From the Guidelines
Sleep apnea significantly increases morbidity across multiple body systems, and untreated sleep apnea is associated with a higher risk of cardiovascular complications, metabolic disorders, and neurocognitive effects, ultimately leading to reduced quality of life and increased mortality risk. The repeated oxygen desaturations and sleep fragmentation lead to increased sympathetic nervous system activity, oxidative stress, and systemic inflammation, as noted in a study published in 2025 1. Metabolically, sleep apnea contributes to insulin resistance and is linked to type 2 diabetes and obesity, creating a dangerous cycle as obesity worsens apnea symptoms. Neurocognitive effects include daytime sleepiness, impaired concentration, memory problems, and increased risk of motor vehicle accidents. Long-term, sleep apnea is associated with depression, anxiety, and reduced quality of life.
Some key points to consider in the management of sleep apnea include:
- The importance of early diagnosis and consistent treatment to reduce morbidity and mortality risk
- The use of continuous positive airway pressure (CPAP) therapy as a first-line treatment, typically starting at 5-10 cmH2O and titrated to effect, as recommended in a study published in 2013 1
- The potential benefits of alternative therapies, such as oral appliances, positional therapy, and surgical interventions, for patients who do not respond to or cannot tolerate CPAP therapy, as discussed in a study published in 2025 1
- The need for ongoing monitoring and adjustment of treatment to ensure optimal outcomes and minimize adverse effects, as noted in a study published in 2013 1
Overall, the management of sleep apnea requires a comprehensive and multidisciplinary approach, taking into account the individual patient's needs and circumstances, and prioritizing the reduction of morbidity, mortality, and improvement of quality of life. Treatment with CPAP therapy, weight loss, and alternative therapies can significantly reduce the risks associated with sleep apnea, and early diagnosis and consistent treatment are essential to improve outcomes.
From the Research
Morbidity Associated with Obstructive Sleep Apnea (OSA)
The morbidity associated with OSA includes:
- Cardiovascular disease 2, 3, 4
- Metabolic syndrome 3
- Neurocognitive impairment 3
- Reductions in quality of life 2, 3
- Increased motor vehicle accidents 3
- Hypertension 4
- Coronary artery disease 4
- Congestive heart disease 4
- Insulin resistance 4
- Death 4
Treatment Outcomes
Treatment of OSA with continuous positive airway pressure (CPAP) has been shown to:
- Improve sleep and daytime symptoms 3, 4
- Minimize cardiovascular risks 3, 4
- Reduce sleepiness as measured by the Epworth Sleepiness Scale 2
- Improve compliance by 11 minutes per night compared to fixed CPAP 2
- Improve minimum oxygen saturation by 1.3% more than auto-titrating positive airway pressure (APAP) 2
Alternative Treatment Options
Alternative treatment options for OSA include: