Sleep Apnea tied to Increased Risk of Death

Sleep Apnea tied to Increased Risk of Death

(Increased risks, pathophysiology, American affected, risk factor, symptoms, Dx & Tx)

1.   Moderate to severe sleep apnea is associated with an increased risk of death from any cause- in middle-aged adults, especially men, as found by Nat’l Heart, Lung & Blood Institute and the NIH

o   Studies have shown that men with the condition between 40-70 were twice as likely to die than those without OSA

o   The Sleep Heart Health Study, the largest comprehensive study to date, also found that both men and women were 1.5 x more likely to die, regardless of any concurrent mortalities such as smoker/nonsmoker, race, weight or presence of CV disease

§   Earlier study findings discussed increased risks for various mortalities (heart disease, stroke)

§  Linked excessive sleepiness- lowers performance & increases accidents like MVA

·       Studies have shown that people with severe OSA 2x more likely to be involved in MVA

·       University of Wisconsin study found that those with >30 pauses per sleeping hour have a 5 time risk of cardiovascular death over 18 year study. Good news is that once people treated with CPAP were excluded from the study, the risks decreased substantially. After they were excluded, the CV mortality risk jumped from 3 fold to 5 fold.

o   Scalia did not use his CPAP--- it laid next to him unplugged when he was found per police reports

2.   Sleep apnea is a common disorder in which air movement through the upper airway is intermittently narrowed during sleep, causing breathing to be difficult or completely blocked.

o   Causes O2 levels to fall and CO2 levels to rise

o   Breathing faster cannot compensate due to airway constriction; typically, requires the person to awaken to activate the upper airway muscles. May awaken and breathe faster or gasping.

o   Some many not recall their periods of awakening, unaware just how much it is affecting their sleep

§  Oftentimes the spouse lets them know they are being disruptive

3·       25% of adults are at risk for sleep apnea, and 12 million Americans have sleep apnea, most of whom are not diagnosed or treated

o   Most have a small upper airway, genetically determined- can explained why OSA runs in the family

o   Obesity is another major factor

o   Tonsil enlargement can be an important cause, especially children

§  Other risk factors include:

·       Increasing age, male gender (twice as likely in men)

·       medication sedation

·       airway abnormality

·       Neck size >17 in- men or >16 in- women

·       High blood pressure and diabetes

§  Other symptoms include:

·       Restless sleep, awakening gasping/choking, morning headaches, groggy, lower energy, nocturia

4.    Testing is usually done in a sleep lab; study is called a polysomnogram

o   Measures RR effort and airflow, blood O2 levels, HR and rhythm, duration of various sleep stages and body movement

·       Home monitoring, at the clinician’s discretion, is a reasonable alternative if OSA is suspected in patients without any other PMHx that can interfere with results.

5.    Treatments to maintain open airway and restore regular breathing during sleep include:

o   Lifestyle changes, ie weight loss

o   Mouthpieces- Dental devices or mandibular advancement device

o   Breathing device such as CPAP (continuous positive airway pressure- alveolar inflation)

o   Surgery- for people who do not respond to CPAP, ie- uvulopalatopharyngoplasty (UPPP) removes uvula, tonsil and excessive soft tissues (50% success, utilize w/ discretion)

§  Trachesotomy for very severe cases

·       All help decrease disruptive snoring (important for happy spouse), decrease excessive sleepiness and improve performance

·       Studies that demonstrate links of OSA treatment and decreasing death rates are needed***