Medical Compass: The importance of a good night’s sleep

Addressing sleep apnea can avert serious health consequences

By David Dunaief, M.D.

Quality sleep feels like it can be elusive these days. Yet, our physical and mental wellbeing depends on getting restful sleep. For those with obstructive sleep apnea (OSA), it can be particularly challenging.

Sleep apnea is defined as an abnormal breathing pause that occurs at least five times an hour while sleeping. While there are many potential causes, the most common is airway obstruction. Some estimates suggest that about 39 million people suffer from sleep apnea in the United States (1).

OSA diagnoses are classified in tiers from mild to severe. The American Academy of Sleep Medicine (AASM) estimates that roughly 80 percent of moderate and severe OSA sufferers are undiagnosed.

Most risk factors for OSA are modifiable. They include excess weight or obesity, alcohol use, smoking, hypertension, type 2 diabetes, and hyperlipidemia (high cholesterol) (2). 

How do you know what to look for?

OSA symptoms include daytime fatigue, loud snoring, breathing cessation observed by another, impaired concentration, and morning headaches. While these are significant quality of life issues, OSA is also associated with an array of more serious health consequences, such as cardiovascular disease, high blood pressure and depression.

Fortunately, there is an array of treatment options, including continuous positive airway pressure (CPAP) devices, oral appliances, positional sleep therapy, and lifestyle modifications.

Sleep apnea and cardiovascular disease risk

In a study of 1,116 women over a six-year duration, cardiovascular mortality risk increased in a linear fashion with the severity of OSA (3). For those with mild-to-moderate untreated sleep apnea, there was a 60 percent increased risk of death; for those in the severe group, this risk jumped to 250 percent. However, the good news is that treating patients with CPAP decreased their risk by 81 percent for mild-to-moderate patients and 45 percent for severe OSA patients.

Another study of 1,500 men with a 10-year follow-up showed similar risks of cardiovascular disease with sleep apnea and benefits from CPAP treatment (4). The authors concluded that severe sleep apnea increases the risk of nonfatal and fatal cardiovascular events, and CPAP was effective in curbing these occurrences.

In a third study, this time involving the elderly, OSA increased the risk of cardiovascular death in mild-to-moderate patients and in those with severe OSA by 38 and 125 percent, respectively (5). But, as in the previous studies, CPAP decreased the risk in both groups significantly. In the elderly, an increased risk of falls, cognitive decline and difficult-to-control high blood pressure may be signs of OSA.

OSA and cancer risk

There have been conflicting study results about the associations between OSA and cancer risk. To reconcile these, a 2023 study of over 62,000 patients in Sweden were followed. Researchers found that OSA was associated with cancer prevalence, independent of other confounding factors (6). 

In a previous study of sleep apnea patients under age 65, researchers also showed an increased risk of cancer (7). The greater the percentage of time patients spend in hypoxia (low oxygen) at night, the greater the risk. The authors believe that intermittent low levels of oxygen, caused by the many frequent short bouts of breathing cessation, may be responsible for the development of tumors and their subsequent growth.

OSA and male sexual function

Erectile dysfunction (ED) may also be associated with OSA and, like other outcomes, CPAP may decrease this incidence. This was demonstrated in a small study involving 92 men with ED (8). The surprising aspects of this study were that, at baseline, the participants were overweight, not obese, on average and were only 45 years old. In those with mild OSA, CPAP had a beneficial effect in more than 50 percent of the men. For those with moderate and severe OSA, the effect was still significant, though not as robust, at 29 and 27 percent, respectively.

Other studies have varying results, depending on the age and existing health challenges of study participants. Researchers have suggested that other underlying health problems may be the cause in some patient populations.

Can diet help with OSA?

For some of my patients, their goal is to discontinue their CPAP. Diet may be an alternative to CPAP, or it may be used in combination with CPAP to improve results.

In a small study of those with moderate-to-severe OSA, a low-energy diet showed positive results. A low-energy diet implies a low-calorie approach, such as a diet that is plant-based and nutrient-rich. In the study, almost 50 percent of those who followed this type of diet were able to discontinue CPAP (9). The results endured for at least one year.

If you think you are suffering from sleep apnea, you should be evaluated at a sleep lab and follow up with your physician.

References:

(1) ncoa.org. (2) Diseases. 2021 Dec; 9(4): 88. (3) Ann Intern Med. 2012 Jan 17;156(2):115-122. (4) Lancet. 2005 Mar 19-25;365(9464):1046-1053. (5) Am J Respir Crit Care Med. 2012;186(9):909-916. (6) BMJ Open. 2023; 13(3): e064501. (7) Am J Respir Crit Care Med. 2012 Nov. 15. (8) Sleep. 2012;35:A0574. (9) BMJ. 2011;342:d3017.

Dr. David Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. For further information, visit www.medicalcompassmd.com or consult your personal physician.