CONSEQUENCES OF OSA
Diseases associated with fragmented sleep
Heart Disease
One of the main consequences of sleep apnoea in older adults is an increased risk of cardiovascular disease. Studies have shown that people with sleep apnoea hypoxemia, hypercapnia, will have high blood pressure, as mentioned large intrathoracic pressure swings (to -120 mm Hg), and surges of systemic blood pressure of up to 250/150 mm Hg, this creates significant stress on arterial linings, in some cases it can create an arterial thickening response and narrowing of the artery.
Other negative consequences of OSA include aneurysm, stroke, and heart failure. This is thought to be since sleep apnoea causes intermittent oxygen deprivation, which damages the cardiovascular system over time, especially via oxidative stress and immune hyperactivations.
Consider the process of the development of heart disease in a younger person who is an older adult in the making.
It’s probable the airway dysfunction, due to tongue tie, poor nasal breathing and chronic inflammation is actually the root cause of the whole issue, seen in a subclinical stage in younger adults and only responded to as the health consequences effect vitality in the older adult.
OSA categorically can cause Sleep fragmentation. Sleep fragmentation causes Diabetes and weight gain which is negatively associated with CHD. We also know that occluded airways in OSA/HS increase blood pressure also strongly associated with CHD, stroke, and negative health consequences.
A paper by Hammond gives supports the view that airway fragmentation and sleep fragmentation may be behind the confluence of all of these diseases.
He found “Death rates from both CHD and stroke were far lower for subjects with neither diabetes nor high blood pressure than for subjects with a history of either of these conditions. In general, subjects with both diabetes and high blood pressure had higher death rates than subjects with just one of these two conditions”.
Tongue Tie and predisposing causes of OSA/HS
Tongue tie is a condition in which the tissue under the tongue is tight, overly thick or too short, restricting movement of the tongue. This can lead to difficulty swallowing and speaking and has been linked to sleep apnoea in some cases. Other predisposing factors include narrowing of pharynx such as obesity (more than 50% of obese patients have body mass index (BMI) greater than 30 kg/m), shortening of the mandible or maxilla shortened cranial bones of the jaw or restrictions sinus airflow due to septal deviation, or the intrusion of the hard palate into the nasal sinus space as occurs in a narrow high palate.
Change in jaw shape may be mild and familial or significant as previously discussed due to teratological issues in the pregnancy.
Hypothyroidism and acromegaly also predispose to OSAHS by narrowing the upper airway with tissue infiltration. Males suffer apnoea more than females, while myotonic dystrophy, Ehlers-Danlos syndrome, and smoking are all risk factors.
Consequences of OSA in the older adult
Sleep apnoea in older adults presents an increased risk of falls and accidents, especially motor vehicle accidents. People with sleep apnoea often feel tired and drowsy during the day, which can impair their ability to concentrate and make them more prone to accidents. In fact, apnoea induced somnolence, causes between a 2.45 and sixfold increase in road accidents. Somnolence is particularly dangerous for older adults, who are already at an increased risk of falls due to decreased muscle mass and other age-related changes. CPAP use ≥ 4 h/night was associated with a reduction of MVA incidence (7.6 to 2.5 accidents/1,000 drivers/y). of note in one study it was found that female apnoea suffers were more likely involved in a motor vehicle accident.
Sleep apnoea and sleep fragmentation can also have negative impacts on mental health in everyone let alone older adults. The lack of quality sleep caused by sleep apnoea can lead to feelings of depression and anxiety, as well as memory problems and difficulty with decision making.
Fragmented sleep and sleep-disturbances resulting from sleep disorders such as OSA have been tied to emotional dysregulation and psychiatric disorders. This is one of the potentially nasty consequences for individuals with obstructive sleep apnoea considering that the stress of disturbed sleep results in more or less constant sympathetic arousal. There is strong evidence showing greater risk of depression with abnormal sympathetic arousal responses. Thus the overactivation of endocrine responses including the release of adrenaline and corticosteroids to activate wakefulness and protect the airway, has a significant effect on depressive outcomes in patient.
Reported REM sleep abnormalities in depressed patient have mainly included a reduced REM sleep latency and reduced REM-sleep density on polysomnography. They persist after remission of depressive disease; thus they are considered to represent markers for susceptibility to mood disorders.
OSA may affect more than 50% of individuals over the age of 65, and significant depressive symptoms may be present in as many as 26% of a community-dwelling population of older adults. What I’m trying to get at here is that depressive symptoms in the elderly may be the as an end result of missed pathology of the head , mouth and airway. A recent publication in adolescents, which found that increased REM fragmentation was independently associated with higher depression scores. This indicates that there is a high likelihood that the process starts in early life, continues through adolescence and is then picked up finally in later adulthood when symptoms are so gross that they can’t be missed.