What are the health effects of obstructive sleep apnea (OSA)?

Health Effects of Obstructive Sleep Apnea

Obstructive sleep apnea (OSA) is associated with significant cardiovascular, metabolic, and neurocognitive consequences that increase morbidity and mortality, making early identification and treatment critical for reducing these risks. 1, 2

Prevalence and Epidemiology

• OSA is a major public health concern affecting approximately:

  • 13% of men and 6% of women in the United States 1
  • Globally, an estimated 936 million adults (30-69 years) have mild to severe OSA 1
  • 425 million adults have moderate to severe OSA 1
  • 80% of cases remain undiagnosed 1

• High-risk populations include:

  • Obese individuals (60-90% of OSA patients have BMI >30 kg/m²) 1, 2
  • Bariatric surgery candidates (70-80%) 1
  • Stroke/TIA patients (60-70%) 1
  • Males (2-3× higher prevalence than females) 1
  • Older adults (prevalence increases with age) 1, 2
  • Postmenopausal women 2

Cardiovascular Effects

• Hypertension:

  • OSA is a major risk factor for resistant hypertension 1, 2
  • Treatment of OSA can improve blood pressure control 1

• Heart Disease:

  • Increased risk of coronary artery disease 1, 2, 3
  • Higher incidence of heart failure (both acute and chronic) 1, 2
  • Elevated risk of atrial fibrillation and other arrhythmias 1, 2
  • Nocturnal cardiac arrhythmias including bradycardia/tachycardia, heart blocks, and sinus pauses 1

• Stroke:

  • Significantly increased stroke risk 1, 4
  • OSA is present in 60-70% of patients who have had a stroke or TIA 1

• Vascular Effects:

  • Atherosclerosis progression 5
  • Mild-to-moderate pulmonary hypertension 1
  • Overall increased cardiovascular mortality 5

Metabolic Effects

• Glucose Metabolism:

  • Insulin resistance and glucose intolerance 2
  • Increased risk of type 2 diabetes 1, 2
  • Bidirectional relationship: diabetes may accelerate OSA progression 2

• Other Metabolic Disorders:

  • Metabolic syndrome components 2
  • Dyslipidemia 2
  • Non-alcoholic fatty liver disease 2
  • Polycystic ovarian disease 2

Neurocognitive and Quality of Life Effects

• Daytime Symptoms:

  • Excessive daytime sleepiness 1
  • Fatigue and poor concentration 1, 2
  • Impaired vigilance and cognitive function 1, 2
  • Increased risk of motor vehicle accidents (comparable to driving above legal blood alcohol limits) 1
  • Higher rates of workplace accidents 1

• Psychological Effects:

  • Depression and other psychological comorbidities 1, 2, 4
  • Decreased quality of life 1, 2
  • Sleep fragmentation leading to mood disturbances 6

Pediatric OSA Consequences

• Unique pediatric manifestations:
  • Behavioral and mood problems 1
  • Poor concentration and academic performance 1
  • Misdiagnosis as attention deficit hyperactivity disorder 1
  • Nocturnal enuresis 1
  • Failure to thrive 1
  • Long-term developmental consequences 1

Other Health Effects

• Sensory Impairments:

  • Hearing loss (both high-frequency and low-to-mid frequency ranges) 2

• Perioperative Risks:

  • Increased vulnerability during anesthesia 1
  • Higher complication rates during the perioperative period 1

• Healthcare Utilization:

  • Increased healthcare costs and utilization 1, 2
  • Higher rates of hospitalization 2

Long-term Consequences

• Mortality:

  • Increased 10-20 year mortality after diagnosis 1
  • Mortality risk increases with number and severity of comorbidities 1

• Disease Progression:

  • OSA severity typically worsens with aging if untreated 1
  • Rapid recurrence of symptoms after treatment discontinuation 1

Clinical Implications

• Early identification and treatment are critical for reducing morbidity and mortality 2
• Treatment improves quality of life, lowers motor vehicle accident rates, and reduces chronic health consequences 1
• Continuous positive airway pressure (CPAP) is the gold standard treatment for moderate-to-severe OSA 1
• Mandibular advancement devices are an alternative for those who cannot tolerate CPAP 1
• Weight loss should be encouraged in obese patients as it may reduce OSA symptoms 1

OSA represents a significant health burden with wide-ranging effects across multiple organ systems. The intermittent hypoxia, sleep fragmentation, and sympathetic activation caused by repeated airway collapse lead to systemic inflammation and oxidative stress, which underlie many of the associated health consequences. Early diagnosis and effective treatment are essential to prevent these serious complications.