The consequences can be greater than snoring and fatigue
By David Dunaieff, MD
Good sleep contributes to our physical and mental well-being, yet many of us struggle to get quality, restful sleep. For those with obstructive sleep apnea (OSA), quality sleep is especially elusive.
Sleep apnea is an abnormal pause in breathing that occurs at least five times per hour during sleep. There can be a number of causes, the most common of which is airway obstruction. Some estimates suggest that as many as 30 million people suffer from sleep apnea in the United States (1).
Obstructive sleep apnea (OSA), also known as sleep-disordered breathing, can affect up to 30 percent of adults. OSA diagnoses are classified as mild, moderate, or severe. It is estimated that approximately 80 percent of moderate to severe OSA sufferers are undiagnosed.
Risk factors for OSA include chronic nasal congestion, large neck circumference, overweight or obesity, alcohol use, smoking, and a family history (2). However, many of these factors are modifiable.
Important symptoms of OSA tend to be quality-of-life issues and include daytime fatigue, loud snoring, other-perceived shortness of breath, impaired concentration, and morning headaches. While these are significant, it is more concerning that OSA is also associated with a number of more serious health consequences, such as cardiovascular disease, high blood pressure and depression.
Fortunately, we have an arsenal of treatment options, including continuous positive airway pressure (CPAP) devices; oral appliances; lifestyle modifications, such as diet, exercise, smoking cessation, and reduced alcohol intake; and some medications.
What is the impact on risk of cardiovascular disease?
In an observational study, the risk of cardiovascular mortality increased linearly with the severity of OSA (3). For those with untreated mild to moderate sleep apnea, there was a 60 percent higher risk of death; for those in the severe group, that risk rose sharply to 250 percent. However, the good news is that treating patients with CPAP significantly reduced their risk by 81 percent for patients with mild to moderate OSA and 45 percent for patients with severe OSA. This study involved 1,116 women over a six-year period.
Another observational study in male subjects showed similar risks of cardiovascular disease with sleep apnea and benefit from CPAP treatment (4). More than 1,500 men participated in this study with a 10-year follow-up. The authors concluded that severe sleep apnea increases the risk of nonfatal and fatal cardiovascular events and CPAP was effective in inhibiting these events.
In a third study, this time involving the elderly, OSA increased the risk of cardiovascular death in patients with mild to moderate OSA and in those with severe OSA by 38 and 125 percent, respectively (5). But, as in previous studies, CPAP significantly reduced the risk in both groups. In the elderly, an increased risk of falls, cognitive decline, and hard-to-control high blood pressure can be signs of OSA.
Is it related to cancer?
In patients with sleep apnea under the age of 65, one study showed an increased risk of cancer (6). The authors believe that persistently low oxygen levels, caused by many short periods of cessation of breathing, may be responsible for the development of tumors and their subsequent growth.
The greater the percentage of time patients spend in hypoxia (low oxygen) at night, the greater the risk of cancer. For those patients with more than 12 percent low oxygen levels at night, there was a two-fold increased risk of developing cancer compared to those with less than 1.2 percent low oxygen levels.
Does OSA affect male sexual function?
It appears that erectile dysfunction (ED) may also be associated with OSA. CPAP may reduce this incidence. This was demonstrated in a small study involving 92 men with ED (7). The surprising aspects of this study were that, at the beginning, the participants were overweight, not obese, on average, and were only 45 years old. In those with mild OSA, CPAP had a beneficial effect in over half of the men. For those with moderate and severe OSA, the effect was still significant, though not as strong, at 29 and 27 percent, respectively.
A number of other studies on the link between OSA and ED have mixed results, depending on the age and existing health challenges of the participants. Some study authors have hypothesized that other underlying health problems may be the cause in some patient populations.
Can diet help?
For some of my patients, their goal is to discontinue their CPAP. Diet can be an alternative to CPAP, or it can be used in combination with CPAP to improve results.
In a small study of those with moderate to severe OSA, a low-energy diet showed positive results. A low-energy diet means a low-calorie approach, such as a diet that is plant-based and nutrient-dense. Makes sense, it can help with weight loss. In the study, almost 50 percent of those following this type of diet were able to discontinue CPAP (8). The results lasted for at least one year.
The bottom line is that if you think you or someone else is suffering from sleep apnea, it’s important to get evaluated at a sleep lab and then follow up with your doctor. Don’t suffer from sleep apnea, and most importantly, don’t let obstructive sleep apnea cause serious complications, possibly robbing you of more than sleep. There are many effective treatments.
(1) sleepapnea.org. (2) JAMA. 2004; 291 (16): 2013. (3) Ann Intern Med. 2012 January 17; 156 (2): 115-122. (4) Lancet. 2005 March 19-25; 365 (9464): 1046-1053. (5) Am J Respir Crit Care Med. 2012; 186 (9): 909-916. (6) Am J Respir Crit Care Med. 2012 November 15. (7) Sleep. 2012; 35: A0574. (8) BMJ. 2011; 342: d3017.
Dr. David Dunaief is a local speaker, author and lifestyle practitioner focused on the integration of medicine, nutrition, fitness and stress management. For more information, visit www.medicalcompassmd.com.