Can Sleep Apnea Kill You?
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Does Sleep Apnea Cause Death?
Sleep apnea is a common but easily overlooked sleep disorder, and its harm goes far beyond snoring at night. This disease may cause a series of health problems, including cardiovascular disease, cognitive decline, and daytime fatigue, and in severe cases, it can even be life-threatening. When we have more than 30 breathing pauses in 7 consecutive hours of sleep, and each breathing pause lasts for 10 seconds or more, or when there are more than five hypopneas per hour on average, it is sleep apnea syndrome.
Sleep apnea syndrome does not usually lead to death directly, but it may be associated with an increased risk of certain deaths. Observational studies have found that obstructive sleep apnea increases the risk of sudden death. The elderly, critically ill patients, and patients with severe obstructive sleep apnea are at higher risk of sudden death. The 5-year mortality rate of untreated patients with sleep apnea syndrome is 11%-13%, and the 8-year mortality rate can be as high as 37%. 7,000 patients with sleep apnea syndrome die every day worldwide. Multiple studies have shown that patients with OSA have a higher risk of all-cause mortality, which means that they are more likely to die from any cause than people without OSA.
Common Symptoms of Sleep Apnea
The most prominent and common feature of sleep apnea is repeated pauses in breathing during sleep. This interrupts the oxygen supply and prevents the patient from getting full rest throughout the night.
In addition to pauses in breathing, the following are some common symptoms of sleep apnea:
1. Loud and regular snoring: The patient will make loud and regular snoring.
2. Sudden awakening: The patient may suddenly wake up at night, feel shortness of breath or suffocation, and sweat a lot.
3. Frequent urge to urinate: Frequently go to the toilet at night, especially when forced to wake up from a deep sleep.
4. Frequent dry throat: Due to discomfort in the mouth and throat caused by sleep apnea syndrome, patients often feel a dry mouth and tongue.
5. Excessive daytime sleepiness: Affected by poor sleep quality, patients may experience persistent sleepiness and lack of concentration during the day. If this fatigue slows down daily work efficiency or driving safety, it should be taken seriously.
6. Morning headache, fatigue, memory loss, lack of concentration, slow reaction, irritability, low work efficiency, strange personality and behavior, etc.
7. Other symptoms: dry mouth and tongue, swallowing difficulties, dreaming, sleepwalking, enuresis, impotence, etc.
Causes of OSA
Any anatomical narrowing or obstruction in the upper airway can lead to obstructive sleep apnea.
1. Diseases of the nose and nasopharynx
Such as decreased elasticity of the nasal valve, narrow nasal valve area, wide columella, narrow or closed anterior nares, or nasopharynx. Deviated nasal septum, nasal polyps, hypertrophic rhinitis, and allergic rhinitis. Sinusitis, nasal and nasopharyngeal tumors, and foreign bodies in the nasal cavity. Nasal packing.
2. Oropharyngeal diseases
Such as enlarged adenoids or tonsils, elongated or enlarged uvula, pharyngeal tumors, pharyngeal wall thickening, pharyngeal burns, pharyngeal hematomas, pharyngeal stenosis, parapharyngeal abscesses, pharyngeal muscle paralysis, and pharyngeal muscle relaxation.
3. Tongue factors: Macroglossia, lingual thyroid, glossoptosis, cellulitis of the floor of the mouth.
4. Jaw deformity
5. Laryngeal disease
Epiglottitis, epiglottal edema, epiglottal tumor, epiglottal cyst, laryngopharyngeal stenosis, laryngeal cartilage softening.
6. Obesity
The tongue of obese people is thick, and excessive fat is deposited on the soft palate, uvula, and pharyngeal wall, resulting in airway obstruction. The volume of obese people’s lungs is significantly reduced, resulting in insufficient lung ventilation.
7. Endocrine disorders
Tongue enlargement caused by acromegaly, myxedema caused by hypothyroidism, and endocrine dysfunction in women after menopause can all lead to the occurrence of OSAS.
8. Tissue relaxation in the elderly
Loss of muscle tone leads to relaxation of the pharyngeal wall, collapse, and inward movement, causing snoring or OSAS.
9. Neck disease
Thyroid tumor, cervical deformity, and head and neck burns.
10. Long-term drinking and smoking
Who Is Prone to Sleep Apnea?
1. Many people have poor sleep quality at night due to a series of factors such as life pressure and work pressure. To ensure adequate sleep, they extend the sleep time to make up for the poor sleep quality. However, the sleep time is enough, but the sleep quality is poor. They still feel sleepy during the day, especially after getting up; they feel that they have not been relieved after sleeping, and they are prone to headaches and dizziness. Such people should be alert to the occurrence of sleep apnea syndrome.
2. Generally speaking, obese people and people with large neck circumference are more likely to develop sleep apnea syndrome.
3. People with short chins are also prone to sleep apnea syndrome.
4. People with loud snoring, such as snoring, can still be heard when the bedroom door is closed.
5. Middle-aged people, aged 40 to 50, and postmenopausal women.
6. Hypertensive patients, diabetic patients, coronary heart disease patients, etc., who have an early onset age should also be alert to the occurrence of the disease; elderly patients with heart failure, or those with central nervous system diseases such as stroke, should be alert to central sleep apnea syndrome.
The Dangers of OSA
When suffering from obstructive sleep apnea syndrome (OSAS), repeated episodes of hypoxia and hypercapnia can lead to neurological dysfunction, catecholamine, endothelin, and renin-angiotensin system disorders, endocrine dysfunction, and hemodynamic changes, causing damage to multiple organs and systems throughout the body, seriously affecting human health. Its hazards are mainly manifested in the following aspects.
Effects On Cardiovascular System
(1) Hypertension: Data show that OSAS is an important factor in the occurrence and development of hypertension. At least 30% of hypertensive patients have OSAS, and 45%-48% of OSAS patients have hypertension. This type of hypertension loses its normal circadian rhythm and is often manifested as high blood pressure when waking up in the morning. It is difficult to control with medication and can usually return to normal after OSAS treatment.
(2) Coronary heart disease: 35% of patients with coronary heart disease who have single or multiple coronary artery stenosis, as shown by coronary angiography, have OSAS. Such patients often have angina attacks at night and cannot be relieved by taking nitroglycerin drugs, but can be relieved after OSAS treatment.
(3) Heart failure: OSAS can cause or aggravate heart failure in patients with heart disease. The main reason is that apnea causes myocardial ischemia, hypoxia, and changes in intrathoracic pressure, which increases the heart load and reduces cardiac output. Some patients were hospitalized for repeated acute left heart failure and were diagnosed with severe OSAS after polysomnography. After continuous positive airway pressure treatment, their heart function recovered quickly.
(4) Arrhythmia: About 80% of OSAS patients have obvious bradycardia, 57%-74% of patients have ventricular premature beats, and 10% of patients have second-degree atrioventricular block. This arrhythmia is the main cause of sudden death in patients. Therefore, for patients with arrhythmia, OSAS should be considered. A 45-year-old male patient had a heart rate of 35 beats/minute due to third-degree atrioventricular block and was planned to have a pacemaker installed. After coronary angiography and other examinations, no organic lesions were found, but polysomnography diagnosed OSAS. After one week of continuous positive airway pressure treatment, the atrioventricular block disappeared, and the heart rate returned to normal.
Damage To The Kidneys
OSAS can be combined with proteinuria or nephrotic syndrome. The cause of renal damage is that the patient’s upper airway is closed, the chest cavity negative pressure increases, the right heart return increases, ischemia, pulmonary vasoconstriction, and the right heart load increases, which leads to right atrial dilation, stimulates the secretion of atrial natriuretic factor, reduces the sodium reabsorption rate of the proximal renal tubules, and reduces urine osmotic pressure and tubular concentration function. Its clinical manifestations are increased nocturia and edema. In severe cases, a series of manifestations of renal insufficiency may occur. Pathological changes are manifested as enlarged glomeruli and a small amount of focal sclerosis. Therefore, proteinuria is functional in the early stage. As OSAS improves or recovers from treatment, proteinuria can be reduced or disappear, and clinical symptoms can also improve or disappear.
Impact On The Nervous System
As blood oxygen saturation decreases, the EEG often shows awakening patterns, which are manifested as non-rapid eye movement sleep, and the sleep structure disorder, such as the reduction of rapid eye movement sleep, leads to reduced sleep efficiency. Some people may have hallucinations and unconscious behaviors before falling asleep, and limb twitching and spasms after falling asleep. Brain damage caused by hypoxia and circulatory disorders can cause intellectual impairment, memory loss, and personality changes.
Effects On The Mental System
(1) Cognitive dysfunction:
The patient’s cognitive function is affected comprehensively, with the most obvious impairments in attention, concentration, complex problem-solving ability, and short-term memory. The alertness of OSAS patients is reduced, which increases the incidence of motor vehicle accidents. Most OSAS patients fall asleep while driving, and 54% fall asleep while driving and have car accidents. These patients reported that they often doze off while driving, sometimes crashing into trees, sometimes crashing into walls, or injuring pedestrians. They often have to stop the car to wake up for a while, and are more likely to doze off when driving on the highway. Generally speaking, the more severe the OSAS condition, the higher the risk of a car accident, so it should be treated in time.
(2) Mental disorders:
Depression, anxiety, and hypochondria are the most common symptoms. Some people used the Minnesota Multiphasic Personality Inventory (MMPI) to test OSAS patients. It was found that 56% of patients had depression, 38% had hypochondria, and 29% had conversion hysteria. Some patients also showed simple paranoid psychosis, manic psychosis, etc. Abnormal behavior is also not uncommon, such as restless sleep, random movements of hands and feet, and sometimes sleepwalking.
Effects On The Blood System
Low blood oxygen can stimulate the kidneys to secrete erythropoietin, causing secondary erythrocytosis, increasing blood viscosity, slowing blood flow, and increasing the chance of cerebral thrombosis. It can also accelerate atherosclerosis and increase the incidence of vascular diseases.
Effects On The Endocrine System
The growth hormone secreted by the anterior pituitary gland is mainly released during rapid eye movement sleep. For children with obstructive sleep apnea, the release of growth hormone is reduced to varying degrees due to the reduction of rapid eye movement sleep, which is one of the factors affecting the slow growth and development of children.
Effects On Sexual Function
Sleep apnea patients may experience sexual dysfunction for the following reasons:
(1) Hypoxia and hypercapnia damage brain function and reduce central excitability. Sexual activity is inhibited.
(2) Patients with this disease have decreased reaction ability, attention, and observation ability, and have difficulty reaching orgasm during sexual intercourse, and the duration is short.
(3) It causes hypoxia of the sexual organs and disorders of androgen production.
Treatment of Sleep Apnea
Sleep apnea is a common sleep disorder, but fortunately, there are several effective treatment options available.
Lifestyle Changes:
Lifestyle changes are often the first approach to treating sleep apnea, especially for mild cases. This includes losing weight (if the patient is overweight or obese), improving diet, quitting smoking, and limiting alcohol and caffeine intake. In addition, regular exercise can also improve symptoms of sleep apnea. These lifestyle changes can not only reduce symptoms but also help improve overall health.
Continuous Positive Airway Pressure (CPAP):
CPAP is a common treatment that prevents airway collapse by providing continuous positive airway pressure. The patient wears a mask while sleeping that is connected to a small machine that provides enough air pressure to keep the airway open. CPAP is widely considered one of the most effective methods of treatment, quickly reducing symptoms and improving sleep quality.
Bi-level positive airway pressure therapy (BiPAP):
Unlike CPAP, BiPAP can provide two different levels of positive airway pressure, one for inspiration and one for expiration. This personalized treatment is suitable for patients who need more support, especially those with lung disease or other comorbidities.
Surgical intervention:
For some severe cases, surgery may be an option. Surgical options include palate suspension resection, palatine tonsillectomy, and maxillofacial surgery, which are designed to widen the airway and relieve symptoms. However, surgeries are usually considered a last resort because they carry certain risks and complications.
Oral devices:
Oral devices are an option that can be used to treat mild to moderate sleep apnea. These devices are usually custom-made by a dentist or oral specialist and can help maintain the position of the jaw and tongue to keep the airway open. Oral devices may be an effective option for patients who cannot tolerate CPAP or are seeking alternative treatments.
Medication:
Medication is often used for mild sleep apnea or as a supplement to other treatments. Some medications can help improve alertness while awake, but are not ideal for long-term treatment because they may have side effects and do not address the underlying problem.
Behavioral therapy
Behavioral therapy can help patients change their sleep habits and reduce symptoms. This includes cognitive behavioral therapy, which can help patients cope with sleep problems and improve sleep quality.
Most importantly, treating sleep apnea should be an individualized choice. Your doctor will recommend the most appropriate treatment based on your specific situation and the severity of your condition. During the treatment process, you need to actively cooperate, have regular checkups to ensure the effectiveness of the treatment, and make adjustments as needed. Effective treatment can not only reduce symptoms but also improve the patient’s quality of life and improve their health. Therefore, understanding treatment options and working with medical experts is the key to defeating sleep apnea.
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