Medical Compass: Sleep apnea is about more than just poor sleep

Left untreated, sleep apnea can raise health risks, but lifestyle changes may help

How much does one lost night of sleep really matter? What about ongoing sleep that is consistently poor in quality? Studies show the effects can reach far beyond fatigue, affecting both mental and physical health, from slower reaction times and depression to heart and immune system problems.

One frequent cause is obstructive sleep apnea, or OSA. This condition happens when the upper airway repeatedly narrows or closes during sleep, disrupting breathing and sometimes lowering oxygen levels in the blood. These episodes can happen many times in an hour, often without the person knowing it.

Current estimates suggest that as many as 85.6 million adults in the United States have OSA, although most have not been diagnosed. Even among people who do receive a diagnosis, some never get treated.

Several risk factors can be changed, including excess weight, alcohol use and smoking. Other risks include age, sex, family history and certain physical traits that make the airway smaller. OSA is also linked with conditions such as high blood pressure and Type 2 diabetes.

What symptoms should you watch for?

Typical signs include loud snoring, gasping or choking during sleep, breathing pauses noticed by a bed partner, morning headaches, daytime sleepiness and trouble concentrating. Still, not everyone with OSA snores or feels tired during the day.

Treatments that can work include continuous positive airway pressure, or CPAP, which uses gentle air pressure to keep the airway open during sleep, along with oral appliances, positional therapy and lifestyle changes.

Cardiovascular disease risk

Studies have connected untreated OSA with a higher risk of cardiovascular disease and death. In a six-year study of 1,116 women, cardiovascular mortality rose as OSA became more severe. Compared with women who did not have OSA, those with untreated mild to moderate OSA had a 60 percent higher risk of cardiovascular death, while women with severe OSA faced a much greater risk.

Another study that followed about 1,500 men for 10 years found similar links between severe OSA and cardiovascular events. Both studies suggested CPAP treatment may improve outcomes. Because these were observational studies, however, they could not prove CPAP directly prevented cardiovascular deaths. Research in older adults also found that cardiovascular mortality increased as OSA severity increased. In that group, hard-to-control hypertension, cognitive problems and excessive daytime sleepiness may be warning signs of an underlying sleep disorder.

Cancer risk

Research on a possible connection between OSA and cancer has produced mixed findings. In a Swedish study involving about 62,000 patients, researchers reported an association between OSA and cancer even after taking several other risk factors into account. That does not prove OSA causes cancer.

Earlier research also found a link between OSA and cancer risk, especially in people who spent long periods with low blood oxygen levels during sleep. More studies are needed to determine whether treating OSA can lower cancer risk.

Erectile dysfunction

Erectile dysfunction may also be related to OSA, and CPAP may help here as well. In a small study of 92 men with erectile dysfunction, CPAP was associated with better sexual function, especially among those with mild OSA. Other studies have shown mixed results, suggesting that age and existing health conditions may affect whether treatment helps.

Can diet help with OSA?

Some patients hope that improving their diet and losing excess weight will eventually allow them to stop using CPAP. For some people, weight loss can significantly reduce OSA severity and may even remove the need for treatment. Still, CPAP should never be stopped without a doctor’s evaluation and follow-up sleep testing.

In a small study of people with moderate to severe OSA, a low-energy diet produced encouraging results. This type of diet is simply a calorie-restricted eating plan designed to promote weight loss. A nutrient-rich, plant-forward diet can be one way to reach that goal. Nearly half of the people who followed this approach were able to stop CPAP, and the benefits lasted for at least a year.

If you snore loudly, wake up gasping, or often feel exhausted despite a full night in bed, talk with your doctor about testing for OSA. Testing can often be done at home, though some patients need an overnight sleep study. With the right treatment and lifestyle changes, better sleep and better health may be possible.