Sleep Apnea is too often undiagnosed or untreated. This was brought to my attention the other day when I was speaking to a client who had called me to have a consultation regarding her father’s possible surgery.
Sally’s dad is in his 70’s and has had at least two heart attacks which then led to stents being inserted into his coronary arteries. In addition to significant heart disease, he also has difficult to control diabetes. Recently, Sally’s father had an appointment with his cardiologist who suggested that open heart/bypass surgery may be necessary. The idea of her dad having such a significant surgery alarmed Sally and she wanted some help in developing questions that her dad could ask his cardiologist at the next appointment.
Sally and I discussed some important questions that I always recommend that patients ask prior to consenting to surgery. These include: What is the goal of this surgery? What are the benefits that I may receive and what possible burdens might this cause me? Specifically, for someone at my age and with my health history, how likely is it that I will see those benefits from this surgery?
Then I asked Sally what her dad hoped to achieve by having the surgery (that is a good question for the family to ask someone who is contemplating surgery because it can help you to know if your loved one has a realistic view of their health). Sally explained that her dad was feeling so tired and low energy that it made life very difficult for him. Those symptoms may be caused by his serious cardiac problems.
Then we continued talking about her dad’s health. And I asked her about his kidney function (not great), and his circulation to his legs and feet (also, not great), and then I asked about respiratory issues. I was happy to hear that he did not smoke or have asthma both of which can be complicating factors when recovering from surgery. It was then that I asked if Sally’s dad had sleep apnea, and she wasn’t sure how to respond. She said, “well, he snores something awful.” Bingo-a major sign of sleep apnea.
We then talked about the other signs of sleep apnea using the STOP-BANG scoring system. This is a system that I and other anesthesia providers use when we talk to patients before surgery to give us an indication if the patient has sleep apnea. We need to know if there is sleep apnea because it has significant implications for how we plan anesthesia and post-operative care for these patients.
Here are the STOP-BANG questions:
S= Snoring T= Tired during the day 0= Observed, has someone seen you stop breathing when you are sleeping? P= Pressure, have you been diagnosed with high blood pressure? B= BMI, is your BMI over 35? A= Age, are you 50 or older? N= Neck size Is your neck larger than 16” (females) or 17” (males)? G= Gender, are you male?
If you answer “yes” to 0-2 then you are considered low risk for sleep apnea, “yes” to 3-4 indicates a moderate risk for it and if you have 5 or more of these then you are considered to be high risk.
Sally’s dad scored 6 on the STOP-BANG questionnaire. It was surprising to me that no one had addressed this important issue with him sooner. He was someone who had significant heart disease and sleep apnea can put a tremendous strain on the heart. This is a medical condition that cardiologists should be especially vigilant about diagnosing.
For someone with sleep apnea, the muscles in the airway relax to such an extent when they are sleeping that the airway may become partially or fully blocked. When it is partially blocked that is when we hear the typical snoring (especially if the person is sleeping on their back). If it becomes fully blocked, breathing stops. That is when there is the characteristic burst of sudden, loud snoring sounds.
The treatment can be life-changing. But it is not easy. Like so many medical problems it may be a trial and error to get the exact right treatment for you. First, you need to be diagnosed. That usually involves a sleep study. These are done at sleep clinics or in hospitals in special rooms that are meant to encourage sleep and your brain waves, oxygen levels, eye movements and more will be monitored by a technician. It does not involve needles or blood tests. But it can be inconvenient to have to spend the night somewhere unfamiliar. Many people avoid having the sleep study because they are convinced they won’t be able to sleep and it will be a waste of time. But, it isn’t necessary that you sleep all night in order to get an accurate diagnosis.
If you are diagnosed you may be prescribed a CPAP machine with a mask to wear when you sleep. The machine sends a certain amount of pressure to your airway with every breath that you take, which allows there to be sufficient pressure to keep your airway open. But it may take a few tries before you are able to find the correct mask fit and the right pressure settings. Your physician will help you with this process and it is well worth the effort.
If Sally’s dad has his possible sleep apnea diagnosed and properly treated he may experience improvement in his energy levels. That is because he would actually be getting adequate rest. This could also have a positive effect on his diabetes because when people are chronically unrested they experience high cortisol levels. Cortisol is a hormone that can raise blood sugar levels.
Additionally, having his sleep apnea treated will improve his chances of doing well after surgery. People with sleep apnea, especially if it remains untreated are at increased risk of significant postoperative complications such as pneumonia, heart attack, heart rhythm disturbances, and postoperative delirium. They are also more likely to need to stay in the ICU and may be at a greater risk for dying than are heavy cigarette smokers.
I have known people who have been successfully treated for sleep apnea and they do describe it as being life-changing. They are religious in their use of the CPAP machines because they never want to return to the exhausted, forgetful, and depressed state that they were in prior to treatment.
Listen to the podcast about Sleep Apnea.
More information: https://www.sleepapnea.org/learn/sleep-apnea American Heart Association Sleep Apnea and Diabetes
