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SLEEP APNEA

Approximately 30 million adults in the US  and 1 billion people globally have been diagnosed with sleep apnea and several million with undiagnosed sleep apnea.

What is sleep apnea and why is this important? 
The American Academy of Sleep Medicine defines apnea as " cessation of airflow for at least 10 seconds". In other words, sleep apnea means repetitive episodes of  stopping breathing during  sleep for 10 to 30 seconds or longer without being aware of it most of the times.  

Chronic diseases such as heart disease, diabetes, stroke, cancer, chronic kidney disease  are the leading cause of  death and disability in the US ( 6 in 10 adults in the US have one chronic disease and 4 in 10 have two or more). Sleep apnea adversely impacts all those chronic conditions!

  
About 50% people with high blood pressure , approximately 71% of people with type 2 diabetes , 50 - 70% percent of people with heart failure , 50 to 70% of people with stroke have sleep apnea based on several studies. Sleep apnea is also associated with a poor outcome after stroke with prolonged hospitalization and extended rehabilitation.

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What are the symptoms of sleep apnea?

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  • Snoring

  • Witnessed apneas/gasping/choking

  • Insomnia with frequent awakenings

  • Fatigue

  • Daytime sleepiness

  • Nonrestorative sleep

  • Memory issues

  • Difficulty with concentration

  • Irritability or mood changes

  • Frequent urination during the night

  • Erectile dysfunction


What are the risk factors for sleep apnea?

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  • Age ( the prevalence of sleep apnea increases with age regardless of other risk factors. Snoring, however, may decrease after age 60. )

  • Gender (sleep apnea is more common in males. However, the prevalence increases in post menopausal women.)

  • Obesity 

  • Alcohol  

  • Smoking  

  • Certain heart conditions like atrial fibrillation and heart failure can increase the risk for development of central sleep apnea.

  • Use of medications like benzodiazepines, opioids


What are the complications of untreated sleep apnea?

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  • Hypertension

  • Diabetes

  • Heart attack

  • Stroke

  • Atrial fibrillation

  • Motor vehicle accidents 

  • Depression


How do you diagnose sleep apnea?
Sleep apnea is diagnosed using objective testing, either a home sleep test or an In-lab sleep test.

A home sleep test (HST) is done in the comforts of your home at your convenient sleep time schedule. The test measures your respiratory airflow (breathing), respiratory effort, body position, pulse rate, oxygen, snoring. Some of the recent HST equipments have sleep monitoring as well. 

An in-lab sleep study is the sleep study performed in a sleep lab, monitored by a sleep technologist. In addition to the parameters measured by the HST, this test also measures your sleep and limb movements.  

 

The good news - sleep apnea is fully treatable!


What are the treatment options for sleep apnea?
There are different treatment modalities available for sleep apnea based on the severity of the condition, patient preference and insurance coverage. 
All the treatment options would be discussed in detail during the appointments. 


1. CPAP 
2. Oral appliance
3. Surgical options including upper airway surgery
4. Inspire therapy - a small device inserted during a surgical outpatient procedure that helps open the airway via nerve stimulation. 
5. Positional therapy

Lifestyle modifications like physical activity, weight loss, healthy diet, smoking cessation and limited alcohol use would also help. 

Patients who are pregnant, patients with DOT/ CDL/FAA requirements , patients with severe medical conditions would be provided with a fast track/ expedited appointment/sleep study schedule.

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