Snoring and Obstructive Sleep Apnoea
Complications of Obstructive Sleep Apnoea
The reason why we treat UARS and sleep apnoea is because they cause huge problems for patients. Below are some of the problems caused by sleep apnoea. Research regarding UARS is still in the early stages and therefore there isn’t any solid data on this yet.
- Mental Slowness. Having sleep apnoea leads to a number of mental difficulties. One study, which looked at all the data on this subject, found that patients had impairment of inductive and deductive reasoning, attention, vigilance, learning, and memory. This means that patients with sleep apnoea are unable to think as clearly as before.
- Road Traffic Accidents. The most worryingly consequence of this difficulty in thinking clearly is seen as a worsening of people’s driving ability. You are 5-12 times more likely to have a road traffic accident if you have obstructive sleep apnoea. This risk of driving with sleep apnoea is becoming more of a public issue, as the DVLA have recently updated their guidance for these patients.
- Growth Hormone. Snoring is normally considered a nuisance and merely a social problem. There is more evidence that suggests that children who snore have reduced levels of growth hormone, they have a higher rate of neurocognitive disorders and it seems to affect the quality of a child’s life. Showing a problem in adults is much harder to investigate, but there are researchers actively looking into this.
- Depression. There is a 1.8 times risk of acquiring depression when you have sleep apnoea. Interestingly it seems depression may actually cause sleep apnoea as well, although the reasons for this haven’t been researched yet.
You are 5-12 times more likely to have a road traffic accident if you have obstructive sleep apnoea.
- High Blood Pressure. Most people with sleep apnoea have a higher blood pressure than before. Many sleep apnoea patients have what is known as resistant hypertension, meaning that their blood pressure is very difficult to control with the normal blood pressure medications. A large study known as the heart BEAT study stated that in cases of resistant hypertension, it is reasonable to investigate for sleep apnoea purely because it is a common cause of this problem (J Clin Sleep Med 2014 Walia). Treating obstructive sleep apnoea also leads to a reduction in blood pressure without requiring any antihypertensive medication. In some cases, Mr Vik Veer has to warn patients that when their sleep apnoea is being treated patients should be keeping a close eye on their blood pressure because it might go too low if they are on a lot of medication for it.
- Heart Failure. One study found that 50% of patients with heart failure also had obstructive sleep apnoea. Heart failure and sleep apnoea seem to be very closely linked. (Macdonald J Clin Sleep Med 2008)
- Stroke. Another study also showed that having sleep apnoea is risk factor for getting a stroke (hazard ratio 1.97). They also found that the higher the number of apnoeas each hour meant there was a higher risk of getting a stroke. (Yaggi N Engl J Med 2005)
- Heart Arrhythmias. The Sleep Heart Health Study found that there is a 5 fold increase in arrhythmias (Am J Respir Crit Care Med 2006). These are abnormal heart rhythm problems like AF (atrial fibrillation). Another study found that electrical reversal (cardioversion), of AF is 82% likely to fail if the patient has sleep apnoea. (Kanagala Circulation 2003)
- Weight Gain. It is extremely hard to lose weight when you have Obstructive Sleep Apnoea. We believe this is because the body is in a ‘stressed’ state, and therefore it reacts by holding on to fat. This is the caveman reaction in all of us preparing for a harsh winter. Mr Vik Veer’s approach in people who have a weight problem with sleep apnoea is just to go ahead with treatment. He has had excellent results this way in the long term, because just giving a little bit of help to these patients mean that they have more energy to go on and exercise and lose weight. Losing 10% of body weight generally translates to reducing snoring and sleep apnoea by 30%. Some people are unable to start this process until they have had a little bit of treatment to get them back on the right path. An honest clear conversation with a multimodal treatment approach to sleep apnoea is what Mr Vik Veer practices in his NHS and private work.
- Diabetes. Patients with sleep apnoea are more likely to have diabetes (European Sleep Apnea Cohort (ESADA) study. Chest 2014; Kent). Similar to high blood pressure, Mr Vik Veer suggests that patients keep a careful eye on their glucose levels during treatment as there is a chance that the diabetes will improve, and therefore patients should avoid the complication of taking too much medication and dropping their glucose levels too low.
- Cholesterol. Levels of fat in the blood also improve after treatment of sleep apnoea.
- Patients with sleep apnoea are more likely to seek medical attention, use medication, be unemployed, and have lower income levels. It was estimated that patients lost up to the equivalent of 12,000 Euros a year and their partners lost about 3000 Euros per year due to sleep apnoea. This is a massive drain on patients and the economy (Danish patient registry 2014 Sleep Medicine). 432 million pounds a year is estimated to be lost in the NHS due to untreated sleep apnoea. It seems incredible that more is not being done to draw attention to this problem and try and prevent these complications.