Let’s Understand the Health Risks of Untreated Obstructive Sleep Apnea (OSA)
Obstructive Sleep Apnea (OSA) is a serious disease most often undiagnosed and under-treated in an estimated 20% of the adult population in the U.S. OSA can have significant adverse, even life-threatening health effects over time on multiple organ systems resulting in obesity, high blood pressure, heart attacks, strokes, diabetes and depression. OSA is caused by the collapse of the soft upper airway tissues during the breathing cycle of sleep resulting in a relative lack of REM sleep (the restful and restorative sleep cycle).
Over time, this decreased time of entering REM sleep can produce chronic fatigue with associated depression, cognitive impairment and/or poor job performance.
Closely associated with OSA is hypoxia (low oxygen concentration) occurring as a result of the partial and episodic closure of the soft upper airway tissues during sleep. This recurrent and chronic hypoxic state, varying between individuals as to frequency, duration and severity, is thought to lead to organ injury at the cellular level. The mechanism of cellular injury appears to be manifested as a vascular endothelial dysfunction which is associated with hypertension (high blood pressure), myocardial infarction (heart attack), cardiac arrhythmias particularly atrial fibrillation, strokes and adult onset diabetes.
OSA is caused by an anatomical obstruction during sleep to the normal flow of air from the upper aerodigestive tract to the lungs. It may be secondary to actual anatomical deficiencies anywhere from the nose, soft palate, or base of tongue , or to the abnormal loss of compliance of the soft tissues of the upper airway.
Common OSA Afflictions
Common afflictions in this group include depression, hypertension, cardiovascular disease, stroke, diabetes, obesity, short term memory deficits, and a predisposition to accidents of all types. It is estimated that up to 20% of all motor vehicle accidents are attributed to sleepiness with this disorder exceeding alcohol in the cause of motor vehicle fatalities. This disease was largely unrecognized as recently as 25 years ago, and today it is poorly represented in the curriculum of many medical schools. As recognition has increased it has become apparent through many studies that OSA represents a major public health and safety risk by not only the medical profession, but by government regulatory agencies, most notably the National Transportation Safety Board(NTSB). The Federal Motor Carriers Safety Association (FMCSA) has identified OSA as a major risk factor for commercial truck drivers and are on the verge of mandating testing for all commercially licensed drivers with a BMI (Basal Metabolic Index) of 33 or more. It is estimated that 2.4-3.9 million truck drivers alone suffer from significant OSA. This is an increasingly recognized liability issue for all commercial transportation operators including airline pilots, bus drivers, taxi drivers, and heavy equipment operators to name a few. Studies have consistently shown that untreated OSA patients are 3-7 times more likely to be involved in an accident.
Common OSA afflictions include depression, hypertension, cardiovascular disease, stroke, diabetes, obesity, short term memory deficits, and a predisposition to accidents of all types.
OSA with secondary daytime impairment or OSA Syndrome, is estimated to occur in 1 of every 20 adults and effects over 10 million individuals. Minimally symptomatic OSA is estimated to occur in 1 of every 5 adults. Many of these individuals with advancing age, and weight gain will progress to OSA syndrome during their lifetime. These statistics illuminate a problem likely to result in a large population-level burden of morbidity. The associated costs to our health care and legal systems of untreated OSA is staggering, and this will become a major consideration in any public health policy discussions.
OSA Affects Both Work & Social Activity
OSA is an increasing problem in younger active individuals who must rely on effective treatment to function in a work and social environment requiring hyper-vigilance, and mental acuity, not to mention the physically active attributes of this population. These individuals typically pursue treatment on an elective basis before medical co-morbidities are manifest.