Why Is Sleep Apnoea Known As A Silent Killer?

Updated at: Jun 25, 2020
Why Is Sleep Apnoea Known As A Silent Killer?

Sleep Apnoea - a silent killer: What are its long term effects, diagnosis and treatment?

Tavishi Dogra
Other DiseasesWritten by: Tavishi DograPublished at: Jun 24, 2020

Sleep Apnoea - a silent killer: Sleep is not only necessary for survival but sub-serves essential physiological functions which are required for adequate functioning of the body. An average individual spends approximately one-third of his life sleeping. Epidemiological studies suggest that one in five individuals suffer from sleep-related disorders yet sleep issues are often ignored, under-diagnosed and inadequately treated. While central sleep apnoea usually occurs in association with heart failure, the ascent to high altitudes and usage of opioid medicines, common risk factors for obstructive sleep apnoea include – obesity and abnormal anatomy of the upper airway resulting in airway crowding.

What is Sleep, Apnoea?

  • It is a disorder wherein there are frequent interruptions in one’s breathing during sleep. This may be in the form of significant airflow limitation during breathing while a person is asleep or complete cessation of breathing during sleep. Together they are known as “Sleep-related breathing disorders”.
  • An average individual may also have up to five interruptions in breathing in an hour during sleep, however when they are more frequent, especially when more than fifteen, it deprives the brain and the rest of the body of oxygen. Because of the non-specific nature of the symptoms, patients usually remain undiagnosed until they suffer from long-term consequences of the disorder. According to a study featured in the 'American Journal of Critical Care and Respiratory Health', untreated sleep apnoea is not only associated with increased risk of heart and brain disorders but also associated with increased mortality, thus earning the name of ‘silent killer’ for this disorder.

Common symptoms include

  • Loud snoring
  • Excessive daytime sleepiness
  • Nonrestorative sleep
  • Difficulty falling asleep
  • Morning headaches
  • Dry mouth in the morning
  • Choking during sleep
  • Breathing pauses witnessed by bed partner during sleep

Consequences of untreated sleep apnoea

  • Impaired concentration and memory resulting in impaired work performance and easy fatiguability
  • Increased risk of vehicle and workplace accidents
  • Irritability and mood swings
  • Impotence and depression
  • Drug-resistant hypertension, heart attack and cardiac rhythm disturbances
  • Stroke
  • Increased risk of diabetes and liver disorder

How to diagnose Sleep apnoea?

  • The analysis is based on a combination of clinical features and subjecting the patient to investigations. There are particular questionnaires to assess a person’s tendency to excessive daytime sleepiness (Epworth sleepiness scale) and his or her risk of developing sleep apnoea (STOP-BANG scoring). In patients with symptoms suggestive of a sleep-related breathing disorder and associated risk factors as outlined above subjecting them to overnight sleep study confirm the diagnosis.
  • ‘Polysomnography’ or sleep study remains the gold standard for the diagnosis of sleep apnoea. Ideally, to be conducted under supervision in a hospital setting, it assesses the patient’s airflow, snoring, brain activity, breathing patterns, oxygen levels and body & leg movements while the patient remains asleep. In certain situations, it can also be conducted at home without supervision but has limitations of assessing fewer parameters and can only be used to screen at-risk patients.

Following are the treatment options:

Conservative measures

  • Medical treatment of nasal congestion – Decongestants
  • Stop Alcohol & smoking
  • Positional therapy
  • Considered in whom sleep apnea is more common in the supine position
  • Treatment consist of using special pillows or other positioning devices to help them avoid supine sleep

Oral appliances

  • Designed to keep the upper airway patent during sleep
  • Various types such as Tongue retaining device and Mandibular repositioning device

Surgical treatment

  • The surgical candidacy of the patient is determined after a thorough evaluation in select cases
  • Most commonly performed surgery is Uvulopalatopharyngoplasty

Positive airway pressure devices

  • CPAP (Continuous positive airway pressure) involves delivering positive influence to the airway of the patient through the battery-operated device while the patient is asleep. It helps to keep the airway patent and avoids breathing interruptions.
  • Specific individuals may require other advanced modes of ventilation such as bi-level positive airway pressure (Bi-PAP) or adaptive servo-ventilation (ASV).
(This article has been medically reviewed by Dr Prashant Makhija, Consultant Neurologist, Wockhardt Hospital Mumbai Central)

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