Sleep apnea is one of the most common and most underdiagnosed sleep disorders in the country. Most people associate it with snoring. The more important story is what happens to the heart, brain, eyes, and metabolism when the condition goes undetected for years.
What is obstructive sleep apnea?
Sleep apnea occurs when breathing is repeatedly interrupted during sleep, causing oxygen levels in the blood to drop. These episodes, called apneic events, can happen dozens or even hundreds of times per night without the person ever fully waking up or knowing it is happening.
There are three types. Central sleep apnea occurs when the brain fails to send the signals needed for breathing. Complex sleep apnea combines central and obstructive patterns. Obstructive sleep apnea (OSA) is the most common and is the focus of this article. In OSA, the airway physically collapses or becomes blocked during sleep, preventing airflow even while the body continues trying to breathe. OSA affects a significant portion of the population and is far more likely to go undiagnosed than other common chronic conditions.
Who is most at risk?
OSA affects people of all body types, but obesity is the single strongest risk factor. It affects roughly 20 percent of obese adults compared to about 3 percent of those at a healthy weight. Men are more commonly affected than women, though this gap narrows significantly after menopause as weight distribution shifts toward the abdomen and upper body, placing more pressure on the airway.
Other factors that increase risk include:
- Narrowed airway from enlarged tonsils or adenoids that physically restrict airflow during sleep
- High blood pressure, which has a well-established bidirectional relationship with OSA
- Chronic nasal congestion that further narrows an already compromised airway during sleep
- Family history of OSA, which suggests a genetic component to airway structure and function
- Asthma, which studies show increases the likelihood of developing OS
- Sedentary lifestyle that contributes to the weight gain associated with airway compression
Signs you may have obstructive sleep apnea
Heavy snoring is the most recognized sign, often first noticed by a partner. But snoring alone is not a reliable indicator. Some people with OSA do not snore significantly, and many heavy snorers do not have OSA. The more telling signs are what happens during waking hours as a result of the disrupted sleep:
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Persistent fatigue even after a full night of sleep
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Waking with a dry mouth or sore throat from breathing through the mouth
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Morning headaches that may result from overnight oxygen deprivation or elevated carbon dioxide
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Memory problems, difficulty concentrating, or mood changes
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Depression or irritability without a clear cause
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Waking up gasping or choking, if the apneic episodes are severe enough to trigger a conscious response
What untreated sleep apnea does to the body over time
The consequences of long-term untreated OSA extend well beyond poor sleep. Chronic oxygen deprivation and the body’s nightly stress response create a cascade of effects across multiple organ systems.
Cardiovascular system
Each apneic episode triggers a stress response that floods the body with cortisol and other hormones. These hormones raise blood pressure, accelerate heart rate, and constrict blood vessels. When this cycle repeats dozens of times every night for years, intermittent high blood pressure becomes chronic hypertension. The American Heart Association has directly linked OSA to elevated cardiovascular risk, including heart attack, stroke, heart failure, artery disease, kidney damage, and aneurysm. The compounding effect of poor oxygenation and a heart working at elevated effort is one of the most serious long-term risks of untreated OSA.
Eyesight
The eyes are particularly vulnerable to the oxygen restriction that occurs during apneic episodes. Documented ocular conditions associated with OSA include:
Nonarteritic anterior ischemic optic neuropathy (NAION)
Oxygen deprivation to the optic nerve can cause temporary vision loss that typically occurs in the morning and improves as oxygen levels normalize after waking.
Glaucoma
Increased intraocular pressure associated with OSA can lead to permanent vision loss. Studies indicate that OSA patients are up to ten times more likely to develop glaucoma.
Floppy eyelid syndrome
Characterized by loose upper eyelids that flip over during sleep, causing chronic eye irritation upon waking. One study found that 90 percent of participants with floppy eyelid syndrome also had OSA.
Metabolic function and diabetes
Chronic oxygen deprivation during sleep raises carbon dioxide levels in the blood, which increases insulin resistance. Over time this disrupts glucose regulation and raises the risk of developing type 2 diabetes. Research has shown that OSA can increase both the likelihood and severity of type 2 diabetes independently of obesity, meaning the effect is not simply explained by the shared risk factor of excess weight.
Brain health and neurodegeneration
During deep sleep, the brain clears beta-amyloid proteins that accumulate throughout the day. When OSA repeatedly interrupts or prevents reaching this stage of sleep, these proteins build up. Their accumulation is strongly associated with Alzheimer’s disease and other forms of dementia. Studies have found that people with OSA are diagnosed with cognitive impairment on average ten years earlier than those without the condition.
The most important thing to understand about OSA: most of its serious consequences are preventable. The heart disease, vision changes, cognitive decline, and metabolic disruption associated with sleep apnea are largely the result of years of undetected, untreated oxygen deprivation. Early diagnosis changes the trajectory significantly.
How sleep apnea is diagnosed and treated
The gold standard for OSA diagnosis is polysomnography, a comprehensive overnight sleep study that monitors breathing, oxygen levels, brain activity, and other measures simultaneously. A specialist can also review medical history and conduct a physical examination that may identify warning signs before a formal sleep study is ordered.
Treatment options depend on the type and severity of OSA and may include:
CPAP therapy
Continuous positive airway pressure is the most widely used treatment for moderate to severe OSA. It delivers a steady stream of air through a mask to keep the airway open during sleep.
Oral appliance therapy
Custom dental devices reposition the jaw and tongue during sleep to prevent airway collapse. These are particularly effective for mild to moderate OSA and for patients who cannot tolerate CPAP.
Lifestyle changes
Weight loss is among the most effective interventions for OSA. Reducing fat accumulation in the neck and upper abdomen directly decreases the pressure placed on the airway during sleep.
Surgical options
For anatomical causes such as enlarged tonsils, a deviated septum, or jaw structure issues, surgical intervention may provide a more permanent solution. Implant-based therapies are also available for select patients.
Addressing underlying conditions
When OSA is driven by a specific medical condition such as chronic nasal congestion, allergies, or hypothyroidism, treating that condition can significantly reduce apneic episodes.
Experiencing symptoms of sleep apnea? Dr. Omrani can help.
Headache TMJ Los Angeles Pain Clinic is a leading orofacial pain clinic serving patients in Los Angeles and Santa Monica. Dr. Katayoun Omrani provides evaluation and treatment for patients experiencing snoring, jaw-related sleep disruption, and symptoms consistent with obstructive sleep apnea. Early diagnosis and treatment can prevent many of the serious complications described above.
Call (310) 422-4246 to schedule an appointment
