About Sleep Apnea

Obstructive Sleep Apnea is an underdiagnosed disorder that leads to high mortality and morbidity if not treated in time. Its prevalence in people aged 30 to 70 years is 25%.
Sleep Apnea

Sleep Apnea Hypopnea Syndrome (SAHS), also known as Obstructive Sleep Apnea (OSA), is the most common sleep-related breathing disorder and is caused by repetitive collapse of the upper airway during sleep.

The prevalence in people aged 30 to 70 years is 25%. OSA is an underdiagnosed disorder that leads to high mortality and morbidity if not treated in time. Untreated patients may suffer from sleepiness, concentration alterations and decreased quality of life. They also have an increased risk of developing cardiovascular disease, including difficulty controlling blood pressure, coronary heart disease and arrhythmias and may suffer from metabolic syndrome with increased glucose and triglyceride levels as well as markers of inflammation, arterial stiffness and atherosclerosis. Patients with OSA are also two to three times more likely to have motor vehicle accidents due to drowsy driving.

Most frequent symptoms of Sleep Apnea Hypopnea Syndrome

The great variability of symptoms hinders the diagnosis. The most frequent clinical features are:

  • Daytime sleepiness
  • Nonrestorative sleep
  • Loud snoring
  • Witnessed apneas by bed partner
  • Awakening with choking or gasping
  • Insomnia with frequent awakenings
  • Lack of concentration
  • Changes in mood
  • Morning headaches
  • Nocturia

As to the main risk factors for developing OSA, the most common are age, obesity and craniofacial and upper airway abnormalities (mainly) in thin patients.

Diagnosis of Sleep Apnea Hypopnea Syndrome

Due to variability in how symptoms are presented and lack of appropriate diagnostic procedures in primary care, SAHS is currently underdiagnosed: only 10% of cases are correctly diagnosed in Spain, with higher levels of underdiagnosis in Portugal. Existing procedures are performed at Hospital Sleep Units, with complex and costly resources and waiting lists resulting in inefficiencies.

The STOP-Bang questionnaire is an eight-item survey – not a diagnostic test – that incorporates information on snoring, tiredness, observed apneas, blood pressure, body mass index (BMI), age, neck circumference and gender. Patients who obtain a high-risk result on this test are potential candidates for another medical visit to complete their clinical history and the polygraph test.

The INNOBICS-SAHS project addresses the underdiagnosis of SAHS and the lack of integration between primary care and Hospital Sleep Units. More information.

Treatment of Sleep Apnea-Hypopnea Syndrome

There are currently no drugs available with proven efficacy in treating SAHS.

The current treatment comprises different medical recommendations divided into four main groups:

  • General measures to achieve good sleep hygiene: maintain a regular sleep schedule and a suitable environment; avoid activities in the hours before sleep that require significant mental concentration, intense physical exercise or an intake of abundant and caloric food; individualize naps, etc.
  • Healthy lifestyle habits: weight loss for patients with obesity, practice physical exercise regularly during the day, avoid alcohol consumption (at least 6 hours before bedtime), avoid smoking and the consumption of Benzodiazepines and their derivatives.
  • Postural treatment: different devices are available to improve the position adopted during sleep, which influences the frequency of respiratory episodes in more than 50% of patients diagnosed with OSA.
  • Continuous Positive Airway Pressure (CPAP) is the most commonly prescribed device for treating sleep apnea disorders. The system is based on a turbine-type generator capable of creating an airflow with an outlet pressure (airway) higher than the inlet pressure (ambient air). The flow generated is directed to the patient by means of a tube and a mask applied to the airway. The continuous supply of oxygen during sleep prevents brief breathing interruptions.