Consequences of Not Treating Moderate to Severe Obstructive Sleep Apnea
Not treating moderate to severe obstructive sleep apnea (OSA) leads to increased mortality risk, cardiovascular morbidity, excessive daytime sleepiness, and significantly impaired quality of life. 1
Cardiovascular and Metabolic Consequences
- Increased mortality risk: Observational studies have demonstrated an association between severe OSA and increased mortality risk 1
- Cardiovascular disease: Untreated OSA is associated with:
- Systemic hypertension
- Coronary artery disease
- Stroke
- Atrial fibrillation
- Congestive heart failure 1
- Metabolic dysfunction: OSA is linked to metabolic syndrome and diabetes mellitus 2
- Elevated sympathetic activity: Intermittent hypoxia and hypercapnia lead to secondary sympathetic activation, oxidative stress, and systemic inflammation 2
Neurocognitive and Quality of Life Consequences
- Excessive daytime sleepiness: A primary symptom that significantly impacts daily functioning 2
- Impaired cognitive function: Including attention, memory, and executive function deficits
- Increased risk of accidents: Higher rates of motor vehicle and workplace accidents 1
- Sleep fragmentation: Frequent arousals lead to poor sleep quality 2
- Reduced quality of life: Overall decreased quality of life measures across multiple domains 1
Disease Progression
- Worsening severity: There is a trend toward worsening of sleep-disordered breathing over time without treatment 1
- Disease progression: Approximately 6% of adults with no or mild OSA progress to moderate to severe OSA over 4 years 1
- Comorbidity exacerbation: Mortality risk increases with the number and severity of comorbidities 1
Treatment Benefits and Considerations
The European Respiratory Society guidelines indicate that CPAP therapy has been shown to:
- Improve symptoms
- Normalize the risk of traffic and workplace accidents
- Reduce elevated sympathetic activity
- Reduce risk for cardiovascular morbidities, especially arterial hypertension
- Normalize mortality in patients with severe OSA 1
For patients unable to tolerate CPAP, alternative treatments include:
- Mandibular advancement devices (MADs) for mild to moderate OSA or in severe OSA when CPAP is not tolerated 1
- Weight reduction for obese patients 1
- Various surgical options for selected patients 1
Clinical Pitfalls and Caveats
- Underdiagnosis: OSA remains undiagnosed in a significant portion of the population despite its high prevalence and serious consequences 3
- Treatment adherence challenges: 14-32% of patients discontinue CPAP treatment over 4 years due to side effects or discomfort 1
- Symptom recognition: Many patients may not recognize their symptoms or report them to clinicians 1
- Comorbidity management: The presence of OSA can complicate management of other conditions and vice versa 1
Not treating moderate to severe OSA has significant health consequences across multiple systems, with cardiovascular complications being particularly concerning. Early diagnosis and appropriate treatment are essential to prevent these adverse outcomes.