Getting less than seven hours of sleep each night is often seen as a minor inconvenience, but for those with sleep apnea, it could be much more serious.
Recent research has shown that sleep duration is closely linked to mortality risk in people with Obstructive Sleep Apnea (OSA). This means that consistently sleeping fewer than seven hours may significantly increase the risk of death in those already grappling with this common sleep disorder.
How Does Sleep Apnea Impact Overall Health?
Sleep apnea is a serious sleep disorder is identified by repeated interruptions in breathing during sleep. These interruptions (Apneas) can last from a few seconds to a minute and can occur multiple times throughout the night. The most common type of sleep apnea is Obstructive Sleep Apnea (OSA). Its where the airway becomes partially or completely blocked.
Another type is Central Sleep Apnea, where the brain fails to send the proper signals to the muscles that control breathing. The impact of sleep apnea on overall health is important for individuals affected by this condition. As well as for healthcare professionals managing it.
Cardiovascular Health
One of the most consequential impacts of sleep apnea is on cardiovascular health. The repeated episodes of breathing cessation cause oxygen levels in the blood to drop leading to oxidative stress and inflammation. This triggers the release of stress hormones like cortisol, which increases heart rate and the blood pressure.
Over time, these effects contribute to the development of hypertension (high blood pressure). A major risk factor for cardiovascular diseases. Accordingly, research shows that individuals with untreated sleep apnea are at a higher risk of developing conditions such as heart disease, stroke and heart failure. On top of that, sleep apnea increases the risk of heart disease up to two times.
Metabolic and Endocrine Disorders
What’s more, sleep apnea also has a profound effect on metabolic health. The disorder is strongly associated with insulin resistance. A condition where the body’s cells do not respond effectively to insulin, leading to elevated blood sugar levels. This insulin resistance can eventually progress to type 2 diabetes. Studies have found that sleep apnea increases the risk of developing type 2 diabetes. And treating sleep apnea can help improve blood glucose control in those already diagnosed with diabetes.
Furthermore, sleep apnea affects hormone regulation. Particularly those involved in appetite control, such as ghrelin and leptin. Mainly ghrelin, the hunger hormone, tends to increase. While leptin, the hormone that signals fullness, decreases in individuals with sleep apnea. This hormonal imbalance can lead to weight gain and obesity. Which then are both risk factors and consequences of sleep apnea creating a vicious cycle that exacerbates the condition.
Mental Health and Cognitive Function
The impact of sleep apnea on mental health and cognitive function is also significant. The repeated disruptions in sleep prevent individuals from reaching the deeper, restorative stages of sleep, leading to chronic sleep deprivation. This lack of quality sleep can result in symptoms of depression and anxiety, which are common in individuals with sleep apnea. In fact it was shown that people with sleep apnea are up to 5 times more likely to develop depression.
Cognitively, sleep apnea can impair attention, memory and executive function. The brain’s oxygen deprivation during apneas can damage brain cells. This can lead to cognitive decline and increasing the risk of neurodegenerative diseases such as Alzheimer’s. Also the daytime sleepiness associated with sleep apnea can impair work performance, increase the risk of motor vehicle accidents and reduce the overall quality of life.
Immune System and Inflammation
Chronic inflammation is another consequence of sleep apnea. The body’s response to repeated oxygen deprivation involves the activation of inflammatory pathways, which can contribute to systemic inflammation.
This chronic inflammation is linked to various conditions. Including atherosclerosis (hardening of the arteries), arthritis and certain cancers. Moreover, sleep apnea can weaken the immune system making individuals more susceptible to infections and illnesses.
Quality of Life and Long-Term Outcomes
Sleep apnea seriously diminishes the quality of life. The chronic fatigue, mood disturbances and cognitive impairments experienced by those with sleep apnea can lead to social and occupational difficulties. Also untreated sleep apnea is associated with increased mortality rates.
What Does the Research Say About the Connection Between Sleep Duration and Mortality Risk?
We all know sleep is a necessary component of overall health. Influencing everything from cognitive function to cardiovascular well-being. However, for individuals with Obstructive Sleep Apnea (OSA), sleep is often disrupted leading to different health complications. A significant question in sleep research is whether the duration of sleep impacts mortality risk among people with OSA. So a study titled “Objective Sleep Duration and All-Cause Mortality Among People With Obstructive Sleep Apnea” provides useful understanding into this connection. Clarifying the importance of sleep duration for this population.
What Does the Study Investigate?
The study, conducted as part of the Sleep Heart Health Study (SHHS), aimed to explore the association between sleep duration and all-cause mortality among individuals with OSA. The research included 2,574 participants. They are diagnosed with OSA defined by an apnea-hypopnea index (AHI) of 15 or more.
These participants were followed for a median period of 11.8 years. During which their sleep duration was objectively measured using polysomnography (PSG) at baseline. Not to mention the participants were categorized into four groups based on their sleep duration: those sleeping at least 7 hours, 6 to less than 7 hours, 5 to less than 6 hours and less than 5 hours.
What Were the Key Findings?
The study revealed a clear link between shorter sleep duration and higher all-cause mortality risk among individuals with OSA.
Compared to participants who slept at least 7 hours per night, those who slept less had significantly higher risks of death from any cause. Specifically, the hazard ratios (HR) for all-cause mortality were 1.53 for those sleeping 6 to less than 7 hours, 1.40 for those sleeping 5 to less than 6 hours and 1.64 for those sleeping less than 5 hours.
These results were independent of the severity of OSA, as measured by the AHI. Indicating that sleep duration itself is important in determining mortality risk.
How Does Sleep Duration Affect Mortality in OSA Patients?
The findings suggest that insufficient sleep exacerbates the health risks associated with OSA. Sleep is essential for the body’s restorative processes. Including cellular repair, hormone regulation, and cognitive function.
For individuals with OSA, who already experience disrupted sleep due to breathing interruptions, getting less than the recommended 7 hours of sleep further impairs these vital processes. This cumulative sleep deficit may lead to increased oxidative stress, inflammation and cardiovascular strain. All of which contribute to a higher risk of mortality.
What Are the Implications of This Research?
The results have meaningful implications for the management and treatment of OSA. It stresses the importance of not only treating the apnea-hypopnea index (AHI) but also ensuring that patients achieve adequate sleep duration.
This might involve using positive airway pressure (PAP) therapy to manage OSA symptoms effectively. And even adopting sleep hygiene practices that promote longer and more restful sleep. On top of that, the findings also suggest that healthcare providers should monitor sleep duration as part of the overall treatment plan for OSA patients.
What Further Research is Needed?
While this study provides strong evidence of the connection between sleep duration and mortality risk in OSA patients, it also emphasizes the need for further research. Specifically future studies should explore whether interventions aimed at extending sleep duration can reduce mortality risk in this population. Additionally, understanding the mechanisms by which short sleep duration exacerbates the health risks of OSA could lead to more targeted and effective treatments.
What Are the Treatment Options for Sleep Apnea and How Do They Affect Sleep Quality?
The are various treatment options are available, each aiming to improve sleep quality by ensuring that the airway remains open during sleep. Among these treatments, Continuous Positive Airway Pressure (CPAP) therapy is the most commonly recommended and effective option.
Continuous Positive Airway Pressure (CPAP)
CPAP therapy is considered the gold standard for treating OSA. It involves wearing a mask over the nose and/or mouth connected to a machine that delivers a continuous stream of air. Keeping the airway open during sleep. This prevents the collapse of the airway, reducing apneas and hypopneas, and thereby improving sleep quality.
Benefits of CPAP:
- Improved Sleep Quality: CPAP prevents airway obstruction. Allowing uninterrupted sleep and enabling individuals to achieve deeper, more restorative sleep stages.
- Reduction in Daytime Sleepiness: Consistent use of CPAP has been shown to reduce daytime sleepiness and improve alertness and cognitive function.
- Cardiovascular Health: CPAP therapy can also lower blood pressure and reduce the risk of cardiovascular complications associated with OSA.
Other Treatment Options
Some individuals may seek alternative treatments. Other options include:
- Oral Appliances: Oral appliances are custom-fitted devices worn in the mouth during sleep. They work by repositioning the lower jaw and tongue to keep the airway open. These appliances are effective for mild to moderate OSA. And some prefer them for their comfort and ease of use.
- Lifestyle Changes: Simple lifestyle modifications can significantly impact the severity of OSA. These include:
- Weight Loss: Excess weight, particularly around the neck can contribute to airway obstruction. Also losing weight can reduce the severity of OSA.
- Positional Therapy: Sleeping on the back can exacerbate OSA. Positional therapy involves training individuals to sleep on their side to prevent airway collapse.
- Avoiding Alcohol and Sedatives: These substances relax the muscles in the throat increasing the risk of airway obstruction.
- Surgical Options: When other treatments prove ineffective, surgery may be considered as a viable option. One of the most innovative surgical treatments available is Inspire therapy, which involves hypoglossal nerve stimulation.
Designed for patients with moderate to severe OSA who are unable to tolerate PAP therapy, Inspire offers a minimally invasive solution. The procedure involves implanting a small device that monitors your breathing patterns and delivers gentle stimulation to the muscles that control your airway, ensuring it remains open throughout the night.
- Continuous Positive Airway Pressure (CPAP) and Other PAP Devices: CPAP therapy is the most common and effective treatment for OSA. Delivering a steady stream of air through a mask and keeping the airway open during sleep.
In addition to CPAP, other Positive Airway Pressure (PAP) devices are available:- BiPAP (Bilevel Positive Airway Pressure): This device provides two different levels of pressure. One for inhalation and one for exhalation. This give more comfort for some users.
- APAP (Automatic Positive Airway Pressure): This device automatically adjusts the pressure throughout the night based on the user’s needs, providing a more tailored approach to treatment.
How Do These Treatments Affect Sleep Quality?
Each treatment option aims to improve sleep quality by ensuring the airway remains open during sleep. CPAP, oral appliances, and surgical interventions directly prevent airway obstruction. Leading to more consistent and restorative sleep. Lifestyle changes support these treatments by managing underlying factors that contribute to OSA.
Disclaimer: The information provided in this content is for informational purposes only and should not be considered as medical advice. Always consult with a qualified healthcare professional for diagnosis and treatment options.
The Insomnia and Sleep Institute of Arizona’s Role
At The Insomnia and Sleep Institute of Arizona we specialize in treating OSA and other sleep disorders. Our team of experts provides comprehensive sleep care. Including the latest in CPAP therapy and other advanced sleep apnea treatments such as remedē System Implant for CSA and Inspire Implant for OSA.
We offer care for both adults and pediatric patients as young as one year old. So every individual receives the personalized treatment they need to achieve better sleep.
References
How does sleep apnea affect the heart? – Harvard Health. (2020, September). Harvard Health; Harvard Health. https://www.health.harvard.edu/heart-health/how-does-sleep-apnea-affect-the-heart
Lin, Y., Wu, Y., Lin, Q., Yun Kwok Wing, Xu, L., Ge, J., Wu, Q., Li, Z., Wu, Q., Lin, B., & Wei, S. (2023). Objective Sleep Duration and All-Cause Mortality Among People With Obstructive Sleep Apnea. JAMA Network Open, 6(12), e2346085–e2346085. https://doi.org/10.1001/jamanetworkopen.2023.46085
Muraki, I., Wada, H., & Tanigawa, T. (2018). Sleep apnea and type 2 diabetes. Journal of Diabetes Investigation, 9(5), 991–997. https://doi.org/10.1111/jdi.12823
Sleep apnea sufferers more likely to develop heart disease. (2024, July 9). Utsouthwestern.edu. https://www.utsouthwestern.edu/newsroom/articles/year-2024/july-sleep-apnea-heart-disease.html
STANFORD, I. (2003, November 6). SLEEP APNEA, DEPRESSION LINKED IN STANFORD STUDY. News Center. https://med.stanford.edu/news/all-news/2003/11/sleep-apnea-depression-linked-in-stanford-study.html
