The clinical consequences
There is growing clinical and epidemiological evidence that the OSAHS and chronic snoring, are associated with a variety of adverse health consequences with increased mortality rates associated with the symptoms. Studies show that moderate or severe obstructive sleep apnea with an AHI ≥ 30, predispose to cardiovascular disease, stroke, neuropsychiatric disorders, is a risk factor in traffic and labor accidents and its importance lies beyond doubt in hypertension. The severity of the consequences in the body depends on the duration and frequency of episodes and is consistent to the alterations in gas exchange, the degree of O2 desaturation and saturation of CO2 and how normal sleep pattern is interrupted . The blood gas changes, and fragmentation of sleep patterns by repeated arousals explain the extensive clinical comorbidity of sleep apnea. There is growing evidence, that sleep apnea causes the development of hypertension, stroke, myocardial infarction and premature death.
The constant awakenings are responsible for the excessive daytime sleepiness, the primary symptom of patients with OSAHS, although the negative impact of OSAHS on quality of life is not only limited to the excessive sleepiness theme. The respiratory efforts have cardiovascular consequences: the mismatches in the balance of gas exchange causing hypoxemia, suffering constant disruption of sleep patterns makes it impossible to sleep, secondary neuropsychological impairment decrease neurospicológical capabilities, cognitive disorders and snoring sometimes reaching a level of unsupportable decibels annoying the human ear. This is just a record of the diverse range of effects and morbidity associated with sequences of varied magnitude. Although data are not conclusive, analyzing OSAHS symptom patterns, all studies suggest that an AHI ≥ 30 is a risk factor for the development of cardiovascular disease, cerebrovascular accidents and death. Epidemiological studies support the causal association of OSAHS with frequent pathological processes such as hypertension, cardiovascular and cerebrovascular diseases. The morbidity associated with OSAHS falls under the definition drawn up by consensus by SEPAR this way:
The serious health consequences of untreated obstructive sleep apnea, are supported by the extensive medical literature, in recent years has shown that socio impact, cardiovascular risk, neurocognitive deficits, cerebrovascular disease to which must be added an increase in labor accidents and road accidents. The pathological wrapper of OSAHS necessarily implies an increased mortality associated.
Sleep apnea: cardiovascular and cerebrovascular risk
One of the clinical aspects has generated most debate, is the gold standard for the consideration of OSAHS as a risk factor for cardiovascular disease. The relationship between OSAHS and cardiovascular risk has been subject to controversy although in the last decade have appeared sufficient clinical evidence demonstrating the causal role of OSAHS in hypertension, insulin resistance, obesity, stroke and cardiovascular disorder what resulting in increased morbidity and mortality.
For years it was erroneously argued that the coexistence of sleep breathing disorders with cardiovascular and cerebrovascular diseases, were the result of common risk factors for these diseases, such as older age, obesity or a sedentary lifestyle. Due to the undeniable association between sleep apnea syndrome and obesity, the dilemma faced by the research is how to isolate the impact affiliated syndrome dissociating other characteristical conditions of OSAHS such as obesity and other related diseases. However, in recent epidemiological studies have been shown that sleep breathing disorders are an independent risk factor for hypertension, probably as a result of a combination of intermittent hypoxia and hypercapnia. Young et al. showed this association in a study on a population sample of 1060 workers by demonstrating that the prevalence of hypertension was increased in relation to AHI regardless of sex, age or body mass index.
The same results emerge from the 2001 study by Duran et al. on a population of individuals with an age range between 30-70 years. Sleep apnea can lead to the development of cardiomyopathy and pulmonary hypertension according to the findings of Partin et al. patients with OSAHS have five times greater risk of mortality related to cardiovascular disease brain. Roux et al. performed a follow-up of 426 elderly people between 1981 and 1986 to determine the relationship between breathing problems, morbidity and mortality, concluding that individuals with severe apnea live less, (approximately two years) than those with mild apnea or healthy individuals. Apnea patients also often suffer neuropsychological deficits, poor concentration, memory loss, increased accident, depression, lack of sexual desire and impotence, etc., All of which will have a profound impact on quality of life by disrupting daily activities . The vast majority of the findings on comorbidity objectify their results based on the presence of severe obstructive sleep apnea (AHI ≥ 30). In the study by Marshall et al. published in 2008 he relates that even a moderate apnea is independently associated with an increased risk of mortality.
Sleep Apnea mortality
The quality of life in OSAHS patients is highly lower compared to the normal population. In more and more jobs there are sleep breathing disorders recoginized as a proven cause of morbidity and mortality. One of the most complete is coordinated by M. Naresh Punjabi at Johns Hopkins Univerity in Baltimore concluding that sleep disorders are associated with increased mortality in all aspects and especially in relation to coronary heart diseases. The risks are most evident in the subgroup population of men 40 to 70 years with a severe course of disease (AHI ≥ 30). According to the report it reflects, that severe sleep apnea increases the risk of premature death by 46%. The results of this study demonstrate, that independent of confounding variables (age, sex, race, weight or smoking), SBD were associated with all cardiovascular causes of morbidity and mortality. Punjabi's team studied 6441 men and women for eight years to conclude that men of 40-70 years old with severe sleep breathing disorders were twice as likely to die from any cause than healthy men of the same age.
Sleep apnea is closely linked to obesity, hypertension, heart failure and stroke, but researchers could not clearly quantify how much more probable is mortality in OSASHS patients and how to determine the real clinical scope of co-morbidity and mortality . Despite the dispute between the different strands of research, there is unanimity of criteria to consider the consequences of untreated obstructive sleep apnea, which affect an increased morbidity, decreased quality of life and are associated with increased mortality rates. The consequences of apnea can be easily corrected with intraoral Orthoapnea treatment, improving sleep quality, reducing the AHI, reducing apneas, drowning and choking spells and sleep pattern disruptions.