Evaluation

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Symptoms of Sleep Apnea

Loud, persistent snoring. The loud snoring is often followed by periods of silence when the airway is completely obstructed. These pauses are often followed by gasps or choking sounds as the person resumes breathing.
Unexplained daytime sleepiness. People with sleep apnea are prone to dozing off while at work or driving or even during conversations. Sleep apnea sufferers are up to six times as likely to get into repeated auto accidents.
Poor sleep. Since the brain repeatedly jolts the body to wake up and resume breathing, sleep quality is disturbed throughout the night.

Other symptoms include:

Hypertension
Morning headaches
Difficulty concentrating
Forgetfulness
Mood disturbance
Anxiety
Depression
Frequent urination at night (nocturia)
Sore throat or dry mouth in the morning
Insomnia
Night sweats
Unexplained weight gain
Increased heart rate
Diminished sex drive

Children with sleep apnea may exhibit hyperactivity, poor academic performance and hostile behavior. Bedwetting and unusual sleep positions are also seen in children with sleep apnea.

Dangers & Complications

Sleep apnea carries a wide range of serious physical and psychological consequences when left untreated.

Daytime fatigue and risk of injury. The reduction of quality sleep leads to chronic sleepiness throughout the day. Sleepiness can affect quality of life, motivation, and raise one’s risk of injury while at work or driving. People with sleep apnea have 2-3 times more likely to get into a car accident and 5-7 times more likely to get into multiple accidents.
Irritability, mood changes, and depression. People with mild sleep apnea are twice as likely to have depression as those without. Those with moderate to severe sleep apnea are 2.6 times as likely to have depression.
Diminished cognitive function. The absence of restful sleep can cause difficulty concentrating and memory disturbance. In turn, these factors can impair job performance. Research indicates that people with OSA show a loss of tissue in brain regions that are involved with memory.
Obesity & diabetes. Sleep apnea is worsened by and worsens obesity. Repeated arousals during sleep may result in insulin resistance. In addition, hormonal changes may facilitate the storage of fat, leading to weight gain. Ninety percent of morbidly obese individuals have sleep apnea. CPAP treatment has been shown to reduce insulin resistance in sleep apnea patients.
Heart disease and congestive heart failure. Patients with moderate to severe sleep apnea have a greater risk of mortality from heart disease and heart failure. A third of patients with sleep apnea also show symptoms of congestive heart failure. Heart failure can be exacerbated by sleep apnea and leads to a greater chance of death. Eleven to 37% percent of patients with heart failure have sleep apnea.
High blood pressure. Sleep apnea is considered an identifiable cause of high blood pressure (hypertension) and is observed in 50-70% of patients. Sleep apnea has been identified as the most common cause of secondary hypertension in the US.
Arrhythmias. Individuals with untreated sleep apnea are 2-4 times as likely to experience nocturnal complex arrhythmia. Bradyarrythmia (slower arrhythmia) is observed in 10% of patients.
Coronary artery disease. There is a very strong, independent association between sleep apnea and coronary artery disease (CAD). Men with untreated severe sleep apnea have an increased number of fatal and non-fatal cardiovascular events.
Arterial fibrillation and complex ventricular ectopy. Untreated obstructive sleep apnea doubles the risk of recurrence of atrial fibrillation.
Stroke. Patients with obstructive sleep apnea are more likely to have a stroke and die than those without sleep apnea. The risk increases as the severity of the sleep apnea increases.
Asthma. Sleep apnea may exacerbate asthma symptoms and reduce the effectiveness of medication.
Seizures, epilepsy, and other nerve disorders. There may be an association between seizures and obstructive sleep apnea, especially in older adults. Some studies have shown treatment of obstructive sleep apnea, when present, may help in the control of refractory seizures.
Headaches. Sleep disorders, including apnea, may be the underlying causes of some chronic headaches. In some patients with both chronic headaches and apnea, treating the sleep disorder has cured the headache, even the very severe and disabling form known as a cluster headache.
Effects on bed partners. Because sleep apnea so often includes noisy snoring, the condition can also adversely affect the sleep quality of a patient's bed partner. Spouses or partners may also suffer from sleeplessness and fatigue. In some cases, the snoring can disrupt relationships. Diagnosis and treatment of sleep apnea in the patient can help eliminate these problems.
Death. People with untreated moderate to severe sleep apnea have an increased all-cause mortality rate, which means they’re more likely to die from any cause as compared to people without sleep apnea. In a study using patients with untreated moderate-to-severe sleep apnea, researchers found that the 5-year risk of death was 14% in those who refused CPAP treatment compared to 4% in those receiving treatment. The 14-year risk of death is 33% compared with only 7.7% in those without sleep apnea. Furthermore, patients with severe sleep apnea are almost three times as likely to die from cardiovascular complications.

OSA Comorbidities

Disease	Prevalence
Stroke	90%
Morbid obesity, male	90%
Daytime sleepiness	87%
Drug-resistant hypertension	83%
Pulmonary hypertension	77%
Congestive heart failure	76%
Gastroesophageal reflux disease	60%
Dysrhythmias	58%
Morbid obesity, female	50%
Atrial fibrillation	49%
Nocturia	48%
Ischemic heart disease	38%
Hypertension	30%
Asthma	17%
Type 2 diabetes mellitus	15%

OSA Risk Factors

Several factors have been identified as increasing one’s risk for sleep apnea. These include:

Male gender. Males, who typically have higher BMI than females, are three times as likely to have sleep apnea.
Older age. As muscles weaken with age, the chances of obstruction increase. Adults between 40 and 60 years old are at significantly greater risk for sleep apnea.
Obesity. More than half of sleep apnea sufferers are overweight. It’s believed that fat deposits narrow the airway, making it more susceptible to obstruction. Ninety percent of morbidly obese individuals suffer from sleep apnea. Large amounts of central body fat is also a risk factor.
A wide neck. Wide necks are indicators of obesity. Men with neck circumferences 17” or great and women with neck circumferences of 16” or greater are at greater risk for sleep apnea.
High blood pressure. Untreated hypertension increases one’s risk of having sleep apnea.
Family history of sleep apnea. Those with family members who have sleep apnea are 2-4 times as likely to have it themselves.
Enlarged tonsils or an enlarged tongue. Both enlarged tonsils and tongues can occlude the airway more easily.
Small airways in the nose, throat, or mouth. Small airways are easier to obstruct, and thus carry a greater risk of sleep apnea.
Nasal congestion. Nasal congestion makes it more difficult for air to pass through to the lungs and can independently disturb sleep by creating physical discomfort.
Abnormal jaw. Morphological features like protruding or small jaws suggest a narrow airway, leading to a higher probability of sleep apnea.
During pregnancy or after menopause. Women during pregnancy and after menopause have a higher BMI and are more susceptible to obstructive sleep apnea. Women are three times as likely to have sleep apnea after menopause.
Race. There is a greater incidence of sleep apnea in African American, Hispanic, Chinese, and Pacific Islander populations.
Sleep position. Those who sleep on their back (supine) are more likely to suffer from sleep apnea.
Use of alcohol or sedatives. Alcohols and sedatives relax the muscles in the throat which makes them more likely to cover the airway and obstruct breathing.
Smoking. Smoking can irritate the back of the throat and promote fluid retention, narrowing the airway. Individuals who smoke more than 2 packs a day at 40 times more likely to have sleep apnea.
Lower extremity edema. Those with unexplained lower extremity edema are as a higher risk for obstructive sleep apnea.
Polycystic Ovary Syndrome (PCOS). Obstructive sleep apnea, daytime sleepiness, and diabetes are all associated with PCOS.

Statistics

Prevalence

According to current estimates, as least 1 in 5 Americans have mild sleep apnea and 1 in 15 have moderate or severe sleep apnea.
It is believed that 80% of those affected with obstructive sleep apnea are undiagnosed and in need of treatment.
It is estimated that 9% of middle-age women and 24% of middle-age men are affected by sleep apnea but are undiagnosed and untreated.
In individuals over 65, obstructive sleep apnea with an AHI>10 has be found in 70% of the men and 56% of the women, triple the estimates for middle age.

Risk Factors

In one clinical study, 17% of African Americans tested positive for obstructive sleep apnea compared to 8% of Caucasians.
Men are at a 2- to 3-fold greater risk for having obstructive sleep apnea compared to women.
In a study comparing snoring habits in pregnant and non-pregnant women, research found that 14% of pregnant women reported snoring often or always versus only 4% of non-pregnant women.

Growth

Over the past 10 years referrals for sleep studies have increased 12-fold.

Dangers & Complications

Between 50-70% of obstructive sleep apnea patients have systemic hypertension independent of obesity, age, smoking, and alcohol intake.
It is an estimated the risk of depression in patients with mild obstructive sleep apnea is doubled. In patients with moderate or severe obstructive sleep apnea, the risk is 2.6 times as great.
Sleep apnea sufferers have a 30% higher risk of heart attack or death compared to those unaffected.
The all-cause mortality rate over a 14-year period for patients with moderate to severe OSA was 33%, compared to 7.7% for people without OSA.

Treatment

According to one study, the 5-year risk of death for moderate-to-severe sleep apnea patients was 14% for those who refused CPAP treatment compared to 4% for those receiving CPAP.
In the US, diagnosing and treating sleep apnea can halve patients’ healthcare costs.
Untreated sleep apnea costs $1,336 more in health care costs per person, compared to individuals without sleep apnea. This accounts for an estimated $3.4 billion a year in additional medical costs.
Approximately 95% of patients with OSA will have a 90%-95% reduction in their apnea-hypopnea index with CPAP treatment.