We need a national dialogue on obstructive sleep apnea and must prioritize it along with other serious chronic conditions, such as obesity and heart disease.
Obstructive sleep apnea (OSA) is understood to be a common chronic medical condition, yet it is often ignored by many. Some people may feel conscious about snoring or the condition which can deter them from discussing the symptoms with their doctors or loved ones. But sleep apnea is more serious than many people realize. It is linked to a number of significant health problems, including cardiovascular disease and diabetes. It raises the risk of workplace and vehicle accidents. And it also increases the risk of death, especially among men under the age of 50 and in those with other health conditions.
In a person with OSA, the airway repeatedly closes during sleep, causing pauses or stops in breathing. That leads to a drop in blood oxygen levels and an adrenaline surge, resulting in arousal from sleep in an effort to reopen the airway. Loud habitual snoring, choking/gasping for breath, unrefreshing sleep, daytime sleepiness, frequent urination at night, and difficulty with memory and concentration are some of the common symptoms, although these can vary among people. Most often, OSA is recognized in men by their bed partners, whose input can be very valuable during evaluation.
There are real-life consequences for untreated OSA, for both the individual and society.
Difficulty in focusing can cause absenteeism from work or school and declining work performance.
Daytime sleepiness or falling asleep inappropriately—especially while driving—can cause accidents.
An investigation conducted by the NTSB found that an engineer with severe OSA had fallen asleep while operating a Metro-North passenger train in the Bronx, New York, on December 1, 2013, leading to a derailment that killed four and injured 59 people. This incident highlighted the need for screening, diagnosis and treatment of OSA, especially in people in safety-sensitive occupations where there was potential serious harm to the public. Another study found that one-third of commercial truck drivers in the U.S. have OSA and noted that a driver with untreated OSA has a 243% higher crash risk compared to a driver without OSA. A recent report estimated that the toll of undiagnosed OSA from medical conditions, workplace accidents, and loss of productivity cost the U.S. $146.9 billion in a single year.
Several conditions are also associated with OSA, such as atrial fibrillation, hypertension, diabetes, congestive heart failure and heart disease. In fact, the American Heart Association has released a scientific statement acknowledging the link between OSA and cardiovascular disease.
Fortunately, treatment can help: Barry Martin, a commercial pilot who shared his story with the Alliance of Sleep Apnea Partners, has successfully sought treatment with continuous positive airway pressure (CPAP) therapy. Like many sleep apnea patients, he has been able to manage his OSA symptoms effectively by seeking help and starting one of the available treatments for sleep apnea.
We have also seen a surge in recent innovations in treatment and management of OSA beyond the traditional CPAP therapy. New therapies such as oral appliance therapy and hypoglossal nerve stimulation are on the market and often covered by medical insurance. Medications for treating OSA are in the development phase currently and studies on these pharmacological options are promising.
As a first step to getting care, it’s important for men to be aware of the multiple risk factors for OSA and to recognize that snoring isn’t a stigma—it’s a symptom. Obesity is a major modifiable risk factor, and weight concentrated around the waist and neck areas are problematic. In men, the risk of having OSA rises with increase in body weight and a neck circumference of 17 inches or more. Cigarette smoking and increased blood alcohol levels can also elevate the risk of OSA. A large tongue, recessed lower jaw, high vault palate, nasal obstructions (polyps, deviated septum, large turbinates) and family history also can contribute to a higher risk of developing OSA.
Given sleep apnea’s risks to the individual and its overall costs to the nation, getting diagnosed and treated is vitally important. But a report by Frost and Sullivan in 2016 estimated that only 20% of the total U.S. population had been diagnosed with OSA, leaving a large majority of the population at risk of being undiagnosed and untreated. An in-lab sleep study called polysomnography can provide a comprehensive diagnosis, but waiting times for in-lab sleep studies can be lengthy. Thanks to recent innovations, OSA can now be diagnosed using a home sleep apnea test that a primary care physician recommends.
It is high time we take OSA as seriously as other chronic conditions, such as cardiovascular disease, diabetes, and obesity. At the Alliance of Sleep Apnea Partners, we’re helping the patient community work with the greater medical community and policymakers to ensure that we make sleep apnea a national priority. We ask men to join us in that effort with a simple first step: make sleep apnea diagnosis a priority in your own life.
Monica Mallampalli, Ph.D., is executive director of the nonprofit Alliance of Sleep Apnea Partners, which is dedicated to serving those with OSA, eliminating gaps in patient care, and ensuring that health care policies benefit patients and improve their health outcomes.
