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Is your brain sleep deprived? Low mood, depression and even Alzheimer's can be linked to tiredness
Sleep apnea
Other namesSleep apnoea, sleep apnea syndrome
Obstruction ventilation apnée sommeil.svg
Obstructive sleep apnea
Pronunciation
SpecialtyOtorhinolaryngology, sleep medicine
SymptomsPauses breathing or periods of shallow breathing during sleep, snoring, tired during the day[1][2]
ComplicationsHeart attack, stroke, diabetes, heart failure, irregular heartbeat, obesity, motor vehicle collisions,[1] Alzheimer's disease, [3][4] and premature death[5]
Usual onsetVaries; 50% of women age 20-70 [6]
TypesObstructive sleep apnea (OSA), central sleep apnea (CSA), mixed sleep apnea[1]
Risk factorsOverweight, family history, allergies, enlarged tonsils[7]
Diagnostic methodOvernight sleep study[8]
TreatmentLifestyle changes, mouthpieces, breathing devices, surgery[1]
Frequency~ 1 in every 10 people,[4][9] 2:1 ratio of men to women, aging and obesity higher risk [10]

Sleep apnea, also spelled sleep apnoea, is a sleep disorder in which pauses in breathing or periods of shallow breathing during sleep occur more often than normal.[1] Each pause can last for a few seconds to a few minutes and they happen many times a night.[1] In the most common form, this follows loud snoring.[2] There may be a choking or snorting sound as breathing resumes.[1] Because the disorder disrupts normal sleep, those affected may experience sleepiness or feel tired during the day.[1] In children, it may cause hyperactivity or problems in school.[2]

Sleep apnea may be either obstructive sleep apnea (OSA), in which breathing is interrupted by a blockage of air flow, central sleep apnea (CSA), in which regular unconscious breath simply stops, or a combination of the two.[1] OSA is the most common form.[1] OSA has four key contributors; these include “anatomical compromises" like a narrow, crowded, or collapsible upper airway. Or “non-anatomical” ones like an ineffective pharyngeal dilator muscle function during sleep, airway narrowing during sleep, or unstable control of breathing (high loop gain).[11] Other risk factors include being overweight, a family history of the condition, allergies, and enlarged tonsils.[7] Some people with sleep apnea are unaware they have the condition.[1] In many cases it is first observed by a family member.[1] Sleep apnea is often diagnosed with an overnight sleep study.[8] For a diagnosis of sleep apnea, more than five episodes per hour must occur.[12]

In central sleep apnea (CSA), the basic neurological controls for breathing rate malfunction and fail to give the signal to inhale, causing the individual to miss one or more cycles of breathing. If the pause in breathing is long enough, the percentage of oxygen in the circulation will drop to a lower than normal level (hypoxaemia) and the concentration of carbon dioxide will build to a higher than normal level (hypercapnia).[13] In turn, these conditions of hypoxia and hypercapnia will trigger additional effects on the body. Brain cells need constant oxygen to live, and if the level of blood oxygen goes low enough for long enough, the consequences of brain damage and even death will occur. However, central sleep apnea is more often a chronic condition that causes much milder effects than sudden death. The exact effects of the condition will depend on how severe the apnea is and on the individual characteristics of the person having the apnea.

Treatment may include lifestyle changes, mouthpieces, breathing devices, and surgery.[1] Lifestyle changes may include avoiding alcohol, losing weight, stopping smoking, and sleeping on one's side.[14] Breathing devices include the use of a CPAP machine.[14] With proper use, CPAP improves outcomes.[15] Evidence suggests that CPAP may improve sensitivity to insulin, blood pressure, and sleepiness.[16][17][18] Long term compliance, however, is an issue with more than half of people not appropriately using the device.[15][19] Only 15% of developed countries use CPAP machines, in developing countries it is closer to only a 1% adoption rate.[20] Without treatment, sleep apnea may increase the risk of heart attack, stroke, diabetes, heart failure, irregular heartbeat, obesity, and motor vehicle collisions.[1]

Alzheimer's Disease and severe obstructive sleep apnea are connected [21] as there is an increase into the protein beta-amyloid or white matter damage, one of the main indictors of Alzheimer's, which in this case comes from the lack of proper rest or poorer sleep efficiency resulting in neurodegeneration.[4] Having sleep apnea in mid-life has a higher likelihood of developing Alzheimer's in older age, and if one has Alzheimer's they are also more likely to have sleep apnea.[9] This is demonstrated with cases of sleep apnea even being misdiagnosed as dementia. [22] With the use of treatment through CPAP there is a reversible risk factor for the amyloid proteins, which usually restores brain structure and cognitive impairment.[23][24]

OSA is a common sleep disorder affecting 936 million—1 billion people globally, or roughly every 1 in 10 people, and up to 30% of the elderly[4][9] Sleep apnea is somewhat more common in men than women, roughly a 2:1 ratio of men to women, with 50% of women age 20-70, and in general more people are likely to have it with older age and obesity.[25]

  1. ^ a b c d e f g h i j k l m n "Sleep Apnea: What Is Sleep Apnea?". NHLBI: Health Information for the Public. U.S. Department of Health and Human Services. July 10, 2012. Archived from the original on August 19, 2016. Retrieved 2016-08-18.
  2. ^ a b c "What Are the Signs and Symptoms of Sleep Apnea?". NHLBI. July 10, 2012. Archived from the original on 26 August 2016. Retrieved 18 August 2016.
  3. ^ Andrade, A.; Bubu, O. M.; Varga, A. W.; Osorio, R. S. (2018). "The relationship between Obstructive Sleep Apnea and Alzheimer's Disease". Journal of Alzheimer's Disease : Jad. 64 (Suppl 1): S255–S270. doi:10.3233/JAD-179936. PMC 6542637. PMID 29782319.
  4. ^ a b c d Jackson, Melinda L.; Cavuoto, Marina; Schembri, Rachel; Doré, Vincent; Villemagne, Victor L.; Barnes, Maree; O’Donoghue, Fergal J.; Rowe, Christopher C.; Robinson, Stephen R. (10 November 2020). "Severe Obstructive Sleep Apnea Is Associated with Higher Brain Amyloid Burden: A Preliminary PET Imaging Study". Journal of Alzheimer's Disease. 78 (2): 611–617. doi:10.3233/JAD-200571. PMID 33016907. Lay summary.
  5. ^ Young, Terry; Finn, Laurel; Peppard, Paul E.; Szklo-Coxe, Mariana; Austin, Diane; Nieto, F. Javier; Stubbs, Robin; Hla, K. Mae (1 August 2008). "Sleep Disordered Breathing and Mortality: Eighteen-Year Follow-up of the Wisconsin Sleep Cohort". Sleep. 31 (8): 1071–1078. PMC 2542952. PMID 18714778. Lay summary.
  6. ^ Franklin, K. A.; Lindberg, E. (2015). "Obstructive sleep apnea is a common disorder in the population—a review on the epidemiology of sleep apnea". Journal of Thoracic Disease. 7 (8): 1311–1322. doi:10.3978/j.issn.2072-1439.2015.06.11. PMC 4561280. PMID 26380759.
  7. ^ a b "Who Is at Risk for Sleep Apnea?". NHLBI. July 10, 2012. Archived from the original on 26 August 2016. Retrieved 18 August 2016.
  8. ^ a b "How Is Sleep Apnea Diagnosed?". NHLBI. July 10, 2012. Archived from the original on 11 August 2016. Retrieved 18 August 2016.
  9. ^ a b c Owen, Jessica E; Benediktsdottir, Bryndis; Cook, Elizabeth; Olafsson, Isleifur; Gislason, Thorarinn; Robinson, Stephen R (21 September 2020). "Alzheimer's disease neuropathology in the hippocampus and brainstem of people with obstructive sleep apnea". Sleep: zsaa195. doi:10.1093/sleep/zsaa195. PMID 32954401. Lay summary.
  10. ^ Franklin, K. A.; Lindberg, E. (2015). "Obstructive sleep apnea is a common disorder in the population—a review on the epidemiology of sleep apnea". Journal of Thoracic Disease. 7 (8): 1311–1322. doi:10.3978/j.issn.2072-1439.2015.06.11. PMC 4561280. PMID 26380759.
  11. ^ Osman, A. M.; Carter, S. G.; Carberry, J. C.; Eckert, D. J. (2018). "Obstructive sleep apnea: Current perspectives". Nature and Science of Sleep. 10: 21–34. doi:10.2147/NSS.S124657. PMC 5789079. PMID 29416383.
  12. ^ De Backer W (June 2013). "Obstructive sleep apnea/hypopnea syndrome". Panminerva Medica. 55 (2): 191–5. PMID 23676959.
  13. ^ Majmundar, Sapan H.; Patel, Shivani (2018-10-27). Physiology, Carbon Dioxide Retention. StatPearls Publishing. PMID 29494063.
  14. ^ a b "How Is Sleep Apnea Treated?". NHLBI. July 10, 2012. Archived from the original on 27 August 2016. Retrieved 18 August 2016.
  15. ^ a b Spicuzza L, Caruso D, Di Maria G (September 2015). "Obstructive sleep apnoea syndrome and its management". Therapeutic Advances in Chronic Disease. 6 (5): 273–85. doi:10.1177/2040622315590318. PMC 4549693. PMID 26336596.
  16. ^ Iftikhar IH, Khan MF, Das A, Magalang UJ (April 2013). "Meta-analysis: continuous positive airway pressure improves insulin resistance in patients with sleep apnea without diabetes". Annals of the American Thoracic Society. 10 (2): 115–20. doi:10.1513/annalsats.201209-081oc. PMC 3960898. PMID 23607839.
  17. ^ Haentjens P, Van Meerhaeghe A, Moscariello A, De Weerdt S, Poppe K, Dupont A, Velkeniers B (April 2007). "The impact of continuous positive airway pressure on blood pressure in patients with obstructive sleep apnea syndrome: evidence from a meta-analysis of placebo-controlled randomized trials". Archives of Internal Medicine. 167 (8): 757–64. doi:10.1001/archinte.167.8.757. PMID 17452537.
  18. ^ Patel SR, White DP, Malhotra A, Stanchina ML, Ayas NT (March 2003). "Continuous positive airway pressure therapy for treating sleepiness in a diverse population with obstructive sleep apnea: results of a meta-analysis". Archives of Internal Medicine. 163 (5): 565–71. doi:10.1001/archinte.163.5.565. PMID 12622603.
  19. ^ Hsu AA, Lo C (December 2003). "Continuous positive airway pressure therapy in sleep apnoea". Respirology. 8 (4): 447–54. doi:10.1046/j.1440-1843.2003.00494.x. PMID 14708553.
  20. ^ https://www.fool.com/investing/2017/11/18/3-top-medical-device-stocks-to-buy-now.aspx[full citation needed]
  21. ^ Andrade, A.; Bubu, O. M.; Varga, A. W.; Osorio, R. S. (2018). "The relationship between Obstructive Sleep Apnea and Alzheimer's Disease". Journal of Alzheimer's Disease : Jad. 64 (Suppl 1): S255–S270. doi:10.3233/JAD-179936. PMC 6542637. PMID 29782319.
  22. ^ https://newoldage.blogs.nytimes.com/2010/10/06/when-sleep-apnea-masquerades-as-dementia/[full citation needed]
  23. ^ Liguori, Claudio; Chiaravalloti, Agostino; Izzi, Francesca; Nuccetelli, Marzia; Bernardini, Sergio; Schillaci, Orazio; Mercuri, Nicola Biagio; Placidi, Fabio (1 December 2017). "Sleep apnoeas may represent a reversible risk factor for amyloid-β pathology". Brain. 140 (12): e75. doi:10.1093/brain/awx281. PMID 29077794.
  24. ^ Castronovo, Vincenza; Scifo, Paola; Castellano, Antonella; Aloia, Mark S.; Iadanza, Antonella; Marelli, Sara; Cappa, Stefano F.; Strambi, Luigi Ferini; Falini, Andrea (1 September 2014). "White Matter Integrity in Obstructive Sleep Apnea before and after Treatment". Sleep. 37 (9): 1465–1475. doi:10.5665/sleep.3994. PMC 4153061. PMID 25142557. Lay summary.
  25. ^ Franklin, K. A.; Lindberg, E. (2015). "Obstructive sleep apnea is a common disorder in the population—a review on the epidemiology of sleep apnea". Journal of Thoracic Disease. 7 (8): 1311–1322. doi:10.3978/j.issn.2072-1439.2015.06.11. PMC 4561280. PMID 26380759.
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