Obstructive Sleep Apnea Hypopnea

Understanding Sleep Apnea

Sleep apnea is a common and potentially serious sleep disorder characterized by repeated interruptions in breathing while sleeping. These interruptions can last from a few seconds to a minute or more and often result in poor sleep quality and reduced oxygen supply to the body. Without treatment, sleep apnea can lead to various health complications, including heart conditions and daytime fatigue.

Obstructive sleep apnea-hypopnea is the most common sleep disorder related to breathing. It happens when the airway gets blocked repeatedly during sleep, causing pauses in breathing (called apneas) or reduced airflow (called hypopneas). An apnea means there is no airflow at all, while a hypopnea means the airflow is less than normal. People with this condition often experience symptoms both during the night and during the day. The main signs are loud snoring and feeling very sleepy during the day.

Diagnosing Obstructive Sleep Apnea

Obstructive sleep apnea-hypopnea in adults is diagnosed using polysomnography (a type of sleep study). Diagnosis is based on either nighttime breathing problems (like snoring, gasping, or pauses in breathing) or daytime issues such as feeling very sleepy, tired, or not refreshed after sleep, even when there’s enough time to sleep. The diagnosis also requires evidence from a sleep study showing five or more breathing interruptions (apneas or hypopneas) per hour of sleep. If there are no symptoms, a diagnosis can still be made if the sleep study shows 15 or more of these breathing interruptions per hour of sleep.

Prevalence of Obstructive Sleep Apnea

Obstructive sleep apnea-hypopnea is a widespread condition, affecting at least 1% to 2% of children, 2% to 15% of middle-aged adults, and over 20% of older adults. However, more people may be at risk of sleep apnea. An article from 2006 discusses the prevalence of sleep apnea in the population of the United States. The article found that about 26% of adults are at high risk for obstructive sleep apnea. The article also points out that the risk of sleep apnea increases with age. Obesity is also a vital factor in obstructive sleep apnea, with up to 57% of obese individuals being at risk.

Development and Progression of Obstructive Sleep Apnea

Obstructive sleep apnea is most common in children aged 3 to 8 years when the airway can be blocked by relatively large tonsils compared to the size of the airway. As children grow and their airway enlarges, the condition becomes less common. However, the prevalence rises again in middle age, partly due to increasing obesity and, for women, the onset of menopause. The pattern in older adults is less clear; some studies suggest the condition stabilizes after age 65, while in others, it continues to increase with age.

Obstructive sleep apnea often gradually worsens over time, becoming a long-term issue. Many people only seek help when their loud snoring or other symptoms worsen. For many, the snoring has been bothering them for years, sometimes even since childhood. An article published in the Journal of Chronic Diseases emphasizes that loud snoring, often beginning before the age of 20, is a critical sign of sleep apnea. The article also states that symptoms such as feeling tired or unrested during the day often appear later, around the age of 36.

While this condition can develop at any age, it is most common between the ages of 40 and 60. The risk of developing sleep apnea is higher in:

• Older men
• Individuals with a higher BMI (body mass index)
• Individuals who gain weight over time

Obstructive Sleep Apnea in Children

As mentioned at the beginning, a paper from 2008 also explains that sleep apnea is common in children because of their enlarged tonsils and adenoids (lymphoid tissue located at the back of the nasal passage), causing poor quality of sleep. However, the article also states that children may also experience:

• Behavioral problems
• Difficulties in attention
• Memory issues
• Low performance in school

Risk Factors for Obstructive Sleep Apnea

The main risk factors for obstructive sleep apnea-hypopnea are obesity and being male. Other factors that increase the risk include:

• Maxillary-mandibular retrognathia (a condition in which the lower jaw is set further back than the upper jaw)
• Micrognathia (a condition in which the jaw is undersized)
• A family history of sleep apnea
• Genetic conditions that affect the upper airway (like Down’s syndrome or Treacher-Collins syndrome)
• Adenotonsillar hypertrophy (abnormal growth of tonsils)
• Menopause
• Various endocrine syndromes (conditions that affect the endocrine system: the system responsible for creating and releasing hormones)

Additionally, medications for mental health or other medical conditions that cause drowsiness can make sleep apnea symptoms worse if not managed properly.

However, the genetic factor is one of the most crucial ones. The risk of having obstructive sleep apnea-hypopnea is about twice as high for first-degree relatives of someone with the condition compared to those from families without it. While there are currently no genetic tests for the diagnosis or prognosis of obstructive sleep apnea-hypopnea, the possibility of considering this diagnosis should increase if a family member has experienced the condition.

Obstructive Sleep Apnea and Culture

The way sleepiness and fatigue are reported can differ between cultures. In many cultures, snoring is viewed as a sign of good health and might not be seen as a cause for concern. Even with a relatively low BMI, people of Asian ancestry may be at a higher risk of obstructive sleep apnea-hypopnea. Many studies, such as a study published in 1999, suggest that this may be due to differences in craniofacial features (the bones of the skull and face). Because of this, anatomy may play an important role in the development of sleep apnea in Asians.

An article from 2018 discusses how sleep apnea varies across ethnicities and cultures. According to the article, in African Americans, for example, symptoms like daytime sleepiness may be more severe, while Hispanic/Mexican Americans show higher rates of snoring. However, obesity is always the most crucial factor. Because of this, it is important to consider cultural and ethnic differences since they can influence the symptoms of sleep apnea.

Obstructive Sleep Apnea and Gender

Sleep apnea affects men and women differently. An article published in 2009 states that women often show milder symptoms than men, including fatigue, insomnia, and mood disturbances, instead of the typical loud snoring and daytime tiredness seen in men. The article also warns that historically, sleep apnea was considered a male condition, often leading to underdiagnosis of the condition in women.

An article from 2008 observes similar differences, explaining that women often experience milder symptoms. However, the article adds that hormonal differences, body fat distribution, and upper airway anatomy also contribute to these gender differences. Crucially, both articles emphasize that sleep apnea in women is often left undiagnosed, potentially leading to serious health issues.

The Impact of Obstructive Sleep Apnea

Cardiovascular Conditions

Many studies emphasize the negative consequences of sleep apnea on the cardiovascular system. A study published in the Clinics in Chest Medicine, for example, describes the serious health consequences of obstructive sleep apnea on the cardiovascular system. The study explains that sleep apnea is linked to:

• Increased risks of high blood pressure
• Heart disease
• Stroke
• Heart failure

The repeated interruptions in breathing during sleep cause drops in oxygen levels, which lead to spikes in blood pressure and stress on the heart.

Another study from 2018 links sleep apnea to the same cardiovascular conditions. The study also emphasizes that patients with heart failure are especially vulnerable since sleep apnea worsens their condition.

Decrease in Motor Functions

Daytime sleepiness is experienced by more than half of people with moderate to severe obstructive sleep apnea. In people with high apnea-hypopnea index values (the severity of sleep apnea), this condition is associated with a seven-fold increased risk of motor vehicle crashes and a two-fold increased risk of workplace accidents. In particular, for commercial drivers, clinicians should be aware of state regulations that may require them to report this condition.

Mental Health Issues

Obstructive sleep apnea may also influence mental health. An article from 2018 explains that poorer quality of sleep and daytime sleepiness can affect mood and cognitive functioning. Because of this, sleep apnea is associated with an increased risk of depression and anxiety due to repeated interruptions in breathing during sleep. These mental health issues can further decrease the quality of life for individuals suffering from obstructive sleep apnea.

Conditions that may appear alongside obstructive sleep apnea

As mentioned, obstructive sleep apnea is strongly linked to several serious health conditions, including:

• High blood pressure
• Coronary artery disease (the narrowing or blockage of coronary arteries)
• Heart failure
• Stroke
• Diabetes
• Increased risk of death

The risk for these conditions in people with moderate to severe obstructive sleep apnea-hypopnea can be 30% to 300% higher.

Furthermore, about 10% of those referred for an evaluation of obstructive sleep apnea report symptoms of depression; up to one-third of them show levels of depression comparable to moderate to severe cases. The degree of depression symptoms has been noticed to be associated with the severity of obstructive sleep apnea. This connection may be stronger in men than in women.

Cognitive Behavioral Therapy (CBT) for Obstructive Sleep Apnea

Positive airway pressure (PAP) therapy is a treatment for sleep apnea that uses a machine to deliver a constant stream of air through a mask, keeping the airway open during sleep and preventing breathing interruptions.

Cognitive behavioral therapy (CBT), on the other hand, is a type of therapy that helps people identify and change negative thought patterns and behaviors. It teaches practical skills to manage stress, anxiety, and depression by promoting healthier ways of thinking and acting.

Many studies emphasize the efficacy of the combination of these two therapies for sleep apnea. A 2019 study, for example, found that receiving CBT before beginning PAP significantly improved the patients’ acceptance of consistent use of PAP. Patients who received CBT also showed better adherence to PAP, with fewer patients rejecting the therapy. Moreover, CBT also helped reduce insomnia, improving the overall quality of sleep.

An article from 2021 discusses how CBT can be used effectively to treat patients suffering from sleep apnea and insomnia. It explains that traditional treatments often handle these conditions separately, which may not be as effective. As with the previous study, the article states that CBT improves insomnia symptoms and also increases the patients’ adherence to PAP. The article emphasizes the necessity of a multidisciplinary approach in the treatment of sleep apnea, considering the patient’s preferences and accessibility to care.

How the Sintelly App Can Help

The app provides CBT exercises tailored to address the anxiety, stress, and depressive symptoms often associated with sleep apnea. These exercises can help users identify and reframe negative thought patterns related to sleep and health, promoting better mental well-being and improved sleep quality.

Sintelly also offers guided mindfulness and relaxation exercises that can reduce anxiety and help users relax before bedtime. By incorporating these practices, users can enhance their overall sleep hygiene and reduce the emotional turmoil that often accompanies sleep disorders.

The app’s interactive therapy chatbot offers real-time emotional support and practical advice. For example, if a user feels anxious about using PAP therapy or struggles with insomnia, the chatbot can provide calming techniques, guided breathing exercises, and reminders of the benefits of sticking with their treatment plan.

The app allows users to track their emotional and behavioral changes over time, providing personalized insights into their progress. For instance, users can monitor their adherence to CBT techniques, track their mood improvements, and see how their sleep quality evolves. This continuous feedback loop encourages sustained effort and adherence to treatment protocols, including Positive Airway Pressure (PAP) therapy.

By combining these features, the Sintelly app can support individuals with Obstructive Sleep Apnea Hypopnea in managing both the psychological and physical aspects of the disorder, ultimately leading to better adherence to treatment and improved quality of life.