What is sleep apnea?
Sleep apnoea occurs during sleep when the regular breathing patterns are disrupted and challenged [1]. Sleep apnoea significantly disrupts normal sleeping patterns and increases the risk for cardiovascular disease, cardiac arrhythmias and stroke [2].
People who have sleep apnea often do not realise that they have this condition. There are two main types of sleep apnoea: obstructive sleep apnoea (OSA) and central sleep apnoea (CSA).
What are the causes of sleep apnoea?
There are two main types of sleep apnoea:
Obstructive sleep apnoea (OSA)
This is when the airway abnormally closes and prevents the passage of air [2]
Most typical form of sleep apnoea [2]
Central sleep apnoea (CSA)
This is when there is a miscommunication between the brain and the respiratory muscles [2]
Who is at risk?
While some risk factors are associated explicitly with either type of sleep apnoea, common risk factors include:
Gender
Age
Comorbidities
What are the symptoms?
Loud snoring [2]
Irritability [3]
Difficulty staying asleep (insomnia) [3]
Difficulty focusing during the day [3]
Excessive daytime drowsiness [2]
Episodes of breathing impairment (where you cannot breathe) [2]
Dry mouth when waking up [4]
Why are they associated with cardiovascular events?
While the exact link between sleep apnoea and cardiovascular disease is unclear, scientists believe that sleep apnoea causes elevations in proinflammatory and prothrombic factors, dysfunctional blood vessels function and enhanced blood clotting capabilities [2].
Consequences of sleep apnoea?
High blood pressure and other heart problems [2]
Stroke [2]
Type II diabetes (modifiable risk factor) [5]
Complications with medicines and surgery [6]
Increased risk for contracting COVID-19 and risk for hospitalisation [7]
Liver issues [8]
How can they be managed or treated?
Treatments can range from clinical to lifestyle modifications:
Clinical treatments
Lifestyle treatments
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Reference:
[1] White DP. Sleep Apnea. Proceedings of the American Thoracic Society. 2006;3(1):124-8.
[2] Bounhoure J-P, Galinier M, Didier A, Leophonte P. [Sleep apnea syndromes and cardiovascular disease]. Bull Acad Natl Med. 2005;189(3):445-59; discussion 60-4.
[3] Grandner MA, Malhotra A. Connecting insomnia, sleep apnoea and depression. Respirology. 2017;22(7):1249-50.
[4] Oksenberg A, Froom P, Melamed S. Dry mouth upon awakening in obstructive sleep apnea. Journal of Sleep Research. 2006;15(3):317-20.
[5] Pamidi S, Tasali E. Obstructive sleep apnea and type 2 diabetes: is there a link? Front Neurol. 2012;3:126.
[6] Faßbender P, Herbstreit F, Eikermann M, Teschler H, Peters J. Obstructive Sleep Apnea — a Perioperative Risk Factor. Deutsches Ärzteblatt international. 2016.
[7] Chung F, Waseem R, Pham C, Penzel T, Han F, Bjorvatn B, et al. The association between high risk of sleep apnea, comorbidities, and risk of COVID-19: a population-based international harmonized study. Sleep and Breathing. 2021;25(2):849-60.
[8] Shah NM, Malhotra AM, Kaltsakas G. Sleep disorder in patients with chronic liver disease: a narrative review. Journal of Thoracic Disease. 2020;12(S2):S248-S60.
[9] Patel SR. The complex relationship between weight and sleep apnoea. Thorax. 2015;70(3):205-6.
[10] Andrade FMDD, Pedrosa RP. The role of physical exercise in obstructive sleep apnea. Jornal Brasileiro de Pneumologia. 2016;42(6):457-64.
[11] Simou E, Britton J, Leonardi-Bee J. Alcohol and the risk of sleep apnoea: a systematic review and meta-analysis. Sleep Med. 2018;42:38-46.
[12] Ravesloot MJL, Vonk PE, Maurer JT, Oksenberg A, De Vries N. Standardized framework to report on the role of sleeping position in sleep apnea patients. Sleep and Breathing. 2021;25(4):1717-28.
[13] Krishnan V, Dixon-Williams S, Thornton JD. Where There Is Smoke…There Is Sleep Apnea. Chest. 2014;146(6):1673-80.
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