Sleep apnea is a serious sleep disorder that happens when a person's breathing is interrupted during sleep. People with untreated sleep apnea stop breathing repeatedly during their sleep, sometimes hundreds of times during the night.
If it’s not treated, sleep apnea can cause a number of health problems, including hypertension (high blood pressure), stroke, cardiomyopathy (enlargement of the muscle tissue of the heart), heart failure, diabetes and heart attacks. Untreated sleep apnea can also be responsible for job impairment, work-related accidents and motor vehicle crashes, as well as underachievement in school in children and adolescents.
There are two types of sleep apnea, obstructive and central:
Sleep apnea occurs in about 25% of men and nearly 10% of women. Sleep apnea can affect people of all ages, including babies and children and particularly people over the age of 50 and those who are overweight.
Certain physical traits and clinical features are common in patients with obstructive sleep apnea. These include excessive weight, large neck and structural abnormalities reducing the diameter of the upper airway, such as nasal obstruction, a low-hanging soft palate, enlarged tonsils or a small jaw with an overbite.
When you stop breathing, your heart rate also tends to drop the longer your body is deprived of oxygen. Then, your involuntary reflexes cause you to startle awake at the end of that period of not breathing. When this occurs, your heart rate tends to accelerate quickly and your blood pressure rises.
These are changes that take place acutely when you stop breathing. However, your body starts to experience chronic effects if you experience frequent apnea. Data suggests increased risk, particularly when you stop breathing roughly 30 times or more per hour. But there is likely a risk at even lower frequency rates.
For example, your blood pressure tends to go up, your heart walls thicken due to increased workload and the structure of your heart changes. It tends to become stiffer and less flexible because there are more fibrous cells growing in between the muscle cells.
All of those things increase the risk that you can have either atrial or ventricular arrhythmias. They also tend to reduce the function of the heart so that it’s less efficient at pumping blood.
Obstructive sleep apnea is caused by a blockage of the airway, usually when the soft tissue in the rear of the throat collapses during sleep. Central sleep apnea is usually observed in patients with central nervous system dysfunction, such as following a stroke or in patients with neuromuscular diseases like amyotrophic lateral sclerosis (ALS, Lou Gehrig’s disease). It is also common in patients with heart failure and other forms of heart, kidney or lung disease.
Often the first signs of OSA are recognized not by the patient, but by the bed partner. Many of those affected have no sleep complaints. The most common signs and symptoms of OSA include:
People with central sleep apnea more often report recurrent awakenings or insomnia, although they may also experience a choking or gasping sensation upon awakening.
Symptoms in children may not be as obvious and include:
If your doctor determines that you have symptoms suggestive of sleep apnea, you may be asked to have a sleep evaluation with a sleep specialist or may order an overnight sleep study to objectively evaluate for sleep apnea.
An HST is not appropriate to be used as a screening tool for patients without symptoms. It’s not used for patients with significant medical problems (such as heart failure, moderate to severe cardiac disease, neuromuscular disease or moderate to severe pulmonary disease). It’s also not used for patients who have other sleep disorders (such as central sleep apnea, restless legs syndrome, insomnia, circadian rhythm disorders, parasomnias or narcolepsy) in addition to the suspected obstructive sleep apnea.
Conservative treatments: In mild cases of obstructive sleep apnea, conservative therapy may be all that is needed.
Mechanical therapy: Positive Airway Pressure (PAP) therapy is the preferred initial treatment for most people with obstructive sleep apnea. With PAP therapy, patients wear a mask over their nose and/or mouth. An air blower gently forces air through the nose and/or mouth. The air pressure is adjusted so that it is just enough to prevent the upper airway tissues from collapsing during sleep. PAP therapy prevents airway closure while in use, but apnea episodes return when PAP is stopped or if it is used improperly. There are several styles, and types of positive airway pressure devices depending on specific needs of patients. Styles and types include:
Mandibular advancement devices: These are devices for patients with mild to moderate obstructive sleep apnea. Dental appliances or oral mandibular advancement devices that help to prevent the tongue from blocking the throat and/or advance the lower jaw forward can be made. These devices help keep the airway open during sleep. A sleep specialist and dentist (with expertise in oral appliances for this purpose) should jointly determine if this treatment is best for you.
Hypoglossal nerve stimulator: A stimulator is implanted under the skin on the right side of the chest with electrodes tunneled under the skin to the hypoglossal nerve in the neck and to intercostal muscles (between two ribs) in the chest. The device is turned on at bedtime with a remote control. With each breath, the hypoglossal nerve is stimulated, the tongue moves forward out of the airway and the airway is opened.
Surgery: Surgical procedures may help people with obstructive sleep apnea and others who snore but don’t have sleep apnea. Among the many types of surgeries done are outpatient procedures. Surgery is for people who have excessive or malformed tissue obstructing airflow through the nose or throat, such as a deviated nasal septum, markedly enlarged tonsils or small lower jaw with an overbite that causes the throat to be abnormally narrow. These procedures are typically performed after sleep apnea has failed to respond to conservative measures and a trial of CPAP. Types of surgery include:
If left untreated, sleep apnea can result in a number of health problems including hypertension, stroke, arrhythmias, cardiomyopathy (enlargement of the muscle tissue of the heart), heart failure, diabetes, obesity and heart attacks.
It’s likely that sleep apnea can cause arrhythmias and heart failure because if you have sleep apnea, you tend to have higher blood pressure. In fact, sleep apnea occurs in about 50% of people with heart failure or atrial fibrillation.
This is because sleep apnea can cause:
With the high prevalence of sleep apnea in cardiac arrhythmias and heart failure (essentially a coin flip as to whether the patient has it), experts recommend that you don’t delay in seeking the advice of your physician.
Last reviewed by a Cleveland Clinic medical professional on 03/03/2020.