Do you snore at night? Do you wake feeling like you need a nap already? Having trouble concentrating at work? If you answered “yes” to these questions, it is possible that you may have sleep apnea. Sleep apnea is defined as being central (caused by the central nervous system), obstructive (caused by collapse of the upper airway), or mixed (caused by a combination of both central and obstructive). As many as 12 million Americans are affected by sleep apnea, but many individuals do not get evaluated for treatment. This is due to many factors which include under-recognition of the disorder, as well as the assumption that sleep apnea is only found in obese middle aged men who snore. It is important to realize that up to 1 in 5 adults have mild sleep apnea, while 1 in 15 suffer from moderate to severe. Not only does untreated sleep apnea negatively effect job performance and increase car accidents, but it can lead to health problems such as heart disease, stroke, insulin resistance, weight gain, impotency, and headaches.
The most common form of sleep apnea is obstructive, and the most common symptom is daytime sleepiness. Questionnaires such as the Epworth Sleepiness Scale and the STOP BANG questionnaire (Snoring, Tired, Observed Apneas, High Blood Pressure, BMI >30 kg/m2, Age, Neck Circumference, male Gender) are highly sensitive for OSA, but the only way to confirm a diagnosis is with a sleep study, or polysomnography. This can be done through a home study or at a a sleep center, and can identify the most effective type of treatment for the individual. OSA is defined as greater than 5 events per hour with an effect on daytime function or symptoms. Risk factors include male gender, age over 40, obesity, a family history of sleep apnea, a recessed chin, a neck circumference of greater than 17 inches if you are a male and greater than 16 inches if you are a female, and tobacco or alcohol use. Important facts to consider are that the prevalence of OSA increases with age independent of weight, and that although weight loss helps the severity of the disorder, it may not completely resolve. There has also been more awareness of sleep apnea in recent years, but in the Wisconsin Sleep Cohort Study, it was estimated that as many as 93% of females and 82% of males with moderate to severe sleep apnea are undiagnosed. What is also alarming is that the risk of depression doubles in patients with mild OSA, and almost triples in patients with moderate or severe OSA.
In addition to cardiovascular risks caused by OSA, metabolic consequences occur that can be independent of weight. These consequences arise from poor quality of sleep, but also from increased sympathetic tone from frequent arousals. OSA increases both insulin and cortisol production, which leads to glucose intolerance and insulin resistance. The hormones leptin and ghrelin also become imbalanced, leading to down regulation of satiety and hunger, which in turn causes an imbalance of fat metabolism. Fat storage increases, while the utilization of it decreases, causing more weight gain and worsening OSA.
Sleep complaints can be very challenging for patients and their doctors, but if you suspect that you may have the symptoms of sleep apnea, it is extremely important to address it as soon as possible in order to prevent devastating consequences such as diabetes, heart disease, and stroke. Questionnaires and resources are available online to help as screening tools, and will aide in the discussion with your doctor. There are also various treatment options, depending on an individual’s exam, as well as degree of impairment.
Written Dr. Allison Helms