Snoring – the Not-So-Silent Killer

Obstructive sleep apnoea (OSA), a condition where the airway is blocked during sleep as a result of tongue and airway muscle relaxation, has recently emerged as a new epidemic in healthcare (1). Often, a person with sleep apnoea may not be aware of their symptoms. Partners and/or family members may observe and report snoring, gasping/grunting during sleep, or episodes where breathing stops (1). It is common for the sleeper to wake suddenly before falling back to sleep and subsequently  the most common symptom of OSA is daytime fatigue or memory ‘fog’ due to poor and irregular sleep (2).

OSA is a common problem that significantly affects multiple aspects of a person’s overall health. It is associated with a higher risk of depression, difficulty maintaining concentration, and cardiovascular and pulmonary effects (2). Regardless of the severity of the condition, the risk of heart disease and death is 7 times higher in people with sleep apnoea when compared with people without the condition (2). Treatment for sleep apnoea removes this risk (2).

Approximately 9% of women and 25% of men in Australia have been diagnosed with clinically significant OSA, however, a large number of Australians are undiagnosed (2). Known risk factors include: obesity, smoking, being over 65 years old, having a wide neck circumference, alcohol consumption, family history and consumption sedatives (2).

How does sleep apnoea affect your eye health?

The American Journal of Ophthalmology has identified an important link between optic neuropathies, such as glaucoma (the ‘silent-thief-of-sight’ condition affecting peripheral vision), and OSA (3).  The Journal of Ophthalmology indicates that damage from a lack of oxygen in OSA episodes is associated with sight-threatening diseases (3). It is understood that retention of carbon dioxide due to low oxygen levels increases intracranial pressure during episodes of OSA, which results in an increase in pressure on the optic nerve head of the eye (3). This process can lead to glaucoma and papilledema (swelling on the optic nerve), that must be closely monitored and treated by an optometrist (3).

OSA is also closely associated with floppy eyelid syndrome (FES), a disease characterised by sore, gritty eyes and eyelid laxity (4,5). FES is most common in obese middle-aged men and can lead to scarring of the eye that may disturb vision (4,5). Anyone believed to be at risk of OSA should inform and discuss with their optometrist, to ensure appropriate assessment for any associated eye conditions is conducted.

How does sleep apnoea affect children’s behaviour and concentration?

Sleep apnoea can also affect children. It has been suggested that behavioural disorders in children can be exacerbated by, or even  be a manifestation of primary sleeping disorders such as OSA (6). Studies have identified that up to 25% of patients with symptoms including motoric hyperactivity, inattention and difficulty focusing have shown improvement in these symptoms following OSA treatment (6). Some studies also suggest that treatment of primary sleeping disorders, such as OSA, can reduce reliance on ADHD management drugs (7).

Other systemic signs of sleep disordered breathing can include bedwetting, night terrors, depression, allergic rhinitis, asthma and mouth breathing (8). Multiple over-the-counter and prescription medications may effect sleep, including anticonvulsants, antihistamines, antidepressants, corticosteroids, benzodiazepines and opioids (9). Management for OSA in children may differ, as there is an association with enlarged tonsils and adenoids as a causative factor. This association should be addressed in addition to performing paediatric sleep studies and treating sleep disordered breathing (7).

The link between sleep apnoea and Alzheimer’s

Furthermore, OSA has serious systemic and psychological effects. People suffering from OSA have a higher prevalence of Alzheimer’s disease (AD). (10) Studies suggest that OSA worsens neurodegenerative changes due to sleep fragmentation and limited oxygen supply, which increases susceptibility to cognitive loss (9,10). Initial studies have also reported that some AD patients even find an improvement in cognitive function once OSA treatment is implemented (10,11).

OSA poses a serious threat to overall wellbeing. It is associated with a 7-times higher risk of heart disease resulting in death, regardless of its severity and other risk factors (2). People with OSA are also 4 to 9 times more likely to be involved in a motor vehicle accident, and OSA can be a cause of sudden death at night (2).

There are treatments available such as Continuous Positive Airway Pressure (CPAP) and Nightshift devices that can be prescribed by a general practitioner or sleep specialist (2). OSA symptoms can also be improved through lifestyle changes including weight loss, limiting alcohol consumption and improving sleep habits (2). OSA is a treatable condition where risks can be minimised through diagnosis and close monitoring by health practitioners.

If you think you or someone you know may be suffering from OSA please consult your general practitioner. You should also discuss this with your optometrist so that they can be alert for any associated eye conditions. There are many benefits to seeking treatment, including a boost in energy and an improved quality of life.

References

  1. Davis (2018). What you need to know about sleep apnea. Medical News Today. Available at: https://www.medicalnewstoday.com/articles/178633.php
  2. Obstructive sleep apnea. SNORE Australia, 2018. Available at: http://www.snoreaustralia.com.au/obstructive-sleep-apnoea.php
  3. Stein, Kim, Mundy, Talwar, Nan, Chervin, Musch (2011). The association between glaucomatous and other causes of optic neuropathy and sleep apnea. American Journal of Ophthalmology. 
  4. Ping Wang, Dao-Jiang Yu, Gang Feng, et al., “Is Floppy Eyelid Syndrome More Prevalent in Obstructive Sleep Apnea Syndrome Patients?,” Journal of Ophthalmology, vol. 2016, Article ID 6980281, 9 pages, 2016. doi:10.1155/2016/6980281
  5. Muniesa M, Huerva V, Sánchez-de-la-Torre M, et al. The relationship between floppy eyelid syndrome and obstructive sleep apnoea. British Journal of Ophthalmology Published Online First: 12 April 2013. doi: 10.1136/bjophthalmol-2012-303051
  6. Owens, Maxim, Nobile, et al (2000). Parental and Self-report of Sleep in Children with Attention-Deficit/Hyperactivity Disorder. Archives of Paediatrics and Adolescent Medicine. 
  7. Huang, Guilleminault, Li, Yang, Wu, Chen (2012). Attention-deficit/hyperactivity disorder with obstructive sleep apnea: a treatment outcome study. Sleep Journal. 
  8. Dayyat, E., Kheirandish-Gozal, L., & Gozal, D. (2007). Childhood Obstructive Sleep Apnea: One or Two Distinct Disease Entities? Sleep Medicine Clinics, 2(3), 433–444. 
  9. Lewandowski, A. S., Ward, T. M., & Palermo, T. M. (2011). Sleep Problems in Children and Adolescents with Common Medical Conditions. Pediatric Clinics of North America, 58(3), 699–713. 
  10. Pan, Kastin (2014). Can sleep apnea cause Alzheimer’s disease? Neuroscience and Biobehavioural Reviews. 
  11. Ancoli-Israel, Palmer, Cooke, Corey-Bloom, Fiorentino, Natarajan, Liu, Ayalon, He, Loredo (2009). Cognitive Effects of Treating Obstructive Sleep Apnea in Alzheimer’s Disease: A Randomised Controlled Study. Journal of the American Geriatrics Society. 
Natalie_bio

About Natalie

Natalie Buckman is a clinical optometrist, educator,  professional leader and ophthalmic medicines prescriber, who enjoys exploring the world and hitting the dance floor in her spare time.