IMPACT

Snoring and OSA are so common that their true impact on our daily lives is difficult to appreciate. These problems can affect all areas of our lives. The wide extent of these effects can be categorized in the following way:

• General well-being or quality of life,
• Occupational impairment,
• Driving,
• Disease in the usual medical sense.

General Well-Being / Quality-of-Life

Snoring can create a severe strain on a relationship. Imagine sleeping next to a buzz-saw every night. Before long, you will become angry and resentful. You may even start waking the snorer up to stop the noise and to reposition the snorer. In the morning, you are both tired and upset from the night's disturbance. In one extreme case, a wife applied Crazy Glue to her husband's lips and nostrils to stop the snoring. He suffocated and died.

Patients with OSA often wake up tired and irritable. They may find it difficult to stay focused and are forgetful. None of these traits are conducive to maintaining good relationships. The fatigue and sleepiness that patients with OSA suffer prevents them from being full participants in life.

There have been several recent scientific studies looking at these issues. These studies found that quality-of-life was significantly impaired in patients with OSA and that treatment could restore normal function.

Occupational Impairment

The best documentation of occupational impairment due to OSA can be found for truck drivers. The Stanford study showed that OSA was common in this group. Other studies have shown that the degree of impairment in driving ability due to OSA could be more severe than that seen in drivers with blood alcohol levels far in excess of the legal limit. There have been a few small studies showing that treatment can restore normal driving ability. There are now several initiatives underway to develop screening programs for OSA in commercial drivers.

OSA affects individuals in all walks of life and occupations. The overall economic impact from OSA in terms of sick-leave, health insurance costs, accidents on the job, and lowered productivity is estimated to be in the tens of billions annually.

Driving

The Wisconsin Sleep Cohort Study recently reported that:

• Drivers with Mild OSA were 3 times as likely to be involved in a car accident as those without OSA,
• Drivers with Moderately Severe OSA were 7 times as likely to be involved in a car accident as those without OSA.

These figures are quite similar to those reported for long-haul truck drivers.

Medical Disease

Snoring by itself is not thought to contribute to other health problems. OSA, on the other hand, is closely associated with a number of serious medical conditions. These include:

• Hypertension - as many as 40 % of people being treated for hypertension will show evidence of OSA. Patients with OSA do not show a normal drop in diastolic blood pressure when they go to sleep. OSA may be the cause of poorly-controlled hypertension in some patients.
  
• Coronary Artery Disease - the evidence is less firm for a connection between OSA and coronary artery disease. However, there does appear to be a 2 - 3 times increased risk of heart attack in patients with OSA. There is speculation that OSA may be one factor in the higher frequency of heart attacks in the early morning hours. Blood factors that promote coagulation are higher in patients with untreated OSA and this may be one explanation of why these patients have more heart attacks.
  
• Stroke - there is mounting evidence of a link between OSA and strokes. The risk for stroke in patients with OSA appears to be increased by a factor of 2 - 3. Recent studies on patients who have had strokes show a very high prevalence of OSA.
  
• Irregular Heart Rhythms/Sudden Death - a connection between OSA and these problems is plausible. However, no one has actually provided good evidence for or against there being a connection.
  
• Adult-Onset Diabetes - there may be a connection between OSA and adult-onset diabetes. One theory is that the stress of OSA is a stimulus to weight gain which causes insulin resistance. This creates a vicious cycle of further weight gain and more insulin resistance. Eventually, the body cannot produce enough insulin and the symptoms of diabetes develop. There has been one study showing improvement in blood sugar control when patients with adult-onset diabetes who also have OSA are placed on treatment for the OSA.

There was a recent review of studies looking at diseases associated with OSA in the Lancet. This study questioned the validity of the conclusions that were drawn in many of the studies. However, this simply reflects the difficulty of showing an independent effect from OSA in populations in which smoking, obesity, and alcoholism are common. More recent studies which were not included in the review have better study designs and provide strong evidence of the important relationships between OSA and these serious medical conditions.

For more information on the economic impact of sleep disorders click here.