What is obstructive sleep apnea?

What is obstructive sleep apnea, and why should we care about this disease? Why is it important? What are the symptoms? How is it diagnosed? What are the treatment options? Why should we care about obstructive sleep apnea? Is it a ‘disease-of-the-week?’ - A nuisance disease without serious consequence? There are many reasons sleep apnea is, and should be taken very seriously.

Hypertension
Hypertension is a serious side effect of sleep apnea, independent of obesity. The throats of the sleep apnea suffer collapses throughout the night. Each event of this occurrence ends with an arousal of near awakeness. Each episode like this represents a spike in blood pressure. It has been clinically proven that there is a direct relationship between daytime high blood pressure and obstructive sleep apnea. It has also been proven that effective treatment of sleep apnea can yield a 10 mm drop in systolic blood pressure; making it as effective as drug therapy in the hypertensive sleep apnea patient.

Heart Failure
Heart Failure is also related to obstructive sleep apnea, independent of traditional risk factors. A full 40% of Congestive Heart Failure (CHF) patients have been found to have obstructive sleep apnea. If left untreated, sleep apnea increases the risk of heart complications by 5 fold. RDI, a measure of sleep apnea severity, which we will define shortly, is an independent predictor of death, in coronary artery disease. During a sleep apnea event, not only is there a drop in oxygen levels, and an increase in blood pressure, it also releases a number of inflammatory agents; these agents are considered to greatly increase the risk of cardiovascular disease. Left Ventricular Hypertrophy also seen in patients with Obstructive Sleep Apnea improves with treatment of OSA.

Increase Accident Rates
Increase Accident Rates are independent of general daytime sleepiness. This means the untreated obstructive sleep apnea patient is 6 - 7 times more likely to be in an automobile accident, even if they do not feel drowsy during the day. New Jersey has just signed the first Drowsy Driver Law recognizing the seriousness of driving without getting an adequate amount of sleep. In some countries, drivers diagnosed with sleep apnea risk losing their job if they are not compliant is getting treatment for Obstructive Sleep Apnea.

Diabetes
The link between obstructive sleep apnea and diabetes is getting stronger. There is growing empirical evidence that sleep apnea starts a chain of events that leads to diabetes. Recent research has identified all the links in this chain, and every week new studies are solidifying this relationship. There is preliminary evidence that suggests diabetes can lead to obstructive sleep apnea. If both of these finds are verified, the potential for a downward spiral is significant.

The Cost of Untreated OSA
If none of the previously mentioned reasons gives you motivation to treat your sleep apnea, perhaps this reason will inspire a closer look at addressing the disease – money. A patient with untreated sleep apnea costs the health care system twice as much as a control patient (patient without sleep apnea). Follow up studies on the treated sleep apnea patient shows that the per-patient costs do come down in the year following treatment, and after 2 years, are no higher than control patients. A study done in Manitoba looked at the cost of patients 10 years preceding diagnosis, overall costs were double, and overnight hospital stays were also doubled over the entire 10-year span. Once again, costs came down after treatment. These results have been replicated by different studies using different measurements of health care costs. On a personal level, I have seen this manifest itself in the clinical environment. Once a patient is effectively treated for OSA, their inpatient hospital stays for their various [other] disease processes, simply put – decreases.

In summary, there are many reasons to care about OSA. Hypertension, stroke, and cardiovascular disease are all complications of OSA. The link to diabetes continues to grow stronger as well. Untreated sleep apnea patients are 6 times more likely to get into a car accident, and the finally, in today’s environment of skyrocketing healthcare costs, an untreated sleep apnea patient, costs the health care system twice as much as someone without sleep apnea.