Originally published in The Ottawa Citizen February 10, 2003
Original Title: No rest for the weary

Last week’s column reviewed how obstructive sleep apnea is more than just a problem of poor sleep. More than 90 per cent of obstructive sleep apnea sufferers remain undiagnosed and face real health risks.

Recent evidence implicates this condition with the development of high blood pressure (hypertension). Half of all people with high blood pressure have obstructive sleep apnea and half of all people with sleep apnea have hypertension. As the severity of obstructive sleep apnea worsens, so too does hypertension.

The effects of uncontrolled hypertension are well known. Recent studies indicate that successful treatment of sleep apnea significantly reduces blood pressure levels. Left untreated, obstructive sleep apnea can contribute to advanced heart disease, stroke, congestive heart failure, irregular heart rhythms, kidney damage, impaired concentration, divorce, headaches and impotence.

Indeed, the standard blood pressure medications do not work as well for some individuals with obstructive sleep apnea. When this occurs, it can confound both doctor and patient because the expectation is that medical therapy should work.

Blood pressure normally drops while you are asleep. Sleep apnea prevents this nighttime relaxation of the cardiovascular system. Breathing can stop (apnea) up to 600 times per night. The brief awakenings following each apneic spell cause a several second spike in blood pressure.

This spike stimulates hormonal changes that can affect kidney function, increase constriction of the arteries slowing blood flow and stimulate the nervous system increasing the heart rate. The sleep apnea sufferer has an increased risk of blood clots and stroke because of an increase in substances that promote clot formation.

Sleep apnea treatment encompasses lifestyle change, the use of special assist devices, and in some instances, surgery.

Lifestyle modifications include weight loss if obese, smoking cessation and avoiding alcohol and prescription sleeping pills. Sleeping on the back can cause loose throat structures to fall back into the airway blocking it. Lying on one’s side can alleviate this problem.

A low-tech solution for some people is using the “tennis ball technique”. Placing a tennis ball near the middle of your back (using a wide cloth belt to hold it in place) will prevent you from rolling onto your back. As you shift to your back the ball will press into the spine forcing you to return to your side.

Another option is to use an oral device such as a custom-made plastic mouthpiece. It can help keep the tongue and jaw remain in a forward position while sleeping.

The most effective means of controlling obstructive sleep apnea is by Continuous Positive Airway Pressure (CPAP). The device pumps air under low pressure through a nasal mask. This air pressure prevents the tissue structures within the throat from collapsing and blocking the airway.

Most patients with mild, moderate and severe obstructive sleep apnea can benefit from CPAP. It might take a few days to get used to wearing the mask but it can change your life for the better.

Surgical solutions are not always curative. An ear, nose and throat specialist (ENT) can determine if there indeed are anatomical causes of sleep apnea.

The ENT specialist will answer your questions about the various success rates and the risks and benefits of the various surgical procedures compared to non-surgical options. Further consultation with a sleep specialist adds another dimension to the decision-making process.

The most common surgical procedure is uvulopalatopharyngoplasty. A portion of the uvula (the tissue that hangs down in the back of the throat) and loose tissue is removed by laser. The success rate varies from 40 to 60 per cent and predicting which patients will respond well to treatment is problematic.

Other surgical procedures include unblocking the nasal cavity, removing the tonsils and adenoids, corrective surgery of the jaw and cheekbones and somnoplasty. The latter involves the use of a high-frequency energy beam to shrink part of the soft palate and tongue.

The treatment goals for obstructive sleep apnea are to prevent the complications of cardiovascular disease, excessive daytime sleepiness, motor vehicle accidents, accidental injury, poor work performance and for some, marital difficulties.

If you suspect you, a friend or family member has sleep apnea please consult your doctor. Some studies indicate that treatment reduces the rate of hospitalizations and death and improves the disease complications.

For more information, contact the National Center on Sleep Disorders Research at the National Heart, Lung, and Blood Institute Information Center, National Institutes of Health (http://www.nhlbi.nih.gov/health/prof/sleep/ index.htm) the American Academy of Sleep Medicine (http://www.aasmnet.org/) or the American Sleep Apnea Association (http://www.sleepapnea.org).
© Dr. Barry Dworkin 2003