Mr. S had gained some weight. His wife noted his snoring was getting worse and he was having spells when he would stop breathing during sleep. She informed his doctor who prescribed a home overnight oximetry test. This home test showed Mr. S’s oxygen levels were dropping dangerously low during much of night. The subsequent full sleep study indicated he would benefit from a continuous positive airway pressure or CPAP device. Five years later, the patient died from a heart attack, and the doctor found out that the CPAP machine stayed under his bed and was rarely, if ever, used. One study showed, despite its benefits, only 30 percent of those prescribed CPAP will actually use it.
An estimated 22 million Americans suffer from sleep apnea and the majority don’t know they have it. Their sleep is interrupted by snoring, choking and prolonged spells of low oxygen levels. Their days are troubled by fatigue, sleepiness, often abnormal heart rhythms and heart failure. Their risk of stroke over five years is two to three times higher than usual and risk of all-cause premature death three to five times higher. One estimate is that 38,000 annual deaths in the U.S. will occur from heart disease due to untreated sleep apnea.
Making the diagnosis is challenging. In 2016, we gave a standardized questionnaire to screen for sleep apnea to 67 people who were 70-years-old or older. Following that, we tested all 67 with home overnight oximetry. Of the 67 tested, 42 percent were normal, 31 percent had mild sleep apnea and 26 percent had moderate to severe sleep apnea. Conclusions from my study were that in this older age group, the commonly used screening questionnaires for sleep apnea misses the diagnosis half the time, about one out of four have life-threatening sleep apnea and, in this older population, women and men are equally burdened by this condition.
Anyone with heart disease, high blood pressure, obesity, a history of heavy snoring or observed spells of apnea (and maybe anyone reaching 70) would benefit from a home overnight oximetry test and, if this test is abnormal, from a full sleep study. If CPAP is prescribed, it would be wise for that individual to make every effort to use the CPAP device, knowing that this non-medicinal therapy reduces death rate by three to five times.
Many premature deaths, especially from heart disease, could be prevented by first discovering the diagnosis of sleep apnea and then, when apropos, by taking the CPAP cure.
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