Thu | Aug 24, 2017

Are you ‘dying’ to sleep? (Part 2)

Published:Monday | October 12, 2015 | 10:00 AM

Obstructive sleep apnoea (OSA) does not allow for adequate sleep - rapid eye movement (REM) and non-rapid eye movement sleep (NREM). People of all ages need about eight hours sleep at nights. During sleep, the body rests, boosts the immune system and repairs itself. Children grow during sleep and adults gain or repair muscle.

Sleep also allows the brain to repair itself and sort through daily information. Additionally, the brain establishes memory pathways while we sleep and opens channels to allow for the flushing out of amyloid (the material that accumulates as plaques in Alzheimer's disease).

The sleep disturbance caused by OSA makes people prone to anxiety disorders, including panic attacks and phobias. They are also at risk for depression and mood swings, including aggression/violence. OSA may also cause concentration and short-term memory problems. OSA sufferers are three times more likely to be involved in motor vehicle crashes than other people.

The cardiopulmonary stress of OSA puts people at a significantly increased risk of heart disease (heart attacks, abnormal rhythms, heart failure) and strokes. OSA is associated with recalcitrant hypertension and with poor glucose control. OSA may also cause urologic symptoms like frequent urination at nights (because of the adrenaline effect on our autonomic nervous system) and erectile dysfunction (ED) in middle-age and older men.

OSA can affect the autonomic nervous system and cause tingling, reduced tolerance to cold or heat and abnormal bowel movements (too much or too little). OSA is associated with gastro-oesophageal-reflux disease (often called GERD). Sometimes, not only is there an association with existing GERD, but during the struggle to inhale against a collapsed airway, stomach secretions and acid are pulled up into the throat, mouth and perhaps nose. This leads to heartburn (caused by oesophagitis that, if chronic, may transform part of the lining to such an extent that it becomes a cancer risk), choking, sometimes chemical pneumonitis/ pneumonia, coughing (perhaps chronic), laryngitis (short- or long-term hoarseness), middle ear disease, tooth problems (sensitivity or loss of teeth enamel) and precipitate sinusitis and asthma in susceptible patients.

 

CARDIAC INVALIDS

 

OSA is strongly linked to abnormal heart rhythms, including atrial fibrillation (AF). Abnormal heart rhythms may not only cause severe health problems (including stroke, heart failure, respiratory failure or sudden death); they can also transform patients into 'cardiac invalids' and demand a lot of financial resources to treat.

The associated blood pressure problems and fluctuation in heart rate caused by OSA may lead to light-headedness and even blackouts. These can be dangerous to the patient and to anyone else if they should occur during the operation of a motor vehicle or heavy-duty equipment.

Because of the potential seriousness, OSA and hypopnoea and with so many people manifesting wide-ranging symptoms that may be either caused by or linked to them, I believe that routine screening should be considered in middle-age individuals and younger patients with a high index of suspicion for OSA/hypopnoea.

Depending on the severity and predisposing factors, OSA/hypopnoea treatments range from lifestyle adjustments to ENT intervention (surgical procedures to keep the upper airway patent during sleep), to using a continuous positive airway pressure (CPAP) machine calibrated to the particular user so that the airway is kept open while the patient sleeps.

I've also been told of the recent development of an implantable device that would sense futile respiratory efforts and trigger contraction of upper airway muscles to open the passage as necessary during sleep.

Many health problems, once confidently attributed to diseases treated by a wide range of specialist physicians, may actually require the intervention/assistance of a pulmonologist. Diagnosing and treating OSA will save people from suffering, save the expense of treating serious chronic illnesses, and avoid premature death.

Sleep apnoea deserves much more attention from medical screening and management guidelines, insurance companies and our health ministry. Furthermore, because of the possible deleterious effects of OSA/hypopnoea, all CPAP devices and accessories should be tax exempt.

- Garth A. Rattray is a medical doctor with a family practice. Email feedback to columns@gleanerjm.com and garthrattray@gmail.com.