Stop Breathing during Sleep Kills

Obstructive sleep apnea is a condition that airway narrows or closes many times during sleep, which causes reduced air exchange, frequent arousals and poor sleep. This is a common condition that occur in 2 percent women and 4 percent men.     

The typically perception of OSA is that it is a nuisance. That people snore is a fact of life, at least that is what we try to tell our spouses. We are used to being tired during the day for a loss of a few hours of sleep the night before.Who wants to miss the World Cup Final just because it was 2 AM.

Mark Twain once said “Don’t go to sleep, so many die there”. Now we seem to support him with some data.

Gami and Somers at Mayo Clinic first showed that people with OSA had a peak in sudden death from cardiac causes in the sleeping hours, which contrasted strikingly with the low rate of death during sleep in people without sleep apnea or in the general population.

Last month, scientists from Spain reported their findings of after following 939 elderly patients for 10 years [1]. They showed that the chance of death over 5 years from stroke, heart failure, or myocardial infarction was doubled in subjects with severe obstructive sleep apnea (apnea hypopnea index greater than 30 events/hr sleep) without treatment when compared with subjects with AHI less than 15 or subjects treated with CPAP (4 hours/day of use). A pretty amazing fact of the impact of sleep apnea that kill and effect effect of sleep apnea treatment that save lives.

This report was similar to another large-scale population-based study from Wisconsin of 1,522 subjects followed over 18 years, which showed 3 times of all cause mortality in subjects with severe OSA.

Both studies showed the relative increased risk of mortality remain associated with sleep apnea after fully adjusted for age, gender, BMI and many other confounding factors. The evidence from randomized-controlled trial will be coming from the SAVE study (www.savetrial.org) that is studying the effect of CPAP to prevent cardiovascular risks in 5,000 subjects.

Don’t wait for the SAVE study though, if anyone tells you that you stop breathing during sleep, go see a sleep doctor, just to be safe.

[1] Martinez-Garcia MA et al. Cardiovascular mortality in obstructive sleep apnea in the elderly: role of long-term continuous airway pressure treatment. Am J Respir Crit Care Med 2012.