling asleep at the wheel of a car when he was in his late 20s. “I drove through a gas station” — at 60 miles per hour — “and by some act of God, we walked away from it.”

It was only after Amdur was diagnosed with OSA after a sleep study — “the gold standard in diagnosing OSA,” according to Yuan — and was aware of the root of all his medical problems, that he realized his parents and grandparents most likely suffered from the condition, too. Undiagnosed and untreated OSA can cause not only difficulties with focus, cognition and memory, but also contribute to metabolic disorders and serious problems in cardiovascular health — as was definitely the case in Amdur’s family.

Amdur’s father had quadruple bypass surgery at age 38, and later got vascular dementia, dying at age 62. His paternal grandfather died of heart disease in his 60s, as did his brother. Amdur’s mother was recently diagnosed with sleep apnea, and her father died at 61 from a sudden heart attack. Her brother died in his late 40s of a brain aneurism. “All the Amdur men look very much alike,” Amdur said of the telltale facial structures that he now knows increase the risk for OSA.

With the development of sleep medicine as a specialty in the late 1990s, doctors have been able to inform parents about signs of OSA they can observe in their children. Parents should be on the lookout for abnormal breathing during sleep: stopped breathing, gasping and snoring. Children who are restless sleepers or exhibit other sleep problems like getting up from bed frequently, nightmares, sleep disturbances and bedwetting should be evaluated for OSA.

There are also other signs that may be spotted not only by parents at home at night, but also by teachers and caregivers during the day. “These can be cognitive or behavioral issues,” said Yuan. “Any children that adults are worried may have attention deficit disorder or hyperactivity should be screened for sleep apnea. Also, if a child is hard to rouse or dozing off during the day — but that is less common in young kids, who are more likely to be overactive.”

Some children, like Amdur’s daughter, use a CPAP machine at night. The CPAP mask and machine provide continuous positive airway pressure to keep the breathing passages open. Amdur’s machine, as well as his daughter’s, stores digital data, which Amdur transmits to their sleep doctors for review on a regular basis.

Amdur learned through difficult life experience how to be an advocate for his own child, and he is writing a memoir about his years prior to and following his diagnosis of OSA to help others. “I am hoping my daughter will be able to avoid the problems that I and my family have had,” he shared. “That’s all a Jewish dad could want for his child.”

For more information on the diagnosis and treatment of OSA, go to http://sleep.stanford.edu