Snoring affects ~40% of the UK population. Those suffering from the pandemic of Obstructive Sleep Apnoea, estimated between 2.8 to 4 million individuals, will ALL have some level of snoring. Snoring may, therefore, NOT be innocuous. OSA has a greater prevalence than diabetes, and unlike diabetes, with little or no public awareness.
Predominantly affecting males, OSA prevalence in women has been increasingly recognised. Studies reveal a prevalence of 31% in obese women. OSA increases with ageing, with a doubling in women around the peri/post-menopausal phase of life.* *It is now increasingly recognised that many of the symptoms of OSA, e.g. fatigue, weight gain, brain fog etc., have incorrectly been attributed to the menopause. As the underlying issue of OSA is, therefore, not addressed, many women choose to leave the workforce as they are unable to cope.
OSA is characterised by occlusion of the upper breathing passages, not lungs, leading to a cessation of airflow. Effectively a STRANGULATION. A cessation of airflow of 10 seconds or over a minute.
Normal threshold is five apnoea episodes or less per hour, as determined by a sleep study. Between 5 to 15 episodes per hour is mild OSA, between 16 to 30 episodes, moderately severe OSA, and 30 plus episodes per hour, severe OSA. Patients can have 50, 60, 70+ episodes per hour.
Severe/acute metabolic and physiological changes occur during these apnoeic episodes: A fight/flight response with huge outpouring of adrenaline into the bloodstream, leading to:
- A fall in blood oxygen levels.
- Downstream medical consequences, particularly of the heart (heart attack, abnormal beats, high blood pressure), brain (stroke and acceleration of dementia), abnormal sugar maintenance (diabetes) and weight gain.
- Daytime sleepiness or microsleeps if the individual is engaged in boring/menial activity e.g. driving on a motorway, in front of TV/cinema.
- Loss of productivity, of 33%, in studies of middle management work patterns.
Why is addressing this OSA epidemic so important to the individual, the family and the country alike? Severe OSA, if left untreated for 12 years, all too frequent, given the lack of NHS facilities, results in 15% fatalities, from a major heart event. The 33% that survive such an event will require long-term health and social care. The survivors will cost ~ £3million over their lifetime.
OSA affects about 30% of the ~1m individuals with cognitive decline/dementia. This figure is predicted to rise to two million by 2030 due to ageing demographics. Most will be women. Studies have shown that addressing the OSA decelerates the progression of dementia and in a significant minority reverses the changes in the brain and improves cognition. In England, the yearly health/social care cost is ~£25K for such individuals. Reducing this need for say three years, for example in 1000 individuals, would save £25m per annum, £75m over three years.
About 25% of diabetics have associated OSA, and if addressed, the diabetes management is easier, requiring reduced medication or reversion to a non-diabetic state.
OSA and obesity are interrelated and over 50% of those who are overweight/obese will have OSA. Managing the OSA can reverse the weight gain, with all its concomitant benefits.
The mental and physical disabilities of OSA have been studied and are the equivalent of suffering from “Parkinson’s disease.
A study in Lincolnshire has revealed that 20% of the local RTAs, involving HGVs/PSVs, were due to a driver falling asleep at the wheel because of OSA.
Women can suffer all these serious consequences of untreated OSA, but they manifest additional complications.
OSA increases the incidence of high blood pressure and pre-eclampsia in pregnancy. Those with OSA are more likely to suffer gestational diabetes and have increased insulin resistance leading to long term diabetes. Babies born to mothers with gestational diabetes are at greater risk of respiratory issues, low blood sugar and neonatal jaundice.
Obesity and overweight, in women, is closely linked to OSA and in women the risk of developing cancer of the breast is higher in such individuals, both before and after menopause. These women are less likely to respond to radiotherapy, chemotherapy and surgery and are at greater risk of local recurrence compared to normal weight individuals. They also have only a 55% as opposed to 80% five-year survival rate. Studies appear to show similar results for endometrial cancer.
OSA is more prevalent in Black and Ethnic Minority and vulnerable groups, who also are more likely to suffer the severe end of the OSA spectrum.
The government needs to urgently address this pandemic, which is largely under the radar, but is costing individuals their health, life, and at huge economic cost to the country. Addressing OSA should be a major plank in the government’s recent announcement focus on “Preventive Medicine” and addressing issues of “The Menopause”.