Hazards of Sleep Apnea
Sleep apnea results from a very complex interaction between anatomic, hormonal, neurological, muscular and postural factors. Sleep apnea is a very dangerous disease, because if left untreated it gets progressively worse and has serious health consequences. Certain of the morbid consequences of sleep apnea are a direct result of the obstruction to breathing, some are effects of sleep deprivation, some are hormonal and others result from the changes caused by reduced oxygen getting to the brain.
The most prevalent and disturbing side effect of sleep apnea is excessive daytime sleepiness (EDS). Patients suffering from EDS are at high risk for automobile accidents, occupational accidents, and poor work performance. Drowsiness was a factor in over 200,000 car crashes, 76,000 injuries and 1,400 deaths in motor vehicle accidents in the year 2000. The odds of having an auto accident are 3 times greater in drowsy drivers. Six states have passed or have legislation pending that a person driving drowsy is subject to reckless homicide felony laws, carrying a prison sentence of 3 - 28 years if found guilty.
When breathing stops during apnea episodes carbon dioxide levels in the blood increase and oxygen levels drop. This sets off a cascade of physical and chemical events. Nitric oxide causes blood vessels to remain elastic, but sleep apnea causes decreased levels of nitric oxide and thus less elasticity in blood vessel walls.
One recent study showed that the greater the number of nightly apnea episodes a person had, the more likely they were to develop hypertension in the order of four years. Blood pressure fluctuates widely and rapidly in response to episodes of apnea and hypopnea. This is an autonomic nervous system response that controls involuntary muscle activity such as the heart. The transient constriction of blood vessels controlling the heart can lead to sustained hypertension (high blood pressure) and eventual heart damage.
The blood in people with sleep apnea has higher levels of plasminogen. This substance causes the blood to become more viscous or sticky, and is thus more apt to clot and cause strokes. Certain immune factors as well are high in the blood of apnea patients. Immune responses cause inflammation that can damage blood vessels. The white blood cells of apnea patients have an increased number of adhesion molecules. These can bind to the blood vessel linings and also cause inflammation. Inflammation of the blood vessel walls has been implicated in coronary artery disease and heart attacks.
Studies in older people with sleep apnea and excessive daytime sleepiness demonstrate lower test scores for cognitive function. In one study 32% of adult apnea patients also had suffered from depression. Studies of children and adolescents with sleep apnea reported academic underachievement, short attention span, and hyperactivity, all thought to be a result of sleepiness.
 Risk Factors for Obstructive Sleep Apnea
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