As the weight of our country rises, so does the incidence of obstructive sleep apnea (OSA). Sleep apnea is when we stop breathing while we sleep. It can be brief or last for several seconds which can cause our oxygen level to drop dramatically. It is estimated that about 43 million Americans suffer from this very treatable condition. See the chart below describing the prevalence of OSA in various medical conditions.
|Condition||% with Obstructive Sleep Apnea||Source|
|High Blood Pressure||30%||Nieto-JAMA 2000|
|Drug Resistant High Blood Pressure||83%||Logan- Hypertension 2001|
|Congestive Heart Failure||85%||Jiang- Journal of Cardiac Failure 2007|
|Atrial Fibrillation||49%||Gami-Nat Clin Pract Cardiovasc Med 2005|
|Coronary Artery Disease||38%||Moore- Am J Resp Crit Care Med 2001|
|Stroke||92%||Noradina- Singapore Med J 2005|
|Metabolic Syndrome (pre-diabetes)||50%||Ambrosetti- J Cardiovasc Med 2006|
|Type II Diabetes||48%||Einhorn- Endocrinology Practice 2007|
|Obese Diabetes||70%||Brooks – J Clin Endocrinol Metab 1994|
|Obesity with BMI>35||50%||Fritscher- Obesity Surg 2007|
|Acid Reflux||60%||Valipour- Chest 2002|
|Simple Snoring||60%||Valipour- Chest 2002|
One misconception is that a person must be obese to have sleep apnea. Many people with sleep apnea are quite thin and simply have oral muscles that relax too much while sleeping. This is accentuated by alcohol consumption. As noted above, 60% of all people who snore have sleep apnea.
Most people are familiar with common sleep apnea symptoms like daytime fatigue and “snorting” while sleeping. Lesser known symptoms are difficult to control blood pressure and blood sugar, as well as acid reflux (especially at night). It also increases nighttime urination. OSA is commonly misdiagnosed as an enlarged prostate or overactive bladder. Lastly, it may be the cause for difficulty with weight loss.
Advanced technology has made testing much easier. It used to require an overnight stay in a sleep lab where you are strapped to many wires. In 2008, the American Society of Sleep Medicine approved the use of home monitors, allowing testing to be done in the comfort of your own home.
If you are diagnosed with sleep apnea, there are four treatment options:
- Effective weight loss is the cornerstone of treatment and often cures OSA.
- For mild/moderate sleep apnea, a well fitting oral device can often resolve OSA while you attempt weight loss. Many insurance companies, including Medicare, are now paying for these devices.
- CPAP or BiPAP- this is a nose or face mask worn while sleeping that provides pressure and oxygen to assist breathing. It is usually very effective and is tolerated by a majority of people.
- Surgical treatment is usually a last resort.
It’s amazing how much better people feel when OSA is successfully treated. It can also dramatically lower blood pressure, blood sugar, vascular inflammatory markers, and allow for more effective weight loss.
We offer the use of a home sleep monitoring device to our patients. The device simply straps on your forehead like a headband. Although it can be a little annoying, the valuable information obtained is well worth the inconvenience.
The cost is $200, which you submit for out-of-network reimbursement if your insurance plan allows you that capability. The co pay for testing in a sleep center is usually the same as your copay for a one day stay in the hospital, typically $125-$200. It may cost up to $1,200 if you have a high deductible Health Insurance.
Who should be tested?
Everyone who has had a stroke or heart disease should be tested. In April 2011, the American Diabetes Association recommended that all diabetics be tested. It should also be considered for anyone who has the conditions listed in the chart above.