Sleep apnea natural history, complications and prognosis: Difference between revisions

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{{Sleep apnea}}
{{CMG}} {{AE}} Saarah T. Alkhairy, M.D.


{{Sleep apnea}}
{{CMG}}; '''Associate Editor(s)-In-Chief:''' [[Kashish Goel|Kashish Goel, M.D.]]
==Overview==
==Overview==
==Complications==
Sleep apnea can begin with loud snoring and eventually lead to serious complications. Common symptoms include somnolence, depression, and headaches. More serious complications include [[cardiovascular]] diseases, [[stroke]], and [[hypertension]]. If sleep apnea is adequately treated, the prognosis is very good. If it is left untreated, patients can develop serious complications and have a poor prognosis.
==Prognosis==
Although it takes some trial and error, most patients find a combination of treatments which reduce apnea events and improve their overall health, energy, and well-being. Without treatment, the [[sleep deprivation]] and lack of oxygen caused by sleep apnea increases health risks such as [[cardiovascular disease]], [[high blood pressure]], [[stroke]], [[diabetes]], [[clinical depression]],<ref name="pmid15982424">{{cite journal |author=Schröder CM, O'Hara R|title=Depression and Obstructive Sleep Apnea (OSA) |journal=Ann Gen Psychiatry |volume=4 |issue= |pages=13|year=2005|pmid=15982424|doi=10.1186/1744-859X-4-13 |url=http://www.annals-general-psychiatry.com/content/4//13}}</ref> weight gain and [[obesity]].


The most serious consequence of untreated obstructive sleep apnea is to the heart. In severe and prolonged cases, there are increases in pulmonary pressures that are transmitted to the right side of the heart. This can result in a severe form of congestive heart failure (''[[cor pulmonale]]'').
==Natural History==
*Sleep apnea is a progressive disease. Snoring is the earliest manifestation of sleep apnea.<ref name="Grunstein1994">{{cite journal|last1=Grunstein|first1=R.R.|title=Sleep apnoea - evolution and doubt|journal=European Respiratory Journal|volume=7|issue=10|year=1994|pages=1741–1743|issn=00000000|doi=10.1183/09031936.94.07101741}}</ref>
*Snoring in sleep apnea is often mild at first, but it often progresses as the disease becomes more severe.


Elevated arterial pressure (commonly called [[high blood pressure]]) can be a consequence of obstructive sleep apnea syndrome.<ref name="Sleep Apnea">{{cite journal
*Sleep apnea with heavy snoring is associated with prolonged apneas, followed by choking and gasping<ref name="Grunstein1994">{{cite journal|last1=Grunstein|first1=R.R.|title=Sleep apnoea - evolution and doubt|journal=European Respiratory Journal|volume=7|issue=10|year=1994|pages=1741–1743|issn=00000000|doi=10.1183/09031936.94.07101741}}</ref>
|url=http://www.aafp.org/afp/20020115/229.html
*As a result, patients develop daytime clinical manifestations, namely somnolence, [[depression]], [[headaches]], and impotence
|author=Silverberg DS, Iaina A and Oksenberg A
*If left untreated, sleep apnea may be associated with the development of serious complications, such as [[hypertension]], [[coronary artery disease]], [[stroke]], [[CHF]], and [[atrial fibrillation]]
|journal=American Family Physicians
|title=Treating Obstructive Sleep Apnea Improves Essential Hypertension and Quality of Life
|year = 2002
|month = January
|volume = 65
|issue = 2
|pages = 229-36
|pmid = 11820487
}}</ref> When high blood pressure is caused by OSA, it is distinctive in that, unlike most cases of high blood pressure (so-called [[essential hypertension]]), the readings do ''not'' drop significantly when the individual is sleeping.<ref>{{cite journal
|author=Grigg-Damberger M.
|title=Why a polysomnogram should become part of the diagnostic evaluation of stroke and transient ischemic attack
|journal=Journal of Clinical Neurophysiology|
volume=23
|issue=1
|pages=21-38
|date=2006-02
|pmid=16514349}}</ref> [[Stroke]] is associated with obstructive sleep apnea.<ref>{{cite journal
  |author = H. Klar Yaggi, M.D., M.P.H.
  |coauthors = John Concato, M.D., M.P.H., Walter N. Kernan, M.D., Judith H. Lichtman, Ph.D., M.P.H., Lawrence M. Brass, M.D., and Vahid Mohsenin, M.D.
  |title = Obstructive Sleep Apnea as a Risk Factor for Stroke and Death
  |journal = The New England Journal of Medicine
  |volume = 353
  |issue = Number 19
  |pages= 2034-2041
  |date= November 10, 2005
  |accessdate = 2007-04-10
  |pmid = 16282178}}</ref>  Sleep apnea sufferers also have a 30% higher risk of heart attack or death than those unaffected.<ref> {{cite web|url=http://www.thoracic.org/sections/publications/press-releases/conference/articles/2007/press-releases/sleep-apnea-increases-risk-of-heart-attack-or-death-by-30.html|title=Sleep Apnea Increases Risk of Heart Attack or Death by 30% |last=N.A. Shah, M.D., N.A. Botros, M.D., H.K. Yaggi, M.D., M., V. Mohsenin, M.D., New Haven, CT|date=May 20, 2007 |work=American Thoracic Society }}</ref>


Many studies indicate that it is the effect of the "fight or flight" response on the body that happens with each apneic event that increases these risks. The [[fight or flight]] response causes many hormonal changes in the body; those changes, coupled with the low oxygen saturation level of the blood, cause damage to the body over time.<ref>[http://www.yale.edu/opa/v35.n30/story17.htmlwww.yale.edu]</ref><ref>[http://www.sciencedaily.com/releases/2002/04/020403025512.htmwww.sciencedaily.com]</ref><ref>http://www.schlaflabor-breisgau.de/Bild_gif/Peppard.pdf</ref><ref>[http://www.sciencedaily.com/releases/2007/05/070520183530.htmwww.sciencedaily.com] </ref>
==Complications==
Untreated sleep apnea is associated with the development of the following complications:
*[[Depression]]
*[[Hypertension]]
*[[Coronary artery disease]]
*[[Stroke]]
*[[CHF]]
*[[Atrial fibrillation]]
*[[Failure to thrive]] among small children


==Prognosis==
*If adequately treated, the prognosis of sleep apnea is generally very good
*Sleep apnea during surgery and anesthesia is associated with poor prognosis
*Opioid-induced central sleep apnea is associated with poor prognosis<ref name=DSMV>{{cite book | title = Diagnostic and statistical manual of mental disorders : DSM-5 | publisher = American Psychiatric Association | location = Washington, D.C | year = 2013 | isbn = 0890425558}}</ref>


==References==
==References==
{{reflist|2}}
{{Reflist|2}}
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[[Category:Sleep disorders]]
[[Category:Cardiology]]
[[Category:Medical conditions related to obesity]]
[[Category:Pulmonology]]
[[Category:Pulmonology]]
[[Category:Cardiology]]
[[Category:Signs and symptoms]]
[[Category:Cardiology]]
[[Category:Primary care]]
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Latest revision as of 00:12, 30 July 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Saarah T. Alkhairy, M.D.

Overview

Sleep apnea can begin with loud snoring and eventually lead to serious complications. Common symptoms include somnolence, depression, and headaches. More serious complications include cardiovascular diseases, stroke, and hypertension. If sleep apnea is adequately treated, the prognosis is very good. If it is left untreated, patients can develop serious complications and have a poor prognosis.

Natural History

  • Sleep apnea is a progressive disease. Snoring is the earliest manifestation of sleep apnea.[1]
  • Snoring in sleep apnea is often mild at first, but it often progresses as the disease becomes more severe.

Complications

Untreated sleep apnea is associated with the development of the following complications:

Prognosis

  • If adequately treated, the prognosis of sleep apnea is generally very good
  • Sleep apnea during surgery and anesthesia is associated with poor prognosis
  • Opioid-induced central sleep apnea is associated with poor prognosis[2]

References

  1. 1.0 1.1 Grunstein, R.R. (1994). "Sleep apnoea - evolution and doubt". European Respiratory Journal. 7 (10): 1741–1743. doi:10.1183/09031936.94.07101741. ISSN 0000-0000.
  2. Diagnostic and statistical manual of mental disorders : DSM-5. Washington, D.C: American Psychiatric Association. 2013. ISBN 0890425558.

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