Clinical Features

Signs and Symptoms of SDB

Excessive Daytime Sleepiness (ESS)

 

Those with SDB are very often more tired and sleepy than normal. The brain is constantly pulled out of deep sleep. Most that have SDB also have excessive daytime sleepiness.

The Epworth Sleepiness Score is a validated questionnaire that helps one evaluate the severity of the ESS. This a series of questions asking the likelihood of dozing off in certain situations. The maximum score is 24/24.

0-5 Lower Normal Daytime Sleepiness

6-10 Higher Normal Daytime Sleepiness

11-12 Mild Excessive Daytime Sleepiness

13-15 Moderate Excessive Daytime Sleepiness

16-24 Severe Excessive Daytime Sleepiness

 

Loud Snoring  

Almost everyone with SDB snores, but not everyone who snores has SDB. Snoring is the hoarse or harsh sound that occurs when air flows past relaxed tissues in your throat, causing the tissues to vibrate as you breathe. Many that snore loudly are completely unaware that they are doing so. It can take some convincing from bed partner and family for those affected to be convinced. 

Memory Loss 

Research suggests that people with SDB have trouble converting short-term memories into long term ones. Consolidating memories or storing experiences so that they can be accessed later, is a vital link in the memory-creating process that occurs during sleep. When sleep is impacted by a disorder, people have trouble incorporating and categorizing their experiences, which 

leads to impaired memory formation and forgetfulness. When SDB is treated memory often improves.

Impotence  

Erectile dysfunction is quite common in men who have OSA. In 2009, German researchers reported that 69% of male study participants with obstructive sleep apnea also had ED. Insufficient sleep, such as that caused by sleep apnea, can reduce testosterone levels, resulting in poor erections and decreased libido. More research is needed, but scientists have found that treating SDB may also help ease symptoms of ED. Many men with OSA who use continuous positive airway pressure (CPAP) for treatment experience improved erections.

Marriage Problems

Couples who struggle with sleep apnea have a high-divorce rate. The lack of sleep for both partners puts a strain on the marriage and creates a hostile and tense situation. Those with SDB are more likely to be irritable, lack focus, and are more prone to mood swings. This in turn leads to a lack of intimacy and partner bonding. When this carries on for years with no resolution or intervention, it becomes clear why snoring is identified as a significant cause of divorce.

Restless Sleep/ Heavy Sweating

When we stop breathing at night our O2 levels drop and our body is thrust into the “fight-or-flight” response, also known as acute stress response. This causes an increase in heart rate, constriction of blood vessels, and sweating. Once SDB is treated, the majority of people never sweat at night again.

Nighttime Choking and Coughing

Very common with SDB and many affected are not even aware of this. The bed partners usually are.

Witnessed Apnea  

The bed partner will often notice pauses in the breathing of their spouse at night. This can be frightening for many. These eyewitness reports are a significant factor when assessing risk of SDB.

Morning Headaches

Morning headaches are often experienced by patients with moderate to severe sleep apnea. The oxygen levels drop and CO2 levels rise due to the intermittent breathing. This lack of oxygen in the bloodstream, along with a build-up of carbon dioxide, negatively affects the brain and may lead to sleep apnea headaches. Morning headaches are often resolved when the SDB is treated properly.

Gastro-Esophageal Reflux (GERD)  

When we stop breathing due to a collapsed airway, the desire to breath continues. This desire increases as time passes without a breath. We continue to have chest movement and this can generate great negative pressures within the thoracic cavity. This often draws stomach contents up into the esophagus causing gastric reflux. As you can well imagine, when the airway remains open with CPAP therapy this can significantly reduce or eliminate GERD at night.

Untreated OSA leads to:

  • Increased Illness   The multiple negative effects of untreated OSA leads to poor general health throughout the patient’s lifetime.

  • Increased Risk of Death   The continual ill effects of untreated OSA throughout our life can contribute to a shorter life span.   

The greater the severity of SDB, the higher the risk:   

  • High blood pressure

  • Stroke  - 4X more likely

  • Heart attacks 

  • Heart failure

How bad is OSA for the heart?

When we pause in breathing during the night our blood O2 levels are likely to drop. This causes the blood vessels in our lungs to constrict, resulting in our heart having to work extra hard to pump blood through the lungs. Little by little this stresses the heart and may weaken the heart muscle and result in an enlarged heart that does not pump as efficiently as it should.