From the Guidelines
Sleep apnea, if left untreated, poses significant long-term health risks, including a 30-50% increased risk of hypertension, 2-3 times increased risk of cardiovascular disease, and a 3.8 times increased risk of mortality. The condition is associated with various complications, such as:
- Increased risk of heart failure by 140% and stroke by 60% 1
- 30% higher risk of heart attack and 46% greater chance of atrial fibrillation 1
- 30% increased risk of developing type 2 diabetes 1
- 26% higher risk of cognitive impairment 1 The underlying mechanism involves repeated oxygen desaturation and sleep fragmentation, which trigger systemic inflammation, oxidative stress, and sympathetic nervous system activation, collectively damaging multiple organ systems over time 1. Treatment with continuous positive airway pressure (CPAP) therapy can substantially reduce these risks, with consistent use showing a reduction in cardiovascular events. Other effective treatments include oral appliances, positional therapy, weight loss, and in some cases, surgical interventions 1. Key statistics on the long-term risks of sleep apnea include:
- 50% of sleep apnea patients developing high blood pressure 1
- 10-20% increased mortality risk 10 to 20 years after diagnosis 1
- 80% prevalence of sleep apnea in certain populations, such as overweight type 2 diabetics and bariatric surgery patients 1
From the Research
Long-term Risks of Sleep Apnea
The long-term risks of sleep apnea include:
- Increased risk of coronary artery disease, congestive heart failure, cerebral vascular events (strokes), and cardiac dysrhythmias, with moderate or severe sleep apnea significantly increasing the risk of these conditions 2
- Increased morbidity and mortality of cardiovascular diseases, with sleep apnea being a common and dangerous cardiovascular risk factor 2
- Association with systemic consequences, including excessive sleepiness, impairment of neurocognitive function and daytime performance, and increased risk for cardiovascular, cerebrovascular, and metabolic syndrome disorders 3
- Potential for premature death if left untreated, with the long-term sequelae of obstructive sleep apnea including increased risk for cardiovascular, cerebrovascular, and metabolic syndrome disorders 3
Prevalence and Severity of Sleep Apnea
- Sleep apnea affects almost one billion individuals worldwide, including 40 million Americans, with the prevalence increasing due to the epidemic of obesity, physical inactivity, and diabetes mellitus 2
- The severity of sleep apnea is measured by polysomnography and the apnea-hypopnea index (AHI), with sleep apnea being classified as mild (AHI 5-14/h), moderate (AHI 15-30/h), or severe (AHI >30/h) 2
Treatment and Management of Sleep Apnea
- Chronic continuous positive airway pressure (CPAP) for ≥4 h/night for >70% of nights is beneficial in the treatment of patients with sleep apnea, improving sleep quality, reducing the AHI, and increasing oxygen delivery to the brain and heart 2
- Oral appliance therapy is a viable treatment alternative to CPAP in patients with mild to moderate obstructive sleep apnea syndrome (OSAS), with combination therapy with CPAP and oral appliance reducing therapeutic CPAP requirements and pharyngeal pressure swings 4, 5
- Comprehensive lifestyle interventions, especially weight-loss interventions, are associated with improvements in OSA severity, cardiometabolic comorbidities, and quality of life, and should be included in the long-term management of sleep apnea 3