Sleep apnea is a deadly disease. Several studies have demonstrated that patients with sleep apnea have a mortality rate six to seven times higher than patients without.
As many as 18 million Americans have sleep apnea, approximately one in every 15 or 6.62 percent of the population. People with sleep apnea are six times more likely to be part of a traffic accident. A bedmate of a person with untreated obstructive sleep apnea can lose one to two hours sleep per night.
According to the National Commission on Sleep Disorders Research, about 38,000 deaths occur annually that relate to cardiovascular problems caused or worsened by sleep apnea. These problems include high blood pressure, hypertension, stroke and heart failure.
Obstructive sleep apnea is caused by repetitive upper airway obstruction during sleep as a result of narrowing of the respiratory passages. Patients with the disorder are most often overweight, with associated throat infiltration of fat and/or increased size of the soft palate and tongue.
These anatomic abnormalities decrease the cross-sectional area of the upper airway. Initially, partial obstruction may occur and lead to snoring. As tissues collapse further or the patient rolls over on his or her back, the airway may become completely obstructed. The patient struggles to breathe and is aroused from sleep. Often, arousals are only partial and are unrecognized by the patient, even if they occur hundreds of times a night. The obstructive episodes often are associated with a reduction in oxygen saturation. Cycles of sleep, snoring, obstruction, arousal and sleep occur throughout the night. Patients with severe apnea may have episodes of upper airway obstruction 100 or more times in one hour. Patients often complain of restless sleep and may awake with intense headaches. Symptoms also may include falling asleep during daily activities such as eating or watching television.
The physiologic impact of decreased oxygen levels and increased carbon dioxide levels are what cause the deadly side effects of sleep apnea. Chronic oxygen deprivation and increased carbon dioxide levels cause high blood pressure to develop. High blood pressure subsequently increases the risk of stroke or heart attack. Decreased oxygen also causes right heart strain that can lead to right heart failure and liver congestion or failure.
The No. 1 cause of sleep apnea is morbid obesity. As weight increases, the fatty deposition occurs in the neck and throat, which leads to the obstructive episodes. External devices known as CPAP machines actively blow air into the mouth and upper airways and hold the airways open to prevent the sleep apnea. In patients who tolerate the devices, the effects are noticed almost immediately with more restful sleep and better daytime energy levels. Unfortunately, around 30 percent of the patients can't tolerate wearing the tight mask necessary for blowing air, or they develop dry mouth. Surgical procedures performed in the mouth or on the jaw are limited to patients who fit certain criteria and only have success rates of 50-70 percent at two years post procedure with success rates decreasing further after two years.
The most effective treatment for patients with obesity and sleep apnea is bariatric weight loss surgery. Patients undergoing weight loss surgery can expect an 85 percent chance of cure for sleep apnea. As weight decreases, the fatty tissue around the neck and in the throat diminish, opening up the airway and completely eliminating the disease. In addition to alleviating sleep apnea, patients undergoing weight loss surgery also will see: 90 percent chance of cure of diabetes; 80 percent chance of cure of high blood pressure; 90 percent cure of heartburn; 90 percent cure of hypercholesterolemia; 50 percent decreased chance of most cancers as well as marked improvement in chronic joint and back problems.
While bariatric surgery is a major surgery that has risks and requires significant work up and careful planning prior to surgery, the benefits are dramatic and lasting.
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