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Overall
Consequences of Obstructive Sleep Apnea
Obstructive sleep apnea syndrome
(OSAS) affects an estimated 20 million Americans and its
consequences range from the annoying to the life-threatening.
OSAS is associated with chronic diseases such as obesity,
hypertension, heart failure, stroke, sexual dysfunction, and
depression.
Sleep fragmentation,
which results from OSAS, can lead to excessive daytime sleepiness,
accidents, headaches, cognitive impairment, and loss of productivity.
It has been estimated that OSAS remains undiagnosed in 82%
of men and 93% of women with the condition (1). The diagnosis
and treatment of OSAS is a growing and vitally important field.
Until medical providers learn to recognize and respond to
the seriousness of sleep disorders, the consequences of undiagnosed
and untreated sleep apnea will continue to be devastating.
Cardiovascular Risk
The cardiovascular consequences of sleep apnea
are among the most profound. Hypertension has been found in
as many as 50% of sleep apnea patients (2). Whether hypertension
is a direct consequence of apnea or an associated finding
has been a subject of extensive debate. Epidemiological studies
suggest that apnea may in fact be causative. In addition,
the data show a linear relationship between the severity of
apnea and the degree of hypertension (3). Because hypertension
is an important risk factor in the development of coronary
artery disease, congestive heart failure, and stroke, the
impact on the sleep apnea population is profound.
Cardiac
arrhythmias have been associated with sleep apnea (4,5). They
may result from the hypoxemia seen during apnea. Bradyarrhythmias
are most common, however, tachyarrhythmias have also been
seen.
Cognitive
Impairment
Among
the most common symptoms of obstructive sleep apnea are those
related to cognitive function. Memory and judgment problems,
irritability, difficulty concentrating, and personality changes
are all prominent complaints (6). Hypoxemia, sleep fragmentation,
and alterations in cerebral blood flow are all potential contributing
factors. Impaired cerebral blood flow has been demonstrated
in patients with OSAS (7).
Fatigue-Related Accidents
Excessive daytime sleepiness is a primary complaint
of patients with sleep apnea. It has been shown that OSAS
patients are involved in traffic accidents two to three times
as often as the general population (8,9,10). Occupational
accidents are also more frequent in OSAS patients (11).
References
1.
Young T, Evans L, Finn L, Palta M. Estimation of the clinically
diagnosed proportion of sleep apnea syndrome in middle-aged
men and women. Sleep. 1997;20:705-6.
2. Fletcher EC. The relationship between systemic hypertension
and obstructive apnea: facts and theory. Am J Med 1995;98:118-28.
3. Strohl KP Novak RD, Singer W, et al. Insulin levels, blood
pressure and sleep apnea. Sleep 1994;17:614-18.
4. Guilleminault C, Connolly SJ, Winkle RA. Cardiac arrhythmias
and conduction disturbances during sleep in 400 patients with
sleep apnea syndrome. An J Cardiol 1983;52:490-4.
5. Shepard JW Jr., Garrison MW, Grither DA, Dolan GF. Relationship
of ventricular ectopy to oxyhemoglobin desaturation in patients
with obstructive sleep apnea. Chest 1985;88:335-40.
6. Roth T, Roehrs TA, Conway WA. Behavioral morbidity of apnea.
Sem Respir Med 1988;9:554-9.
7. Balfors EM, Franklin KA. Impairment of cerebral perfusion
during obstructive sleep apneas. Am J Respir Crit Care Med
1994;150:1587-91.
8. Findley LJ, Fabizio M, Thommi G, Surratt PM. Severity of
sleep apnea and automobile crashes. N Engl Med 1989;320:868-9.
9. Haraldsson P-O, Carenfelt C, Diderichsen F, Nygren A, Tingvall
C. Clinical symptoms of sleep apnea syndrome and automobile
accidents. ORLJ Otorhinolaryngol Relat Spec 1990;52:57-62.
10. Findley LJ, Unverzagt ME, Suratt PM. Automobile accidents
involving patients with obstructive sleep apnea. Am Rev Respir
Dis 1988;138:337-40.
11. Ulfberg J, Carter N, Edling C. Sleep-disordered breathing
and occupational accidents. Scan J Work Environ Health 2000;26:237-42.
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