Sleep Apnea: Causes, Impacts and Treatments

Sleep apnea is a common and very serious sleep disorder that causes breathing to be interrupted, stopped or for it to get shallow. This disorder can affect anyone. To be diagnosed with Sleep apnea the interruption between breathing has to last at least ten seconds. The word “apnea” in Sleep apnea refers to the interruption in breathing. Chronic snoring is thought to be an indicator of sleep apnea. Most people who have this disorder are unaware of it and with more awareness, they can get the treatment or more knowledge about the disorder.

There are two types of this sleep disorder.  Obstructive Sleep apnea which happens when the muscles in the back of the throat fail to keep the airway open. During sleep, the tongue falls back against the soft palate and in return, the soft palate and uvula fall back into the throat. This ends up closing the airway. There is no clear reason why some have Sleep apnea and others do not but it is suspected that those with smaller upper airways, overbites, larger necks, smaller jaws, recessed chins, weight problems, drug, and alcohol use, being older than forty, ethnicity, and even genetics have a better risk at developing it.  This disorder can also affect those who lie on their back. This is a disorder that can develop in anyone regardless of age, gender, health, and sleeping positions. While Central Sleep apnea happens when the brain fails to control breathing during sleep. This causes the person to stop breathing completely or breathes are so shallow that the oxygen intake is ineffective. Those who have Central Sleep apnea may also have Obstructive sleep apnea. Obstructive Sleep apnea is more common than Central Sleep apnea. Sleep apnea overall is important to the health of the USA people because more than 18 million American adults have sleep apnea. Sleep apnea can occur in all ages and both sexes. This disorder can also go undiagnosed. As some people who have Sleep apnea do not realize it. Those who do not realize they have Sleep apnea are at an increased risk of stroke, heart attacks, and high blood pressure.

Sleep apnea affects the leading Health indicator of Nutrition, Physical Activity, and obesity. Nutrition and Physical activity are important because it helps people maintain a healthy weight, while also reducing health risks. Obesity is described as having too much body fat and it is a growing problem in America. Most Americans do not have a healthy diet and are not physically active. As 1 in 3 adults and 1 in 6 children and adolescents are obese (Nutrition, Physical Activity, and Obesity. (n.d.). This can be fixed by making changes to a diet and exercising. The majority of adults about 81.6% and adolescents about 81.8% do not get the right amount of physical activity (Nutrition, Physical Activity, and Obesity. (n.d.).This can be fixed by taking stairs instead of an elevator or walking to destinations instead of driving.  The growing problem of Obesity has added to the risk of  Sleep apnea. To reduce this risk of Sleep apnea it is suggested to maintain healthy body weight, to lose weight, avoid alcohol, and quit smoking. Losing weight can actually help cure sleep apnea or lessen the symptoms in an overweight man or woman. Alcohol causes nighttime awakenings and causes the muscles in the upper airway to relax. Finally, Smoking makes the swelling worse in the upper airway which causes apnea and even snoring to be worse.

Sleep apnea was discovered in 1965. Before this discovery specialists looked into obstructive sleep apnea as an intermittent closure of the upper airway. Early treatments focused mainly on eliminating the airway obstruction. Before the 1980s the only effective treatment for Obstructive Sleep Apnea was a Tracheostomy. A Tracheostomy is a surgical procedure to create an opening in the neck for access to the trachea. They are usually performed for airway obstructions, ineffective oxygen intake, and problems with secretions. They used Tracheostomy as a treatment because it bypassed the upper airway obstruction. In 1981 CPAP ( Continuous positive airway pressure) therapy with a nasal mask was introduced. The CPAP machine works by blowing air into the throat through a mask, the CPAP then increases the air pressure in the throat and prevents the airway from narrowing. The machine offers several health benefits and lessens the chances of heart disease, fatigue, and high blood pressure. This disorder again can affect anyone regardless of age or gender, but it is most frequently seen in men over 40, especially those who are overweight or obese.  Economically diagnosing and treating every patient in the U.S. who has sleep apnea would produce an annual economic savings of $100.1 billion dollars. On the other hand, there is an annual economic burden of undiagnosed sleep apnea among U.S. adults is approximately $149.6 billion. The estimated costs include $86.9 billion in lost productivity (Economic burden of undiagnosed sleep apnea in U.S. is nearly $150B. (2017, November 8).Untreated sleep apnea also increases the risk of costly health complications such as hypertension, heart disease, diabetes, and depression. The report estimates that undiagnosed sleep apnea also costs $30 billion annually in increased health care utilization and medication costs related to these health risks. people with untreated  OSA also have greater rates of hospitalization and healthcare costs.  Successful treatment of OSA can reduce these rates and costs. People with Obstructive Sleep apnea are also up to ten times more likely to have a motor vehicle accident as a result of sleepiness, sometimes with fatal results. While people who knowingly drive while tired may be at risk for civil and criminal liability. Obstructive Sleep apnea related sleepiness can be devastating with commercial truck drivers (they have higher rates of having Obstructive sleep apnea) as well as operators of public transportation vehicles. In 2008 a train crash in Boston was attributed to the sleepiness of a driver who likely had undiagnosed Obstructive Sleep apnea. The driver was unfortunately killed, passengers were injured, and millions of dollars of damages were incurred ( Personal & Societal Consequences. (n.d.).

This issue is an important one to address because so many people are affected by this disorder and some do not even know they have it. As more than 85% of patients with Obstructive sleep apnea are believed to have never been diagnosed. Most people are not even aware of their nocturnal arousals or heavy snoring. This disorder also leads to people having other health problems or risks.  As recent studies have shown that Obstructive Sleep apnea is associated with increased all-cause mortality and risk of cardiovascular morbidity and mortality. Additionally, a causal relationship has been established between Obstructive sleep apnea and some cardiovascular diseases like systemic arterial hypertension. Evidence also supports an association between Obstructive sleep apnea and ischemic heart disease, arrhythmia, heart failure, and stroke. This disorder can affect anyone but there is a greater risk of men developing this disorder than women. As 24% of middle-aged males develop this disorder versus 9% of middle-aged females. The chance of developing sleep apnea is even lower among people of Asian descent. There is also a higher risk for those who are African-American, Pacific Islanders, and Hispanics to increase the risk of having Sleep apnea. About 1 of 5 adults have at least mild symptoms of sleep apnea while 1 of 15 has moderate to severe symptoms. Those who have sleep apnea tend to be sleep-deprived and may have sleeplessness and other symptoms such as difficulty concentrating, depression, irritability, sexual dysfunction, learning and memory difficulties, they may fall asleep while at work or on the phone, or even while driving. If Sleep apnea is not treated then symptoms can consist of disturbed sleep, excessive sleepiness during the day, high blood pressure, heart attack, congestive heart failure, cardiac arrhythmia, stroke or depression.

Addressing this issue might lead to better health conditions because this disorder is treatable. Effective treatment should improve the quality of life, physical and mental health, and reduces safety risks. If the treatment is effective it should get rid of daytime fatigue. It should also improve the quality of sleep. Treatment should reduce snoring and other related symptoms of Obstructive Sleep apnea like cardiovascular risks. Those who used a CPAP machine had the same cardiovascular and mortality risk as people without Obstructive Sleep apnea. While those who had Obstructive Sleep apnea and were not treated with the CPAP machine had an increased risk.

In the United States, the Centers for Disease Control and Prevention identifies commercial motor vehicle drivers, shift workers, drivers with untreated sleep disorders such as Obstructive sleep apnea, drivers using sedative medications, and drivers who do not have adequate sleep as populations most likely to drive drowsy.  The National Highway Traffic Safety Administration estimates that about 2.4% of fatal crashes and 2% of injury crashes involve drowsy driving in the United States. Focus on Obstructive Sleep apnea and drowsy driving have not been evaluated enough throughout the world to have an advance policy for sleep-related disorders. The United States currently does not have an enforced regulation specifically for identifying drowsy driving to identify commercial drivers potentially at risk, to ensure treatment compliance, and to prevent potential accidents caused by Obstructive sleep apnea induced drowsy driving. The lack of enforced regulation on Obstructive Sleep apnea induced drowsy driving may be because of low focus on drowsy driving in general. To develop policies on Obstructive sleep apnea the population is also needed. At the federal level in the United States, President Barack Obama signed into law a bill that requires the Department of Transportation’s Federal Motor Carrier Safety Administration to use a formal rulemaking process instead of guidance if they wish to require sleep apnea testing for commercial truck drivers. This was signed in October of 2013. Guidance is a variety of documents to explain, interpret, or advise people about rules, laws, and procedures. Guidance can be issued without public comment and can completely bypass the formal rulemaking process, which permits public comment before setting guidelines. Currently, there are only seven states with laws, resolutions, guidelines, or policies pertaining to drowsy driving in the United States.  Arkansas, California, Florida, New Jersey, Pennsylvania, Texas, and Utah have various laws and resolutions in place for drowsy driving but nothing that’s set in stone.  Arkansas and New Jersey are the only states that have actual laws that have an impact on drowsy driving they do this by classifying drowsy driving as a Class-A misdemeanor or as an intoxicated driver. A Class-A misdemeanor is the most serious classification of misdemeanor charges. Punishments for a Class-A misdemeanor ranges from fines that are ＄500 to ＄5,000, one year in jail, and a potential mandatory rehabilitation program or community service depending on the judge (Filomeno, R., Ikeda, A., & Tanigawa, T. (2016, October 8). Developing policy regarding obstructive sleep apnea and driving among commercial drivers in the United States and Japan.)

Interventions have been established and focus on treatment for Obstructive Sleep apnea. The AASM commissioned a task force of experts in sleep medicine. The task force developed recommendations and assigned strengths based on the quality of evidence, the balance of clinically significant benefits and harms, patient values and preferences, and resource use (Patil, et al., 2019). The task force also used recommendations from prior guidelines that established the basis for appropriate and effective treatment of Obstructive Sleep apnea. The recommendations are intended for clinicians using PAP to treat patients. The recommendations are categorized as strong or conditional. If the recommendations are categorized under strong it is one a clinician should follow under most circumstances. If it is categorized under Conditional it is more of a suggestion. This category shows a lesser certainty of the outcome and appropriateness of the patient-care strategy for all patients. The AASM  also set up educational and behavioral interventions. The educational interventions focus on providing information about what Obstructive Sleep apnea is, the consequences, what PAP therapy is, and positive outcomes from using PAP therapy. Behavioral interventions deal with behavior changes before, during, and after PAP therapy. (Patil, et al., 2019). There are minimal harms to these interventions. Interventions that focus on education are

Good for this public health concern. These interventions would bring more attention and awareness to sleep apnea. The intervention would be able to provide information about something that

someone might not know about sleep apnea. For example how to lower the risks of sleep apnea or even asking about the risks of sleep apnea. The expected outcome for this intervention would be that everyone would take away an understanding of sleep apnea. The latest improvement in sleep apnea for treatment is from 2014. Its called hypoglossus nerve stimulation or HNS. its a surgically implanted device in the chest and can be turned on and off by patients. When sleeping the device monitors breathing and stimulates a nerve that keeps the upper airway open. HNS has improved sleep apnea conditions and reduced risks. There is also the EPAP or the Expiratory Positive Airway Pressure system which uses disposable adhesive valves that get placed over the nose while sleeping.  When inhaling the valve opens and helps the airway remain unobstructed. When exhaling, the airflow is directed into small channels, which creates pressure and, again, keeps the airways open. Open airways mean fewer incidences of obstructed breathing and interruptions in sleep. These treatments are recorded in The Latest Treatments for Obstructive Sleep Apnea from the sleep foundation.org.

Sleep apnea is a common and very serious sleep disorder that causes breathing to be interrupted, stopped or for it to get shallow. There are many health risks that go along with sleep apnea. Most people who have it are usually unaware and most go undiagnosed, but with awareness, interventions, and policies put in place people with sleep apnea can get the treatment or help they deserve,

• Bahammam, A. (2011). Obstructive sleep apnea: from simple upper airway obstruction to systemic inflammation. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3101717/
• Central Sleep Apnea. (n.d.). Retrieved from https://www.sleepapnea.org/learn/sleep-apnea/central-sleep-apnea/
• Economic burden of undiagnosed sleep apnea in U.S. is nearly $150B. (2017, November 8). Retrieved from https://aasm.org/economic-burden-of-undiagnosed-sleep-apnea-in-u-s-is-nearly-150b-per-year/
• Filomeno, R., Ikeda, A., & Tanigawa, T. (2016, October 8). Developing policy regarding obstructive sleep apnea and driving among commercial drivers in the United States and Japan. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5054288/
• How to Use a CPAP Machine for Better Sleep. (n.d.). Retrieved from https://www.sleepfoundation.org/articles/how-use-cpap-machine-better-sleep
• Nutrition, Physical Activity, and Obesity. (n.d.). Retrieved from https://www.healthypeople.gov/2020/leading-health-indicators/2020-lhi-topics/Nutrition-Physical-Activity-and-Obesity
• Patil, S. P., Patil, S. P., Ayappa, I. A., Caples, S. M., Kimoff, R. J., Patel, S. R., … Kribbs NB. (2019, February 15). Treatment of Adult Obstructive Sleep Apnea with Positive Airway Pressure: An American Academy of Sleep Medicine Clinical Practice Guideline. Retrieved from https://jcsm.aasm.org/doi/10.5664/jcsm.7640
• Pavwoski, P., & Shelgikar, A. V. (2017, February). Treatment options for obstructive sleep apnea. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5964869/
• Personal & Societal Consequences. (n.d.). Retrieved from http://healthysleep.med.harvard.edu/sleep-apnea/living-with-osa/persona-societal
• Sleep Apnea. (n.d.). Retrieved from https://www.sleepfoundation.org/sleep-apnea
• Sleep Apnea Information for Clinicians. (n.d.). Retrieved from https://www.sleepapnea.org/learn/sleep-apnea-information-clinicians/
• The Latest Treatments for Obstructive Sleep Apnea. (n.d.). Retrieved from https://www.sleepfoundation.org/articles/latest-treatments-obstructive-sleep-apnea