Obstructive sleep apnea (OSA) is a condition where your airway repeatedly becomes blocked during sleep, causing you to stop breathing for short periods. This blockage is usually due to the relaxation of throat muscles, leading to snoring and disrupted sleep. People with OSA often feel very sleepy during the day and might have health problems like high blood pressure or heart issues. Proper diagnosis and treatment can significantly improve sleep quality and overall health.
OSA affects a significant portion of the population, often undiagnosed. In the U.S., it’s estimated that 24% of men and 9% of women have mild OSA. The prevalence increases with age and is higher in men, particularly those who are overweight. In the U.S., 82% of men and 93% of women with OSA remain undiagnosed. These statistics highlight the widespread but underrecognized nature of the condition across different demographics.
Common nighttime symptoms of OSA include the following:
- Snoring: One of the most noticeable signs of obstructive sleep apnea is loud, persistent snoring. It’s often so loud that it can disturb others’ sleep.
- Choking or Gasping for Air: People with OSA often wake up suddenly, gasping for air or choking, due to their airway being blocked.
- Interrupted Sleep: Frequent pauses in breathing can lead to repeated awakenings throughout the night, resulting in fragmented and poor-quality sleep.
Common Daytime Symptoms of OSA include the following:
- Excessive Daytime Sleepiness: Despite spending enough time in bed, people with OSA often feel extremely sleepy during the day. This can affect their ability to concentrate and stay awake during activities.
- Fatigue: Even after a full night’s sleep, those with OSA may feel constantly tired and lacking in energy.
- Morning Headaches: Frequent interruptions in sleep can lead to headaches upon waking.
- Irritability and Mood Changes: Poor sleep can contribute to irritability, mood swings, and even depression.
Unmodifiable Risk Factors for OSA include the following:
- Age: The risk of obstructive sleep apnea increases as you get older.
- Gender: Men are more likely to develop OSA than premenopausal women. However, after menopause, women’s risk increases to be more similar to men’s.
- Race: Certain racial groups, such as African Americans, Hispanics, and Asians, have a higher prevalence of OSA, possibly due to anatomical differences.
Modifiable Risk Factors for OSA include the following:
- Obesity: Excess weight is a significant risk factor for OSA. Fat deposits around the upper airway can obstruct breathing.
- Smoking: Smoking increases inflammation and fluid retention in the upper airway, worsening OSA.
- Alcohol Use: Alcohol relaxes the muscles in your throat, making it easier for your airway to become blocked.
Common comorbid conditions include stroke, myocardial infarction, hypertension, hyperlipidemia, glucose intolerance, diabetes, arrhythmias including atrial fibrillation, pulmonary hypertension, congestive heart failure, and depression. Patients with moderate or severe OSA are at higher risk of these comorbid conditions. Patients with cardiovascular disease have a very high prevalence of OSA: hypertension 83% Increased awareness and early diagnosis of OSA is critical to reducing cardiovascular disease burden!
Screening patients for OSA starts with a good sleep history to identify symptoms, risk factors, and comorbid conditions, as well as a physical examination for OSA-related features. Common tools that we use in our office are the Epworth Sleepiness Scale and STOP-BANG questionnaires which are brief questionnaires that inform the need for further testing.
After a thorough sleep history, clinical examination, and screening tools are assessed either a polysomnography (PSG) or a home sleep apnea tests (HSAT) will be recommended.
OSA develops from airway collapse and obstruction during sleep, often causing you to wake up multiple times throughout the night. The extent of OSA is underestimated and it is underdiagnosed despite known risk factors and comorbid conditions. Screening for OSA with a sleep history, simple upper airway examination, and questionnaire like the Epworth Sleepiness Scale can aid in identifying the need for testing for OSA.
If you suspect you or someone you know has OSA share the blog, comment with experiences, and schedule a sleep study!
Rundo, Jessica Vensel. “Obstructive Sleep Apnea Basics.” Cleveland Clinic, Sleep Disorders Center, Neurological Institute, Cleveland Clinic. September 2019. https://www.ccjm.org/content/ccjom/86/9_suppl_1/2.full.pdf