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Sleep Apnea (cont.)

How common is obstructive sleep apnea?

Obstructive sleep apnea (OSA) is estimated to affect about 4% of men and 2% of women. In one study of people over 18 years of age, obstructive sleep apnea was estimated to develop in 1.5 % of people per year over the 5 year study. It is probably more common than either of these numbers because the population is becoming more obese, and obesity worsens obstructive sleep apnea. More shocking is the estimate that only 10% of people with obstructive sleep apnea are currently receiving treatment.

Some groups are more likely to develop obstructive sleep apnea.

  • Men are more likely to have obstructive sleep apnea than women before age 50.
  • After age 50, the risk is the same in men and women.
  • Among obese patients, 70% have obstructive sleep apnea. Obstructive sleep apnea worsens in severity and prevalence with increasing obesity.
  • Among cardiac patients, 30-50% have obstructive sleep apnea, and among patients with strokes, 60% have obstructive sleep apnea.
  • A recent study estimated that 14% of NFL football players and 34% of NFL linemen have obstructive sleep apnea.
  • African-Americans have a 2.5 times greater risk of obstructive sleep apnea than Caucasians. In India, 7.5% of males have obstructive sleep apnea. Chinese males have a 4% prevalence and Chinese females a 2% prevalence of obstructive sleep apnea. This is interesting because the prevalence is similar to American Caucasians, but the Chinese population is generally smaller and less obese than the general American population. Therefore, something besides obesity must be the explanation for Chinese obstructive sleep apnea. We do not understand the reasons for these differences, but studies are ongoing to better define the risks.

What are obstructive sleep apnea symptoms?

Obstructive sleep apnea has many well-studied consequences. First, as you would expect, it disrupts sleep. Patients with disrupted sleep cannot concentrate, think, or remember as well during the day. This has been shown to cause more accidents in the work place and while driving. Thus, people with obstructive sleep apnea have a three-fold greater risk of a car accident than the general population (there aren't many diseases that can kill the patient AND the people in the car next to him or her!).

High blood pressure

Sleep apnea causes high blood pressure and heart problems. Stopping breathing frequently during the night (every 1-4 minutes) can cause increased stress on the heart. As the oxygen saturation in the blood decreases and the apnea continues, the sympathetic system ("Fight or Flight" response) is activated. This sends nerve signals and adrenaline signals to the blood vessels to constrict and to the heart to work harder. When the vessels constrict, more blood is sent to the brain and muscles. However, this increases the blood pressure, which requires the heart to work harder to pump blood through the smaller vessels. That, combined with the signal for the heart to work harder and the lower available oxygen in the blood, causes increased stress on the heart throughout the night. During sleep is the time when the heart usually has less work to do and can "rest."

Among patients with obstructive sleep apnea that do not have high blood pressure, 45% will develop high blood pressure within 4 years. If you look at patients who have hard-to-control blood pressure, that is, taking more than one medicine for control, 80% have obstructive sleep apnea. When the obstructive sleep apnea is treated, the high blood pressure comes down. For more, please read the High Blood Pressure article.

Heart complications

The risk for congestive heart failure increases by 2.3 times and the risk of stroke by 1.5 times with obstructive sleep apnea. For more, please read the Congestive Heart Failure article.

Obstructive sleep apnea can complicate atrial fibrillation treatment. Atrial fibrillation is a condition in which the upper part of the heart (atrium) is beating out of coordination with the lower part (ventricle). The treatment is to cardiovert the heart, which resets the atrium and allows it to synchronize with the ventricle. After cardioversion, 50% of patients have a recurrence of atrial fibrillation, but patients with obstructive sleep apnea have an 80% recurrence. Finally, obstructive sleep apnea can increase the risk of sudden death. For more, please read the Atrial Fibrillation article.

Obstructive sleep apnea has many consequences, some of which can kill patient and their loved ones. Again, it is estimated that only 10% of people with obstructive sleep apnea are being treated. Just treating the obstructive sleep apnea would improve many other areas of their lives.



Next: How is obstructive sleep apnea diagnosed and evaluated? »

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