Obstructive Sleep Apnea: Sleep Well, Breathe Easy

What is obstructive sleep apnea, also known as OSA? Apnea means to stop breathing, and in the context of OSA this happens while asleep. That sound you hear is the often loud snoring that accompanies these episodes of breathlessness. The obstructive part is in the upper airway system caused by the inadequate function of the tongue muscles or surrounding muscles that keep the airways open (1).

In the 1830’s, the English novelist Charles Dickens published a series of stories called “The Pickwick Papers”. One character, the larger-than life Joe, was known for his prodigious appetite, large build with an ability to fall asleep quickly and often during the day. In 1956, an astute medical researcher named Burwell and his colleagues published an article in the American Journal of Medicine titled, “Extreme obesity associated with alveolar hypoventilation-a Pickwickian syndrome”. This was the first modern day presentation of the sleep-related breathing disorder now known as obstructive sleep apnea (2).

Before we consider how serious OSA might be, we know that this is the most common sleep-related breathing disorder, affecting an estimated and staggering 936 million people and by far, mostly men, worldwide (3). However, it is estimated that only 1 in 5 cases are diagnosed (4).

Is a supposed disorder associated with snoring and maybe gasping for air at night a problem?

Perhaps you’re a little tired during the day or even falling asleep often and quickly just like our character Joe from “The Pickwick Papers”. Most cases of OSA, diagnosed or not, occur in ages 50 and higher and particularly among the overweight/obese, smokers, and those who may be genetically predisposition to this condition. Untreated OSA can increase the risk of developing everything from Type 2 diabetes to kidney disease and heart failure (5).

So, how can OSA be diagnosed and treated?

Polysomnography is a sleep study that can be done in a clinic or at home and will measure a number of things, but most important, the number of times the patient stops breathing (apneas) or reduces breathing (hypopneas) over the course of an hour. If the result is 5-15 apneas/hypopneas per hour (AHI), mild OSA is present. An AHI of 30 or more is severe disease. The risk of complications is that much higher with severe OSA. The good news is that OSA has a number of treatment options that can include weight loss, alcohol reduction or even simply sleeping on your side more often than on your back. For most cases of OSA, the only effective treatment is to keep the airways open by applying continued positive airway pressure (CPAP). Current generation CPAP appliances not only keep the airways clear but provide usage data confirming AHI, oxygen saturation and other metrics that confirm the efficacy of the treatment.

For those with suspected OSA, get tested. For those with confirmed OSA, use CPAP, if prescribed. Diagnosis and treatment are always half the battle and can allow you to sleep well and breathe easy.

References

1. Park, John G. Updates on Definition, Consequences, and Management of Obstructive Sleep Apnea. Mayo Clinic Proceedings. 86(6): 549-555. June 2011.

2. Ferriss, J. Barry. Obstructive sleep apnea syndrome: the first picture? Journal of the Royal society of Medicine. 102(5) 201-202. May 1, 2009.

3. Ling, Vanessa. Sleep Apnea Statistics and Facts You Should Know. National Council on Aging Adviser. October 4, 2023.

4. Benjafield et al. Estimation of the prevalence and burden of obstructive sleep apnea: a literature-based analysis. Lancet Respir Med. 7(8): 687-698. July 9, 2019.

5. Ling, Vanessa. Sleep Apnea Statistics and Facts You Should Know. National Council on Aging Adviser. October 4, 2023.