Sleep apnea: An under-diagnosed disorder with underestimated consequences

Repeated awakenings, while often brief, can significantly fragment sleep. As a result, the next day, the person is tired, sleepy, easily distracted, and even irritable. The ensuing drop in alertness and changes in mood increase the risk of road or work accidents. They can also affect interpersonal relationships and job performance. In addition, sleep apnea promotes weight gain. 

This disorder is a risk factor for various illnesses such as diabetes, cardiovascular disease and depression. Such conditions may take longer to appear, but they are no less harmful to those affected.

Finally, sleep apnea can cause various cognitive problems ranging from memory problems and difficulty concentrating to depression. According to a study at Monash University in Australia, published in the Journal of Alzheimer’s Disease in 2020, it may also increase the amyloid load (i.e., an accumulation of proteins known to be responsible for several diseases) in the brain and heighten the risk of dementia.[3]

While most people experience occasional pauses in breathing during sleep, the following factors increase the risk of developing obstructive sleep apnea (OSA):[2]

• Obesity
• Facial shape (e.g., recessed or receding chin, narrow face or small jaw)
• Large tonsils
• Wide neck
• Gender (higher risk in men)
• Age (risk increases with age)
• Menopause
• Use of tobacco, alcohol, sleeping pills or opiates
• Allergies or respiratory problems
• Significant nasal obstruction

About 60% of people with OSA are obese. Dr. Mayer estimates that being overweight increases the risk of developing sleep apnea by a factor of six. He also states that “apnea episodes decrease by 30% for every 10% of weight loss.” 

Given the same morphology and clinical characteristics, women are two to three times less likely to experience sleep apnea episodes, according to Mayer. “They’re actually protected by hormones such as estrogen and progesterone,” he adds.

However, after menopause, this natural defence disappears and the statistical curves balance out between men and women.

The symptoms are also more subtle in women and, as a result, are not always diagnosed. Because women are more prone to fatigue, insomnia, memory loss and lack of energy, their doctors may mistakenly attribute these symptoms of OSA to a depressive episode. In contrast, men are more likely to experience drowsiness and be less alert during the day.

Studies estimate that 40% of apnea cases can be explained by genetic factors,[4] such as a facial morphology that promotes this disorder or even overweight (which is partly considered hereditary). As a result, the risk of developing the disease increases two to four times if a close family member also suffers from it.

The information obtained from the diagnostic test will be used to determine the most effective treatment for sleep apnea. In many cases, it is possible to reduce or even eliminate symptoms by modifying the lifestyle habits of those affected. An appropriate medical follow-up can help them change their sleeping position, treat nasal congestion, modify their diet or plan their weekly physical activities.

When OSA is more severe or treatment needs to be adapted to specific situations or morphologies, there are other possibilities:

• Continuous positive airway pressure (CPAP) : Used in the majority of cases, this therapy employs a device to continuously blow air through a mask that covers the mouth, nose or both, freeing up the airway. 
• Positional therapy : This uses a device worn on the chest or neck which vibrates when it detects sleep in the dorsal position.
• Dental treatment : In cases of mild to moderate apnea, a mandibular advancement orthosis is used to change the position of the jaw to facilitate airflow.
• Surgery : Repositioning of the jaws, removal of the uvula or tonsils, or bariatric surgery to help with weight loss, can be considered in some more severe cases.

Sleep apnea is very well understood and documented by specialists, making it possible for patients to find relief. The greatest challenge remains their ability to detect the telltale symptoms themselves. Keep in mind that 80% of apnea cases are not diagnosed.[2]

The bottom line is that, if you or anyone in your family experience sleep problems (e.g., snoring, recurrent awakenings, insomnia, fatigue or daytime drowsiness), you should tell your doctor, who will assess whether a diagnostic test is appropriate. It is important to remember that the consequences of OSA are far from trivial.