by Habibat Aziz Garuba, MD, FRCPC
What is obstructive sleep apnea?
Obstructive sleep apnea (OSA) is breathing disorder that occurs during sleep. People with OSA experience multiple episodes where breathing becomes slow and shallow or even stops entirely (apnea spells) during sleep which may cause them to wake up several times a night. It is due to collapse of muscles in the upper part of the windpipe/airway which blocks airflow during sleep. This may even lead to drop in oxygen levels in the body.
OSA is the most common sleep-related breathing disorder but has only recently gained significant attention. There is still not much public awareness about this condition. Approximately 20-30% of men and 10-15% of women in North America have at least a mild form of OSA. Studies show that OSA is more common in Blacks, particularly those who are younger than 25 years and those who are older than 65 years compared to Caucasians and other racial groups, even after accounting for other risk factors.
What are the symptoms of obstructive sleep apnea?
People with OSA are often not aware of their symptoms until they are noticed by others. Symptoms include:
- Loud snoring or interruptions in breathing while sleeping;
- Spontaneously waking up due to gasping, choking, or holding one’s breath;
- Waking up feeling unrefreshed in the morning or experiencing morning headaches;
- Feeling extremely sleepy or fatigued during the daytime and having difficulty concentrating;
- Waking up with a dry mouth or sore throat;
- Moodiness or irritability;
- Falling asleep while driving or performing other important tasks.
A study published in 2006 showed that more Blacks considered snoring to be normal compared to whites and that bed partners of Blacks were more likely to accept loud snoring as normal. It is important to seek medical attention for an assessment for sleep apnea if you experience any of the above symptoms or if they are observed repeatedly by others.
What are the consequences of obstructive sleep apnea?
Untreated OSA is associated with high blood pressure (hypertension) which may be difficult to treat, heart attacks, congestive heart failure, heart rhythm abnormalities (such as atrial fibrillation), increased pressure in the lungs (pulmonary hypertension), and stroke. Many of these conditions also tend to be more prevalent in Blacks. Excessive sleepiness with untreated OSA can result in motor-vehicle accidents. OSA increases the risk of undergoing major surgery that requires general anesthesia.
Am I at risk for obstructive sleep apnea?
Obesity is the strongest risk factor for OSA. The condition is more common in people who have a higher body mass index (a measurement of the ratio of weight to height), higher waist-to-hip ratio, and higher neck circumference (usually more than 17 inches in men and 16 inches in women). The prevalence of OSA increases as we age and it is more common in men than women by two-to-threefold. Women who have experienced menopause have a higher risk than women who have not. Abnormalities in facial bones, jaw structure, and in the muscles in the upper windpipe also increase the risk of OSA. Smoking also increases the risk of OSA.
How is obstructive sleep apnea diagnosed?
OSA is diagnosed based on a combination of symptoms, the presence of certain medical conditions (hypertension, diabetes, atrial fibrillation, stroke etc.), and specific laboratory testing – usually an overnight sleep study in a sleep-medicine laboratory where the number of episodes of reduced breathing or apnea spells as well as levels of oxygen are recorded. The results are interpreted by a physician who is a sleep medicine specialist. OSA can be classified as mild, moderate, or severe depending on the number of episodes per hour during a night of sleep.
How is obstructive sleep apnea treated?
Conservative management includes weight loss, exercise, changing positions during sleep (if OSA is positional), alcohol abstinence, and avoiding medications that cause drowsiness. Patients may require the use of a device worn as a mask at night that continuously blows air (a continuous positive-airway pressure (CPAP) machine) to keep the upper airway open and prevent it from collapsing repeatedly. Some patients may require surgery of the upper airway or other appliances to keep the airway open. If you have been diagnosed with OSA, depending on its severity, you may be restricted from driving until you have been treated.
Where can I find more information?
Your physician is the best resource to assess whether or not you have obstructive sleep apnea. The following websites provide more general information about this condition:
American Sleep Apnea Association: www.sleepapnea.org
U.S. National Library of Medicine: www.medlineplus.gov/ency/article/000811.htm
- Olafiranye O, Akinboboye O, Mitchell J, et al. Obstructive sleep apnea and cardiovascular disease in Blacks: a call to action from Association of Black Cardiologists. Am Heart J. 2013 April ; 165(4): 468–476
- Friedman M, Bliznikas D, Klein M, et al. Comparison of the incidences of obstructive sleep apnea- hypopnea syndrome in African-Americans versus Caucasian-Americans. Otolaryngol Head Neck Surg. 2006 Apr; 134(4):545–50.
- Jean-Louis G, Zizi F, Casimir G, et al. Sleep-disordered breathing and hypertension among African Americans. J Hum Hypertens. 2005; 19(6):485–90
- Redline S, Tishler PV, Hans MG, et al. Racial differences in sleep-disordered breathing in African- Americans and Caucasians. Am J Respir Crit Care Med. 1997; 155:186–92
- Strohl K. Overview of obstructive sleep apnea in adults. UpToDate. uptodate.com. Accessed May 5, 2017.
THE CHECK-UP is a column aimed at increasing awareness and providing general information on selected health topics that are more prevalent in people of African and Caribbean descent. The information presented is not exhaustive and does NOT represent personalized medical advice nor does it replace an individualized assessment and treatment by a physician or other medical professional. Please contact your doctor or seek medical attention if you have any concerns about your health or any matters referenced in this article.
About the writer
Dr. Habibat Aziz Garuba is a Cardiology Resident Physician at the University of Ottawa Heart Institute. She is a licensed Internal Medicine Specialist and a Fellow of the Royal College of Physicians of Canada in Internal Medicine. She also holds a Bachelor of Science degree in Pharmacy from the University of Toronto and a licensed and registered pharmacist in Ontario. Her areas of interest include clinical cardiology, echocardiography, heart failure, public and global health, and pharmaceutical policy.