Medical Complications
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Hypertension
Apnea and hypopnea episodes during sleep cause acute
blood pressure changes. Nightly episodes of hypoxia, arousals and swings
in chest pressure due to obstructive sleep apnea (OSA) may lead to sustained
elevation of blood pressure.
OSA is an important risk factor for hypertension. An
association appears to be present even at the mild end of the OSA spectrum.
The high prevalence of OSA implies that it may be responsible for a
substantial portion of the population burden of hypertension. [1]
Stroke
Sleep-disordered breathing has been linked to stroke
in previous studies
These data demonstrate a strong association
between moderate to severe sleep-disordered breathing and prevalent
stroke, independent of contributing factors. They also provide the
first prospective evidence that sleep disordered breathing precedes
stroke and may contribute to the development of stroke.[2]
Diabetes
Diabetes is more prevalent in sleep-disordered breathing
(SDB) and this relationship is independent of other risk factors. However,
it is not clear that SDB is causal in the development of diabetes. [3]
Excessive Daytime Sleepiness Syndrome
Excessive
daytime sleepiness is a cardinal feature of the OSA syndrome
there
is evidence that both OSA and nonapneic snoring are important causes
of daytime sleepiness
. [In one study] approximately 23% of women
and 16% of men with an AHI of 5 or more reported experiencing three
measures of sleepiness (excessive daytime sleepiness plus awakening
unrefreshed no matter how long they had slept plus uncontrollable daytime
sleepiness that interfered with daily living) 2 days or more per week
[In another study] there was a significant increase
in Epworth Sleepiness Scale (ESS) score with increasing AHI. AHI is
the total of apneic events (cessation of breathing of 10 sec or more)
and hypopnea events (drop of oxygen saturation by more than 4%) divided
by hours of sleep.
A number of epidemiological studies have evaluated the
relationship between snoring and daytime sleepiness and almost all have
found a insignificant association. As snoring is a strong marker of
the of the presence of OSA, the association of snoring with sleepiness
might be due to their joint association with OSA ; however, several
studies suggest that snoring is independently associated with excessive
sleepiness
studies suggest that snoring without frank apnea
and hypopnea episodes is associated with daytime sleepiness independent
of AHI. If so, the very high prevalence of snoring in the adult population
suggests that public health burden of snoring-related sleepiness might
well exceed that of overt OSA.[4]
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