4 Beyond snoring: Sleep apnea has dangerous consequences
Obstructive Sleep Apnea (OSA) is a major health problem with potentially dangerous consequences.
For instance, truck drivers with this sleep disorder who did not get or did not follow treatment had a five times higher rate of preventable crashes than truckers without sleep apnea, according to researchers of a large-scale 2016 study of the U.S. trucking industry.
Even for people with sleep apnea who don’t operate heavy machinery, this disorder can seriously compromise well-being, raising a person’s risk of irregular heart rate (atrial fibrillation), heart disease, stroke, hypertension, diabetes and depression. Untreated OSA causes repeated episodes of low oxygenation at night when the airway is briefly obstructed, causing cardiovascular stress and diminished sleep.
These issues are why I keep an eye out for patients who display symptoms that may be predictive of sleep apnea, and assess risk for this disorder when I am doing pre-operative exams. People with sleep apnea may be more likely to experience complications with major surgery and general anesthesia because these people are prone to breathing problems, especially when sedated and lying on their backs. It is important for your doctor to know if you have sleep apnea and, if so, how you are treating it, before you have surgery.
The cabin test
Do you snore? Heavy snoring is one of the primary symptoms of this disorder. People who live alone, or with deep-sleeping companions, may not know the answer to this question, but I’ve noticed that some of my patients find out during the summer. It’s what I call the cabin test: did you stay in a cabin (or hotel room or other lodging) with other people this summer? Did any of them mention that you snore?
Snoring is common, and not all patients who snore will have sleep apnea.
However, in tandem with certain other symptoms, it might be worth talking to your health provider about getting a screening. Some of the main predictive features of OSA — apart from loud snoring — include gasping during sleep, headache in the morning, excessive daytime sleepiness, and having a neck circumference of greater than 16 inches (40.6 cm). Risk factors include age between 40-70, obesity, family history of obstructive sleep apnea, and being a postmenopausal woman who is not taking hormone therapy. Men are actually three times more likely to have OSA, but they are nine times more likely to be referred for polysomnography—a sleep study that diagnoses sleep disorders—so women may be underdiagnosed. We don’t know the exact prevalence of sleep apnea in the population, with estimates ranging from 2-14 percent. Our aging population and rising rates of obesity are contributing to those numbers.
If you need a sleep study
If you have suspected sleep apnea, your doctor will likely screen you using a questionnaire. One common one, the STOP-Bang, can also be found online and asks questions about your health and body, such as snoring, tiredness, stopping breathing during sleep or gasping during sleep, blood pressure, age, body mass index, neck circumference and gender.
If this or another screening method warrants it, your doctor will then order a sleep study. This may take place at home, or it may need to be performed at a sleep laboratory. Many patients prefer to do a home study, I’m told, because it is hard to sleep away from home, but home studies are generally considered less accurate than sleep lab studies. Both quantify how often airflow is partially or completely obstructed during sleep. Apnea is a complete obstruction of airflow, while hypopnea is a partial obstruction of airflow. Either must last a minimum of 10 seconds in order to count toward the apnea-hypopnea index, the calculation that is required to diagnose OSA. Partial obstruction (hypopnea) is measured by a drop in the level of oxygen in the blood, known as oxygen desaturation, of 4 percent or more, or by arousal from sleep. The index is calculated by adding partial and complete obstruction events together, then dividing it by total sleep time. An index of 15 or more events per hour, or five more events per hour when certain other symptoms are present, or the patient has a history of hypertension, ischemic heart disease, or stroke, is diagnostic for OSA. A sleep study is interpreted by a pulmonologist, who determines if these criteria are met. This doctor also often recommends appropriate therapy and next steps.
Treatments that can help
Treatment for sleep apnea may involve lifestyle changes, such as changing sleep position to a side posture rather than a back-lying or supine position. Weight loss may also be an important part of the process, as fatty deposits around the neck in some people with obesity can lead to obstruction.
The most common therapy for OSA is one of several positive pressure therapies to be used during sleep, such as a CPAP (continuous positive airway pressure) device. I find that patients who want to lose weight to treat their sleep apnea are able to do so much more effectively by using positive pressure therapy devices during the process — good sleep will allow you to lose weight more easily. The device also makes it much easier to control hypertension for people with OSA.
If you were diagnosed with sleep apnea 5-10 years ago, and you couldn’t tolerate the sleep equipment at the time, I recommend that you try again, as the machines are much improved and quieter. Patients may also get an Automatic Positive Airway Pressure (APAP) machine, which monitors breathing and varies pressure as needed, which is often more comfortable for the user. Some people may be given a special oral appliance for sleep if they cannot tolerate the CPAP or APAP machines. The most effective is a mandibular advancement device, which keeps the patient’s jaw forward to maintain an open airway.
I can’t stress enough the benefits of getting treatment for obstructive sleep apnea for patients with OSA. Sleep is such a critical time for our bodies, and we often don’t realize how deprived we are. Sleeping well can protect your heart, reduce hypertension, help with depression, increase concentration, make it easier to lose weight. It gives you energy to spend time with family and friends, and has many other benefits. If you suspect you have this disorder, please make an office visit with your primary care provider to discuss symptoms and get a referral to a sleep clinic for evaluation.
Ginny Sugimoto, MD, is a board-certified family practice doctor at Kaiser Permanente Port Orchard Medical Center. Her philosophy of care includes a emphasizing a preventive lifestyle and shared decision-making in partnership with her patients.
