One of the most common complaints from patients in a primary care practice setting is fatigue. There are many possible underlying diseases that can present with fatigue and lack of energy. However, there is one condition that is a very common cause but is frequently overlooked: sleep apnea.
It is estimated that the prevalence of sleep apnea in North America is as high as 30% in males and 15% in females, and a large percentage of these people are not being treated. Not only does this condition adversely impact quality of life, but there is also mounting scientific evidence about the health hazards resulting from untreated sleep apnea.
Sleep apnea is a breathing disorder whereby, during sleep, breathing is transiently and repeatedly disrupted. People with sleep apnea tend to snore, snort, and strangle when sleeping. This is interspersed with periods of complete silence when the person either under breathes (hypopnea) or stops breathing (apnea). Most people do not recall having these issues and mistakenly think they have slept quietly and soundly. It is most common for a bed-mate to make note of and express concern about these signs and symptoms.
The most common type of sleep apnea is obstructive sleep apnea (OSA). In OSA, the tissues in the mouth and throat (tongue, soft palate, tonsils, and uvula) collapse in the back part of the throat and obstruct airflow into the lungs. This obstruction results in periods of apnea and hypopnea, which causes a significant decline in the oxygen saturation in the blood (hypoxemia). Long-standing periodic hypoxemia can be damaging to vital organs, and many clinical studies have documented that OSA is associated with increased all-cause and cardiovascular mortality approximately four times above the general population. Importantly, it has also been shown to compromise neurocognitive performance (memory disturbance, poor concentration) that can lead to dementia. If a person is predisposed to dementia, OSA can contribute to its progression.
The most frequent complaints expressed by people with OSA are nonspecific and include severe fatigue and lack of energy, daytime somnolence (excessive sleepiness), headaches, elevated blood pressure, and sexual dysfunction. Frequent naps are required during the day, and there is difficulty staying awake when watching TV, reading a book, or driving a vehicle.
Documented complications from chronic untreated OSA include asthma; atrial fibrillation; type 2 diabetes; eye disorders, such as glaucoma or dry eyes; hypertension; heart attack; stroke; and even sudden death during sleep. In our practice, we screen all patients with new onset atrial fibrillation for OSA, and we investigate for underlying OSA when a patient’s blood pressure is difficult to control. New investigational findings indicate that pregnant women with OSA are at risk of developing high blood pressure, which can lead to premature birth.
OSA occurs randomly, but there is a familial tendency, and it is commonly found as a complication of chronic kidney disease, congestive heart failure, dementia, and obesity. Some cases of OSA are significantly weight-dependent, and reducing weight by relatively small amounts can lessen the obstruction and diminish the symptoms of hypoxemia.
Screening patients for OSA is a simple process. A recording nocturnal pulse oximeter can be used initially. An oxygen sensor is placed on a finger and connected to a recorder attached to the wrist and worn for one night. When returned to the office, the recorder is connected to a computer and a print-out of oxygen levels is produced. If there are significant drops in oxygen levels, a home sleep study is scheduled.
No drugs are currently on the market to treat OSA. Some help can be obtained by weight loss, sleeping on your side, and exercising throat muscles. However, most patients require a medical device that delivers pressure through a tube to a face mask and the pressure prevents the collapse of the oral structures inhibiting obstruction. Also, this system most often relieves the problem of snoring.
Other treatment options used less frequently are oral appliances that pull the lower jaw forward; implants that stimulate airway and tongue muscles; and pharyngoplasty, a surgical procedure to widen the breathing passages.
In summary, if you suffer from fatigue and daytime sleepiness and snore, discuss screening for OSA with your healthcare provider.
Dr. Tippett is the founder of Comprehensive Quality Healthcare Providers, a concierge internal medicine practice located at 1210 Commerce Dr. Suite 106, Greensboro, GA. 30642. He can be reached at 706-510-3659. Visit his webpage at www.drtippett.com.