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Chapters

0:00 Introduction
1:24 Causes of Breathing-Related Sleep Disorder
2:26 Symptoms of Breathing-Related Sleep Disorder
3:54 treatment for Breathing-Related Sleep Disorder





Breathing-related sleep disorder refers to a spectrum of breathing anomalies ranging from chronic or habitual snoring to upper airway resistance syndrome (UARS) to frank obstructive sleep apnea (OSA) or, in some cases, obesity hypoventilation syndrome (OHS).

Obstructive sleep apnea (OSA) is one of the most common and serious sleep-related breathing disorders. In OSA, the airway repeatedly collapses during sleep, causing lapses in breathing that both fragment sleep and affect the body’s oxygen levels. Upper airway resistance syndrome (UARS) is a milder form of OSA in which sleep is disrupted but oxygen levels are not affected to the same degree.

OSA may affect as many as 30% of adults and is more common in men than women2. The condition is likely underdiagnosed, and many experts anticipate that its prevalence will increase in the future along with growing rates of obesity, which is one of the major risk factors for OSA.

Snoring, gasping or choking during sleep, and excessive daytime sleepiness are central symptoms of OSA. When left untreated, the condition can cause significant health problems including cardiovascular issues like high blood pressure and stroke. A range of treatment options are effective in addressing obstructive sleep apnea and reducing its symptoms.

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). 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, brain damage and even death will occur. A systemic disorder, sleep apnea is associated with a wide array of effects, including increased risk of car accidents, hypertension, cardiovascular disease, myocardial infarction, stroke, atrial fibrillation, insulin resistance, higher incidence of cancer, and neurodegeneration. 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. Effective lifestyle changes may include avoiding alcohol, losing weight, stopping smoking, and sleeping on one's side. Breathing devices include the use of a CPAP machine. With proper use, CPAP improves outcomes. Evidence suggests that CPAP may improve sensitivity to insulin, blood pressure, and sleepiness. Long term compliance, however, is an issue with more than half of people not appropriately using the device. In 2017, only 15% of potential patients in developed countries used CPAP machines, while in developing countries well under 1% of potential patients used CPAP. Without treatment, sleep apnea may increase the risk of heart attack, stroke, diabetes, heart failure, irregular heartbeat, obesity, and motor vehicle collisions.

Alzheimer's disease and severe obstructive sleep apnea are connected because there is an increase in the protein beta-amyloid as well as white-matter damage. These are the main indicators of Alzheimer's, which in this case comes from the lack of proper rest or poorer sleep efficiency resulting in neurodegeneration. Having sleep apnea in mid-life brings a higher likelihood of developing Alzheimer's in older age, and if one has Alzheimer's then one is also more likely to have sleep apnea. This is demonstrated by cases of sleep apnea even being misdiagnosed as dementia. With the use of treatment through CPAP, there is a reversible risk factor in terms of the amyloid proteins. This usually restores brain structure and diminishes cognitive impairment.

OSA is a common sleep disorder. A large analysis in 2019 of the estimated prevalence of OSA found that OSA affects 936 million—1 billion people between the ages of 30-69 globally, or roughly every 1 in 10 people, and up to 30% of the elderly. Sleep apnea is somewhat more common in men than women, roughly a 2:1 ratio of men to women, and in general more people are likely to have it with older age and obesity.