Risk factors for developing OSA:

• Older age (the incidence of this disease increases with age)
• Men and post-menopausal women
• Obesity (as your weight increases the likelihood of developing OSA increases significantly)
• Upper airway abnormalities (e.g. large tonsils / small chin and others increase your risk)
• Other risk factors:
  • Smoking
  • Someone else in the family with OSA
  • Heart failure
  • Kidney disease
  • Chronic lung disease
  • Thyroid disease

Clinical features of OSA:

• Daytime sleepiness
  • This can be subtle as you grow accustomed to feeling tired and frequently mentioned as feeling tired / low energy levels / poor concentration to your doctor
  • Sometimes this may be overt and you may be falling asleep in conversation / while driving / at work and this may cause problems in your everyday life
• Loud snoring / gasping / choking or interruptions of sleep (usually identified by your partner) is common
• Morning headaches / ‘feeling dull’ after you wake up
• Insomnia (up to 30% people with OSA suffer from insomnia and not daytime sleepiness)
• Needing to pass urine frequently at night

What other diseases to consider:

• There are a variety of other clinical conditions that may cause similar symptoms to OSA, especially the daytime sleepiness.
• Some of these conditions are then also strongly associated with OSA and these conditions need to be excluded after you have tested for OSA and your symptoms persist.

Diagnosis of OSA:

• OSA can not be diagnosed in your doctor’s office although he / she might suspect it based on your symptoms and complaints
• If you have risk factors for cardiovascular disease (e.g. hypertension / diabetes / smoking / cholesterol / family history and others) and some of the symptoms above, you should have a low threshold to do the objective diagnostic test (sleep study).
• The diagnostic test performed to diagnose OSA is called a sleep study or polysomnogram and can be performed at home or in-hospital or centre.
• Please refer to the section on diagnosis of OSA for further details.

Cardiovascular problems and sleep apnoea

Several cardiovascular complications occur with untreated sleep apnoea such as hypertension, atrial fibrillation (a condition where the heart is out of rhythm), coronary artery disease (hardening and narrowing of the arteries supplying the heart) and heart failure.¹

All the above conditions can be improved by treating OSA and people with OSA should be screened for these conditions.  People with cardiovascular disease should also be screened for OSA as they go hand in hand.¹

Link between sleep apnoea and heart disease

Obstructive sleep apnea causes frequent pauses in your breathing. Sometimes this will cause you to wake up at night but you may not be aware of them. When these breathing pauses happen, the oxygen level in your blood gets low. It is thought that the frequent drops in low oxygen levels during sleep damages the blood vessels that supply the heart. Each time the oxygen level drops, your body tells your heart to beat faster and your blood pressure to go up. Stress on the heart from severe OSA can also cause the heart to get enlarged. An enlarged heart does not pump as well and the heart and body gets even less oxygen.¹

Treatment of OSA

Treating OSA can help prevent and/or improve heart problems. The most common way of treating obstructive sleep apnea is with a mechanical device known as continuous positive airway pressure (CPAP). The CPAP machine blows air through a hose into a mask worn snugly over your nose or mouth. This air helps keep your airway from closing during sleep. This corrects your sleep apnea, prevents your blood oxygen levels from falling during sleep, and allows you to get a more restful sleep. Using CPAP regularly at night as prescribed by your healthcare provider also helps lower the stress on your heart. If you have atrial fibrillation, CPAP use may control your irregular heartbeat. If you have both severe sleep apnea and hypertension, CPAP may help control your blood pressure. People can become comfortable with wearing the CPAP device over time. Those who wear CPAP at night often say that they are getting the best sleep that they have gotten in a long time. ²

References:

1. American Thoracic Society. Sleep apnoea.  thoracic.org/patients
2. Harvard Healthy Sleep. Sleep apnoea.  healthysleep.med.harvard.edu/railroad-sleep/problems/apnea