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Sleep apnea considered dangerous

Breathing {and sleeping} easier Apnea considered dangerous, debilitating but treatable Wednesday, January 12, 2005 Dennis Fiely The Columbus Dispatch

A good night’s sleep was a dream come true for Kim Green. She will always remember the day after her first night of successful treatment for sleep apnea four years ago.

"I mopped the kitchen floor twice," said the East Side resident, 44. "I had so much energy it was magical." Sleep apnea refers to an airway obstruction that halts breathing, sometimes hundreds of times a night. In response, the brain enters a survival mode that repeatedly yanks the breathless awake.

Fitful nights preceded lousy days for Green, a Columbus Public Schools instructional assistant. She routinely returned home from work and fell ‘‘dead asleep" on the couch for three to four hours.

Her teenage son complained that her snoring drowned out the television. Green wouldn’t drive at night, for fear of sleeping at the wheel, and, feeling tired, wouldn’t go out to a movie or restaurant.

"I felt like my son was being abandoned because I slept so much," she said.

Daytime drowsiness is just one of the risks that accompany a common but an often overlooked condition.

"Sleep apnea has two major consequences," said Dr. Ulysses Magalang, medical director of the Ohio State University Sleep Disorders Clinic. "The first is related to quality of life: I have seen patients repeatedly fired from their jobs for falling asleep at work.

"The second consequence is cardiovascular: Sleep apnea is a risk factor for hypertension and is associated with heart attacks and strokes" — because of the stress of the breathing struggle on the respiratory and vascular systems.

In rare cases, people whose early-morning deaths are attributed to "natural causes" experienced apnea from which they never resumed normal breathing.

Yet most nocturnal deaths, such as that of White, result from cardiac arrhythmia and other problems related to the ailment.

More than a nuisance, daytime fatigue also might be lifethreatening: Patients with apnea are six times more likely to be involved in vehicle accidents than the rest of the population.

Even physicians marvel at the effect on the body. The compromised pumping ability of the heart often reduces blood oxygen to dangerously low levels.

A sleep-lab study, for example, indicated that the "blood gas" in Paul Davis, 50, of the South Side dipped to 79 percent, about 20 points below normal.

"Anything under 90 percent runs the risk of brain damage," said wife Carolyn Murray-Davis, a registered nurse at Children’s Hospital.

Dr. David Ralston, a lung and sleep specialist with Central Ohio Sleep Medicine in Gahanna, routinely sees levels fall to 80 percent and lower in the sleep lab.

"I am always amazed to realize that these lifethreateningly low levels are happening night after night for years in some patients," he said. "In any other part of the hospital, the staff would be extremely concerned. But we see it on a nightly basis in the lab."

A bed partner is often the first to suspect something amiss. Snoring is a telltale sign.

"Snoring by definition is an airway obstruction," Ralston said, "and the louder it is, the more obstruction is going on."

Physicians usually interview spouses to help determine diagnoses.

"My wife would wake me up 10 to 15 times a night, tell me to roll over and stop snoring," Davis said.

Sleeping on the back exacerbates apnea, physicians noted.

Davis, a facilities manager at the OSU Medical Center, fits the classic profile: He is middleaged and overweight, with a 17-inch neck.

A neck circumference of at least 16 inches for women and 17 for men contributes to an upper-airway blockage during sleep and an increased risk of apnea, Magalang said.

In a survey of 300 professional football players published last year in the New England Journal of Medicine, 14 percent had sleep apnea - including 34 percent of the linemen.

Weight gain seems to deposit fatty tissue in the upper airway, reducing the muscular tension needed to keep it open.

"As people become obese, their upper airway narrows," Magalang said. "Exactly how body weight narrows the upper airway is not fully known."

Green and Davis have enjoyed relief with a breathing mask known as Continuous Positive Airway Pressure, which is connected to a machine that opens the airway by pushing air into the nose. The device is 95 percent effective, according to physicians. Many patients, however, call it inconvenient and uncomfortable.

"During the first two weeks," Green said, "I wanted to pitch mine out the window, but now I am totally adjusted to it."

Other treatments to open the airway include dental appliances that create more room in the oral cavity and surgeries that remove tissue. Surgery alone has a success rate of 50 percent to 60 percent, physicians said.

Excessive snoring combined with chronic daytime fatigue, including a tendency to fall asleep at inappropriate times, indicates apnea and requires further evaluation, according to sleep specialists.

A stay of one or two nights in a sleep lab confirms the ailment and helps design a treatment.

"This is not that hard to diagnose; you don’t need to be a rocket scientist," Magalang said.

Still, patients typically suffer apnea for years before they receive help.

Families often dismiss snoring as a harmless annoyance, and primary-care physicians frequently don’t consider apnea as a source of symptoms.

"We spend one-third of our lives sleeping," Magalang said, "and yet sleep disorders have not been taken seriously."

Green endured the condition for several years, until a hypertension specialist mentioned her nocturnal patterns.

"I was extremely lucky to receive a diagnosis," she said, "and so thankful a doctor finally asked me how well I was sleeping."

During a five-year period, Davis said, his snoring and fatigue grew worse - until his wife insisted on a search for answers.

She has noticed a renewed vitality in him since he got a breathing mask eight weeks ago.

He wants to be more intimate at night," Murray-Davis said with a chuckle. "Sometimes I have to tell him I have a headache. But I missed saying that before, when he was tired all the time. It’s nice to have him back to his old self."