Treat Sleep Apnea to Protect Overall Health

A new study underlines the health risks associated with obstructive sleep apnea (OSA). The study (American Journal of Respiratory and Critical Care Medicine, March 1) found that severe OSA is associated with recurrent cardiovascular events in people with cardiovascular disease. Other recent data points to the importance of staying compliant with the most effective treatment for OSA: a continuous positive airway pressure (CPAP) machine. Researchers writing in the Journal of Clinical Sleep Medicine, Feb. 15, found that that people with sleep apnea who have been hospitalized and who, after discharge, don’t use CPAP are more than three times as likely to be readmitted to hospital within 30 days.

What Is Sleep Apnea? In sleep apnea, excess soft tissue at the back of the throat essentially “collapses” while you sleep, blocking your airway. This interrupts breathing, resulting in low blood oxygen levels (hypoxia) that alert the brain to wake you. At this point, you start breathing again, often making a loud gasp or choking sound in the process. “These episodes can happen 30 times or more per hour during the night,” says David M. Rapoport, MD, professor of medicine in Mount Sinai’s division of pulmonary, critical care and sleep medicine, and director of the Sleep Medicine Research Program at Mount Sinai.

Harmful to Your Health OSA prevents you from getting the deep, restorative sleep you need—but that isn’t all it does. “We now know it can do a lot more than make you sleepy in the daytime,” Dr. Rapoport confirms. “OSA can cause high blood pressure, or make it worse and harder to treat. It affects your risk of having a stroke or heart attack, and research is pointing to links with diabetes, weight gain, and cancer.” OSA also impacts your neurocognitive performance as you age, impairing your memory, focus, and attention; and it may cause depression. 

Lack of Awareness The symptoms of OSA include snoring, a dry mouth, sore throat and/or headache in the morning when you wake, and unexplained daytime sleepiness that may cause you to fall asleep when you’re not actively engaged in something. However, Dr. Rapoport notes that you may not realize what’s causing your symptoms. “Many people with sleep apnea are completely unaware of the problem or even of waking up, as the arousal after an apnea can last as little as 10 to 30 seconds,” he explains. “But bed partners often are disturbed by gasping and severe snoring, of which the patient is entirely unaware.”

Diagnosing Sleep Apnea The American Academy of Sleep Medicine recommends that doctors ask about possible OSA symptoms during routine physicals, but if your doctor doesn’t, mention any suspicions you have. In order to be sure about your diagnosis, your doctor will likely refer you for a sleep study. This is performed using a test called polysomnography, and can take place either in a lab or at home.

In the Lab You’ll attend the lab in the evening, and should bring your usual nighttime attire and anything else you use during your bedtime routine. The room where you’ll sleep is similar to a hotel room, but will have a camera so you can be observed as you sleep, and an audio link so the technician can hear any sounds that may signal OSA-related arousals.

Lab-based polysomnography incorporates an electroencephalogram (EEG) to measure your brain waves as you sleep, an electrooculogram (EOG) to track your eye movements, and an electromyogram (EMG) to track chin movement. These tests involve having sensors attached to your scalp, temples, and chin. Other sensors will be attached to your chest and legs, to track your heart rate and leg movements. You’ll also wear a clip on your finger to monitor your blood oxygen levels.

While you may find it difficult to drift off to sleep in the lab, you won’t need to sleep for a full night to get accurate study results. “You may get an OSA diagnosis even from what seems to be a short or mediocre night of sleep,” Dr. Rapoport confirms. “This is because most of us underestimate how much sleep occurs during a sleep study, and even short periods of sleep will show the problem.”

At Home Polysomnography also can be performed at home using a portable monitor. These monitors are more limited, incorporating a nasal cannula to measure your airflow, a chest belt to monitor your breathing, and a finger clip to keep track of your blood oxygen levels.

“Most people sleep better in their own bed, so a home study works well to diagnose uncomplicated OSA,” Dr. Rapoport observes. “However, the absence of EEG, EOG, and EMG means we won’t be able to confirm that you actually slept, so if the study shows no apnea, it’s possible—even if highly unlikely—that you didn’t sleep at all. If your doctor thinks it’s highly likely that you have OSA, a negative home test will usually prompt a follow-up lab study.” Dr. Rapoport adds that a home sleep study won’t diagnose other sleep disorders (such as restless legs syndrome) because of its limited tracking of movement. A home sleep study also may not be suitable for people with other health conditions that may affect the accuracy of polysomnography (for example, heart failure).

Treating OSA You’re at greater risk for sleep apnea if you are overweight or obese, smoke, and/or consume excessive amounts of alcohol, so take steps to address these risk factors if necessary. You also should follow your doctor’s advice for treating any conditions that may be connected to your OSA, such as high blood pressure.

If lifestyle changes don’t ease your OSA, mild cases may respond to oral devices that keep the throat open by repositioning the tongue and jaw. “There are also several other gadgets, including an implantable ‘pacemaker’ for the tongue,” Dr. Rapoport adds, “but none of them works consistently for everyone.” One option that has proven quite successful for Dr. Rapoport and his team at Mount Sinai is a device called Night Shift, which vibrates to alert you if you roll over onto your back during sleep (sleeping on your back makes it easier for the tissue of the upper airway to collapse and block your airflow). The intensity of the vibration gradually increases until you change position.

However, none of these options is as effective as a CPAP machine, which delivers a steady flow of air via nasal cannula or a mask. “CPAP essentially always cures the blockage that is causing OSA,” Dr. Rapoport observes. “Unfortunately not all people are able or willing to use CPAP, or they do so for only part of the night.”

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