The Impact of Untreated Sleep Apnea on Life Expectancy: Is Sleep Apnea a Silent Threat?

Sleep apnea is a common sleep disorder where breathing repeatedly stops and starts. There are different levels of severity, ranging from mild sleep apnea to severe sleep apnea. If left untreated, sleep apnea can have a significant impact on life expectancy. Treatment for sleep apnea typically involves the use of a CPAP machine to help ensure better sleep.

According to the American Academy of Sleep Medicine, people with severe sleep apnea have a lower life expectancy compared to those with moderate or mild cases. In this article, we will cover the signs of sleep apnea, potential remedies, the importance of getting a sleep test if diagnosed with sleep apnea, and how treatment can improve life expectancy for sleep apnea patients.

What is Sleep Apnea?

Sleep apnea is a disorder characterized by breathing that repeatedly stops and starts during sleep. This can lead to a variety of symptoms and health issues. OSA(Obstructive Sleep Apnea) occurs when throat muscles reduce the space for air to pass through, while central sleep apnea is related to issues in the respiratory control center of the brain.(1)

Sleep apnea encompasses several types, each with distinct characteristics and causes:

Obstructive Sleep Apnea (OSA):

• OSA is the most common type of sleep apnea, estimated to affect 10% to 30% of adults.
• It occurs when the upper airway becomes blocked, leading to interruptions in breathing during sleep.
• The soft tissue at the back of the throat collapses when the muscles in the face and neck relax during sleep, causing the airways to become partially or completely blocked.
• Factors such as obesity, large tonsils, or hormonal changes can increase the risk of OSA 

Central Sleep Apnea (CSA):

• CSA is characterized by a lack of communication between the brain and the muscles involved in breathing, leading to breathing disruptions during sleep.
• CSA is less common than OSA and can be trickier to diagnose and treat.
• This type most often affects people with neuromuscular diseases such as amyotrophic lateral sclerosis (ALS), those who've had a stroke, or those who have heart failure or other forms of heart, kidney, or lung disease.

Complex Sleep Apnea Syndrome:

• This type combines features of both OSA and CSA.
• It occurs when a patient initially has the obstructive type but it turns into the central type after receiving treatment.
• It may become apparent when traditional OSA treatments do not resolve the apnea, or it may be identified during an initial sleep study

Symptoms and Risk factors 

Symptoms:

• Loud snoring: This is often more prominent in obstructive sleep apnea. However, it's important to note that not everyone who snores has sleep apnea.
• Episodes of stopped breathing during sleep: This symptom is usually reported by another person who observes the individual during sleep.
• Gasping for air during sleep: Individuals with sleep apnea may frequently wake up gasping for air.
• Awakening with a dry mouth: This can occur due to breathing through the mouth instead of the nose during sleep.
• Morning headache: Many people with sleep apnea wake up with a headache, likely due to the lack of oxygen during sleep.
• Difficulty staying asleep (insomnia): This can occur due to the repeated awakenings throughout the night caused by the disorder.
• Excessive daytime sleepiness (hypersomnia): This is a result of interrupted sleep during the night, leading to excessive sleepiness during the day.
• Difficulty paying attention while awake: Lack of quality sleep can lead to attention issues during the day.
• Irritability: Sleep deprivation can lead to mood changes, including irritability.

Risk Factors

• Obesity: Excess body weight is a major risk factor for sleep apnea, with the condition being more prevalent in individuals with obesity.
• Family History: Research suggests that sleep apnea may run in families, indicating a genetic predisposition to the disorder.
• Age: The risk of sleep apnea increases with age, particularly as fatty tissue accumulates in the neck and tongue, potentially obstructing the airway.
• Gender: Men are two to three times more likely to have obstructive sleep apnea than premenopausal women, although the risk becomes similar for men and postmenopausal women.
• Medical Conditions: Conditions such as type 2 diabetes, congestive heart failure, high blood pressure, Parkinson's disease, and hormonal disorders can increase the risk of sleep apnea
• Hormonal Changes: Hormonal changes, such as those during pregnancy, can raise the risk for sleep apnea.
• Use of alcohol, sedatives, or tranquilizers: These substances relax the muscles in your throat, which can worsen obstructive sleep apnea.
• Smoking: Smokers are three times more likely to have obstructive sleep apnea than are people who've never smoked. Smoking can increase the amount of inflammation and fluid retention in the upper airway.

What is Untreated Sleep Apnea Life Expectancy?

Increased Mortality Risk:                                                                

•  Untreated sleep apnea can have a significant impact on overall health and life expectancy. An 18-year follow-up study conducted by the Wisconsin Sleep Cohort Study showed that people with severe sleep apnea have a higher risk of mortality than people without sleep apnea, and this risk of death increases when sleep apnea is left untreated.
• Specifically, individuals with severe sleep apnea have three times the risk of dying due to any cause compared to those without sleep apnea. This risk increased to 4.3 when individuals who reported regular use of continuous positive airway pressure (CPAP) therapy were removed from the statistical analysis.(2)

Long-Term Health Impact:                                                              

• Furthermore, untreated sleep apnea can lead to serious medical conditions such as high blood pressure, heart disease, and diabetes, as well as constant fatigue, brain fog, and mood changes, which can significantly affect the quality of life.
• Studies have also shown that untreated moderate-to-severe sleep apnea is associated with increased mortality, even after controlling for relevant covariates. Additionally, sleep apnea can contribute to the risk of sudden cardiac death, especially in older individuals with more severe apnea or very low oxygen levels.(3)

Shortened Lifespan:   

• Sleep apnea can shorten lifespan by making individuals vulnerable to multiple health issues. It is associated with interrupting circadian rhythms, throwing off the chemistry between the body and brain, increasing blood pressure, disrupting cardiac and respiratory function, and elevating the heart rate. When left untreated, sleep apnea is likely to lead to a shorter life expectancy.

• For instance, individuals under 50 who suffer from sleep apnea have an estimated life expectancy of 8 to 18 years, but appropriate treatment can significantly extend their lifespan and reduce the likelihood of experiencing additional health complications compared to those who remain untreated.4

• It is estimated that untreated sleep apnea can reduce life expectancy by over a decade while treating sleep apnea can add 7-10 years to an individual's lifespan.
• The American Academy of Sleep Medicine states that having sleep apnea increases the risk of death by 17%, and severe untreated sleep apnea could double that risk. 

Sleep apnea can significantly affect life expectancy due to its association with various health complications. Here are some main effects :

Cardiovascular Problems:

• Hypertension: Sleep apnea causes frequent drops in blood oxygen levels, which leads to an increase in blood pressure. Chronic hypertension is a well-known risk factor for cardiovascular diseases.
• Heart Disease: People with sleep apnea are at a higher risk for heart attacks, heart failure, and other heart-related conditions. The intermittent oxygen deprivation stresses the cardiovascular system.
• Stroke: The risk of stroke is significantly higher in people with untreated sleep apnea.

Diabetes:

• Sleep apnea is associated with insulin resistance and glucose intolerance, increasing the risk of developing type 2 diabetes. This condition can lead to a range of complications that can shorten life expectancy.

Obesity:

• There is a bidirectional relationship between obesity and sleep apnea. Obesity increases the risk of developing sleep apnea, and sleep apnea can contribute to weight gain due to metabolic and hormonal disruptions.

Chronic Fatigue and Daytime Sleepiness:

• Persistent fatigue and daytime sleepiness due to poor sleep quality can lead to accidents, both at work and on the road. These accidents can be fatal or lead to serious injuries.

Mental Health Issues:

• Sleep apnea is linked to depression, anxiety, and other mental health disorders. Poor mental health can decrease quality of life and contribute to a shorter lifespan.

Reduced Overall Quality of Life:

• The cumulative effect of poor sleep quality, increased health risks, and associated complications can severely impact daily functioning and overall quality of life, indirectly affecting life expectancy

The treatment options for sleep apnea include a range of approaches, from lifestyle changes to medical devices and surgical interventions. Here are some of the key treatment options:

Continuous Positive Airway Pressure (CPAP) Therapy:

• CPAP therapy involves using a machine that delivers a continuous flow of air through a mask worn over the nose or mouth during sleep. This air pressure helps keep the airways open, preventing pauses in breathing.
• Seeking treatment, particularly with continuous positive airway pressure (CPAP) therapy, has a positive effect on mortality rates. Studies indicate that CPAP use can improve health-related quality of life, reduce snoring, and alleviate daytime sleepiness, potentially contributing to improved life expectancy.
• CPAP is considered the gold standard treatment for obstructive sleep apnea (OSA) and is usually the first treatment offered to people diagnosed with moderate or severe OSA.

Types of CPAP Machines

• BiPAP Machines(Bilevel Positive Airway Pressure): BiPAP machines provide a more specialized form of PAP therapy. They are usually prescribed for people with OSA who do not respond to traditional CPAP therapy. Additionally, BiPAP can be effective for sleepers with other breathing-related conditions, such as central sleep apnea
• APAP Machines (Auto-adjusting Positive Airway Pressure) : APAP machines, or auto-adjustable positive airway pressure machines, automatically adjust the level of positive airway pressure in response to changes in airflow. They are useful for those who have problems with traditional CPAP machines and can be a more flexible option for some individuals 

Oral Appliances:

• Oral appliances, also known as mandibular advancement devices, are custom-designed mouthpieces by dentists that can reposition the jaw and tongue to keep the airway open during sleep. These devices are often used for individuals with mild to moderate sleep apnea or for those who cannot tolerate CPAP therapy.

Surgery:

• Surgical options may be considered when other treatments are not suitable or effective. Surgical procedures for sleep apnea can include tissue reduction in the back of the throat, repositioning of the tongue, or the insertion of a nerve stimulator to open the airway during sleep.

Surgical options may also include:

• Maxillomandibular Expansion (MME) surgery: This surgery aims to expand or widen the upper and lower jaw to create more room for the tongue and expand the airway. It may be performed by an ear, nose, and throat (ENT) surgeon or an oral and maxillofacial specialist.
• Genioglossus Advancement: This minimally invasive surgery involves detaching the chin bone to pull the lower jaw forward, making it less likely for the tongue to block the airway during sleep 5
• Midline Glossectomy (Lingualplasty): This surgery reduces the size of the tongue, sometimes involving trimming the tonsils and back of the tongue to enlarge the airway.
• Hypoglossal Nerve Stimulation: This procedure involves electrically stimulating a nerve that leads past the lungs to the diaphragm, preventing the tongue from collapsing the airway during sleep. 

Lifestyle Changes:

• Lifestyle modifications, such as weight loss, regular exercise, and avoiding alcohol and sedatives, can help reduce the severity of sleep apnea. Additionally, changing sleep positions, such as avoiding sleeping on the back, can also be beneficial.

Orofacial Therapy:

• Orofacial therapy involves exercises for the mouth and facial muscles to improve the position of the tongue and strengthen the muscles that impact sleep apnea. This may be an effective treatment for sleep apnea in both children and adults. Orofacial therapy also known as myofunctional therapy, is a potential treatment for obstructive sleep apnea. with the goal of improving functions like eating, talking, and breathing
• These exercises aim to increase muscle tone, endurance, and coordinated movements of pharyngeal and peripharyngeal muscles, which can potentially help reduce snoring, the apnea-hypopnea index, and daytime sleepiness, and improve oxygen saturation and sleep quality 6

Other Non-Invasive Options:

• Other non-invasive treatment options may include positive airway pressure (PAP) devices and alternative pressurized air devices, which can be prescribed based on individual circumstances.

Home Remedies

• Body Positioning Pillow or Device:

 Using a body positioning pillow or similar device can prevent sleeping on the back, which can worsen obstructive sleep apnea by allowing the tongue to fall to the back of the throat and block the airway

• Weight Management:

 Maintaining a healthy weight is important, as excess body weight, particularly around the neck, can potentially impair breathing and worsen sleep apnea.

• Sleep Position:

 Changing sleep position, such as avoiding sleeping on the back, may help improve sleep apnea symptoms.

• Avoid Alcohol and Sedating Medications:

Alcohol and certain medications that make you sleepy can relax the muscles in your throat, worsening sleep apnea. Avoiding these substances, especially before bedtime, may provide some relief.

• Positional Therapy

One of the most common home remedies is using a body positioning pillow or device to keep from sleeping on your back. People with obstructive sleep apnea are more likely to have episodes when sleeping on their back. Positional therapy works by preventing you from rolling onto your back during sleep.

It's important to note that while these home remedies may offer some relief, especially for mild sleep apnea, they should be used in conjunction with, not as a replacement for, medical treatments like CPAP or surgery. Sleep apnea is a serious condition that requires proper diagnosis and ongoing management by a healthcare professional.

Relying solely on home remedies can be dangerous and delay getting effective treatment. Always consult with your doctor before starting any at-home treatments.

Improving Life Expectancy with Sleep Apnea

Improving life expectancy with sleep apnea starts with recognizing the importance of diagnosis and treatment. With proper sleep apnea treatment, individuals can see an increase in their life expectancy with treated sleep apnea. It is crucial to address sleep apnea symptoms early on and implement remedies for sleep apnea to prevent any further sleep apnea risk factors. A study found that the benefits of CPAP were associated with a substantial 62% reduction in the odds of death over an 11-year follow-up period. 

Recognizing the link between sleep apnea and life expectancy is key to understanding the impact of this form of sleep apnea on one's health. Untreated sleep apnea can lead to serious side effects and decrease one's life expectancy. By seeking help at a sleep clinic and following tips for managing sleep apnea, individuals can work towards achieving a good night's sleep and ultimately improving their overall well-being. 

Tips for Managing Sleep Apnea and Improving Overall Health

 Managing sleep apnea and improving overall health involves a multifaceted approach that encompasses lifestyle changes, treatment adherence, and potential complementary strategies. Here are some tips based on the provided sources:

Effective Treatment and Adherence:

• Effective treatment, such as CPAP therapy, can help individuals feel more alert, and rested, and reduce symptoms such as snoring and nighttime wakefulness. It's important to continue sleep apnea treatment for overall health, even if immediate improvements in sleep are not felt.5
• Adhering to recommended treatment plans, including the use of CPAP machines or oral appliances, is crucial for managing sleep apnea and potentially improving overall health.

Lifestyle Changes:

• Healthy lifestyle changes can be very effective in managing sleep apnea. These include maintaining a healthy weight, engaging in regular physical activity, adopting healthy sleeping habits, limiting alcohol and caffeine intake, and quitting smoking. Sleeping on your side instead of your back can also help keep the airway open while sleeping 
• Weight loss and changes in sleeping position have been identified as potential home remedies that may help relieve obstructive sleep apnea and improve sleep quality

Complementary Approaches:

• Complementary strategies, such as mouth exercises (oropharyngeal exercises), maintaining a healthy diet, and creating a conducive sleep environment, can complement traditional treatment for sleep apnea and contribute to improved sleep quality.

Seeking Professional Guidance:

• It's important to work with healthcare providers to determine the best management approach for sleep apnea. This may involve discussing lifelong heart-healthy lifestyle changes, using breathing or oral devices, and considering other interventions to help keep the airways open while sleeping.6

 Here are some valuable sources of support and assistance:

Financial Assistance and Programs:

• Organizations such as the American Sleep Apnea Association and the American Alliance for Healthy Sleep offer financial assistance programs for individuals with sleep disorders. These programs may provide support for specific medications, equipment, or ancillary services, helping to alleviate the financial burden associated with sleep apnea treatment.

Lifestyle and Treatment Support:

• The National Heart, Lung, and Blood Institute (NHLBI) provides information on heart-healthy lifestyle changes and the use of breathing or oral devices to help manage sleep apnea. Additionally, online forums and support groups, such as the AWAKE Network and CPAP support groups, offer a platform for individuals to connect, share experiences, and seek advice on sleep apnea treatment options 

Educational and Mindfulness Resources:

• The University of California, San Francisco (UCSF) offers resources for mindfulness practices, stress reduction, and overall health improvement. These resources may include classes that teach mindfulness practices, meditation, and body awareness, which can be beneficial for individuals managing sleep apnea.

Professional Guidance and Assistance:

• The American Academy of Sleep Medicine provides information on applying for the CPAP Assistance Program, which offers equipment packages to eligible sleep apnea patients experiencing financial hardship. This program can provide a new or gently used PAP machine, a new factory-sealed mask, tubing, machine filter, and a carrying case at a reduced cost

 Conclusion

Sleep apnea is a sleep disorder that affects millions of people worldwide. Those who suffer from sleep apnea may experience breathing pauses during sleep, known as apnea episodes. Studies have found that sleep apnea can also impact life expectancy. By addressing sleep apnea, individuals can experience a good night's sleep and reduce the risk of related health issues.

Dealing with sleep apnea can be challenging, but it is important to seek treatment if you suspect you have sleep apnea. Fortunately, sleep apnea is treatable and there are options available to help manage the condition.  Life expectancy with treated sleep apnea is typically higher than with untreated sleep apnea. Although sleep apnea can shorten life expectancy, proper treatment can greatly improve outcomes. It is important to be aware of the potential side effects of sleep apnea and take proactive steps toward managing this condition for a healthier future.