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Can Sleep Apnea Kill You?

Can Sleep Apnea Kill You?
Written by Matthew Hermann

If your question is - does sleep apnea kill you by itself? -then it depends. Some studies state there is no increased risk of death and that sleep apnea in itself is not an increased risk factor for increased mortality[1],[2].

However, there is conflicting data and other studies show that sleep apnea, even in the absence of other risk factors, can cause death.  Even the severity of sleep apnea in itself could cause death by having worsening respiratory instability[3].

Does Sleep Apnea Increase Your Risk of Death?

If your question is—can sleep apnea increase my risk of death? Then the answer is likely yes if you have other medical conditions. Sleep apnea causes decreased oxygen (ischemia) to your tissues, meaning that virtually every organ system is affected.

  • Cardiovascular disease, the leading cause of death for over the past 100 years, can get worse with under-treated or untreated sleep apnea[4]. Sleep apnea can worsen cardiovascular disease by causing worsening left ventricular dysfunction.
  • Sleep apnea can increase the risk of cardiovascular events (i.e.: heart attacks) according to a study at Yale.[5]
  • Sleep apnea can also increase your risk of diabetes according to the same study at Yale.
  • Obstructive sleep apnea has even been shown to be an independent risk factor for stroke and other complications[6].
  • Sleep apnea can worsen asthma.[7]
  • The decreased oxygen to your neural tissues can induce neural injury causing memory difficulty, dementia and cognitive decline. Sleep apnea also worsens hypertension if untreated[8].
  • Some studies have shown sleep apnea to be an independent risk factor for diabetes[9]

So, if your anxiety has increased, don’t despair. Instead of focusing on whether sleep apnea itself can cause increased risk of death, it’s more important to focus on the fact that sleep apnea can worsen other medical conditions (which can also worsen sleep apnea), and that can cause increased mortality.

Types of Sleep Apnea

There are different kinds of sleep apnea, and the most common is Obstructive Sleep Apnea (OSA). There are other kinds of sleep apnea such as Central Sleep Apnea and Complex Sleep Apnea.

Are you worried that you have sleep apnea? Are you diagnosed and concerned about your health?

Getting Diagnosed With Sleep Apnea

To be diagnosed with sleep apnea, you need to undergo a sleep study. These are usually done in one of two ways[10]:

  • Polysomnography in a sleep center - This entails going to a sleep center and getting different instruments actually attached to your body to monitor your breathing, brain waves, oxygen levels, amongst other parameters. Be prepared to not sleep in your own bed.
  • Home polysomnography - This is like a sleep study above but it is done in your own home. It presents its own challenges, but there are advantages such as sleeping better in your own bed.[11]
  • Clinical diagnosis- Not recommended but sometimes used in the presence of some patients with excessive snoring and daytime sleepiness that responds to continuous positive airway pressure (CPAP).

First and foremost, speak with a sleep specialist about getting diagnosed and/or treated if you are concerned. Sleep apnea is a heavily-underdiagnosed condition, especially in the elderly and children[12].

What Are the Signs and Symptoms of Sleep Apnea?

Sleep apnea has a variety of symptoms, one of the main symptoms is excessive daytime sleepiness[13]. Other causes can include[14]:

  • Snoring
  • Gasping
  • Memory difficulty
  • Impotence
  • Heartburn
  • Depression
  • Teeth grinding
  • Daytime headaches (especially when you wake up)
  • Sleeping on your back

Even if you don’t think you have sleep apnea, you may depending on other conditions you may have. If you have heart failure or cardiovascular disease, you should be screened for sleep apnea[15]. Sleep apnea is also more prevalent in other disorders such as diabetes and hypertension[16]. Treating sleep apnea can may also help these other conditions[17][18][19].

Sleep Apnea Treatment

There is no magic pill (or sleep strip) for treating sleep apnea. Taking sleeping pills in the absence of actual treatment for sleep apnea may even worsen your condition. Your doctor may discuss with you some treatments for sleep apnea which may include:

Continuous Positive Airway Pressure

Continuous Positive Airway Pressure (or CPAP) can help with all three types of obstructive sleep apnea.[20] Unfortunately, this is not universally-tolerated and compliance can be difficult. It’s important that if you use CPAP to have it regularly fitted or it will not work effectively.

Mandibular Advancement Devices

Depending on the level of obstruction, mandibular advancement devices may be helpful for opening up the airway. [21]

Surgery

Depending on the structural abnormality you may have, surgery may be a viable option to open up your airway. Whether it is nasal septal deviation, macroglossia (large tongue), small mouth (micrognathia), amongst other anatomic variants, surgery can have positive outcomes. Consider speaking with your sleep specialist about this as you would need to be referred to an ear, nose, and throat surgeon (ENT) who specializes in sleep apnea treatment.

Weight Loss

Excess tissue around your neck from being overweight or obese can definitely affect your ability to breathe while lying flat. Weight loss, in addition to helping people with sleep apnea, can also help other conditions that come with being overweight or obese (hypertension, cardiovascular disease, diabetes, etc…).[22][23]

Smoking Cessation

As smoking changes normal sleep architecture, stopping smoking can help not only stop this disordered architecture but also may have a synergistic effect on people with cardiovascular disease.[24]

    As stated, there is no pill or supplement to help with sleep apnea. While many medical conditions such as chronic pain or high blood pressure can be treated with pills, sleep apnea is a structural disorder that requires some sort of intervention to relieve the obstruction.

    Because of increased risk of other diseases, it’s important to get treated for sleep apnea sooner rather than later due to increased risk for heart disease, stroke, dementia, amongst other complications.

    Even if you aren’t too excited about getting a CPAP machine, consider at least talking with a sleep provider to see if you are a candidate for other interventions.

    References 

    [1] Yu J, Zhou Z, McEvoy RD, Anderson CS, Rodgers A, Perkovic V, Neal B. Association of Positive Airway Pressure With Cardiovascular Events and Death in Adults With Sleep Apnea: A Systematic Review and Meta-analysis. JAMA. 2017 Jul 11;318(2):156-166. doi: 10.1001/jama.2017.7967. PMID: 28697252; PMCID: PMC5541330.

    [2] Rod NH, Kjeldgård L, Åkerstedt T, Ferrie JE, Salo P, Vahtera J, Alexanderson K. Sleep Apnea, Disability Pensions, and Cause-Specific Mortality: A Swedish Nationwide Register Linkage Study. Am J Epidemiol. 2017 Sep 15;186(6):709-718. doi: 10.1093/aje/kwx138. PMID: 28520881.

    [3] Butler MP, Emch JT, Rueschman M, Sands SA, Shea SA, Wellman A, Redline S. Apnea-Hypopnea Event Duration Predicts Mortality in Men and Women in the Sleep Heart Health Study. Am J Respir Crit Care Med. 2019 Apr 1;199(7):903-912. doi: 10.1164/rccm.201804-0758OC. PMID: 30336691; PMCID: PMC6444651.

    [4] Selim B, Won C, Yaggi HK. Cardiovascular consequences of sleep apnea. Clin Chest Med. 2010 Jun;31(2):203-20. doi: 10.1016/j.ccm.2010.02.010. PMID: 20488282.

    [5]  Botros N, Concato J, Mohsenin V, Selim B, Doctor K, Yaggi HK. Obstructive sleep apnea as a risk factor for type 2 diabetes. Am J Med. 2009 Dec;122(12):1122-7. doi: 10.1016/j.amjmed.2009.04.026. PMID: 19958890; PMCID: PMC2799991.s

    [6] McDermott M, Brown DL. Sleep apnea and stroke. Curr Opin Neurol. 2020 Feb;33(1):4-9. doi: 10.1097/WCO.0000000000000781. PMID: 31809332.

    [7] Rundo JV. Obstructive sleep apnea basics. Cleve Clin J Med. 2019 Sep;86(9 Suppl 1):2-9. doi: 10.3949/ccjm.86.s1.02. PMID: 31509498.

    [8] Dempsey JA, Veasey SC, Morgan BJ, O'Donnell CP. Pathophysiology of sleep apnea. Physiol Rev. 2010 Jan;90(1):47-112. doi: 10.1152/physrev.00043.2008. Erratum in: Physiol Rev.2010 Apr;90(2):797-8. PMID: 20086074; PMCID: PMC3970937.

    [9] Muraki, I., Wada, H., & Tanigawa, T. (2018). Sleep apnea and type 2 diabetes. Journal of diabetes investigation, 9(5), 991–997. https://doi.org/10.1111/jdi.12823

    [10] Rundo JV. Obstructive sleep apnea basics. Cleve Clin J Med. 2019 Sep;86(9 Suppl 1):2-9. doi: 10.3949/ccjm.86.s1.02. PMID: 31509498.

    [11] Bruyneel M, Ninane V. Unattended home-based polysomnography for sleep disordered breathing: current concepts and perspectives. Sleep Med Rev. 2014 Aug;18(4):341-7. doi: 10.1016/j.smrv.2013.12.002. Epub 2013 Dec 12. PMID: 24388970.

    [12] Lin J, Suurna M. Sleep Apnea and Sleep-Disordered Breathing. Otolaryngol Clin North Am. 2018 Aug;51(4):827-833. doi: 10.1016/j.otc.2018.03.009. Epub 2018 May 17. PMID: 29779616.

    [13] Bonsignore MR, Marrone O, Fanfulla F. Sleep Apnea, Sleepiness, and Driving Risk. Sleep Med Clin. 2019 Dec;14(4):431-439. doi: 10.1016/j.jsmc.2019.08.001. Epub 2019 Sep 25. PMID: 31640871.

    [14] Martynowicz, H., Gac, P., Brzecka, A., Poreba, R., Wojakowska, A., Mazur, G., Smardz, J., & Wieckiewicz, M. (2019). The Relationship between Sleep Bruxism and Obstructive Sleep Apnea Based on Polysomnographic Findings. Journal of Clinical Medicine, 8(10), 1653. https://doi.org/10.3390/jcm8101653

    [15] Woehrle H, Oldenburg O, Stadler S, Arzt M. Schlafapnoe als Komorbidität bei Herzinsuffizienz [Comorbidities of heart failure: sleep apnea]. Internist (Berl). 2018 May;59(5):428-438. German. doi: 10.1007/s00108-018-0412-7. Erratum in: Internist (Berl). 2018 Aug;59(8):871-872. PMID: 29637238.

    [16] Floras JS. Hypertension and Sleep Apnea. Can J Cardiol. 2015 Jul;31(7):889-97. doi: 10.1016/j.cjca.2015.05.003. Epub 2015 May 16. PMID: 26112299.

    [17] Woehrle H, Oldenburg O, Stadler S, Arzt M. Schlafapnoe als Komorbidität bei Herzinsuffizienz [Comorbidities of heart failure: sleep apnea]. Internist (Berl). 2018 May;59(5):428-438. German. doi: 10.1007/s00108-018-0412-7. Erratum in: Internist (Berl). 2018 Aug;59(8):871-872. PMID: 29637238.

    [18] Arzt M, Bradley TD. Treatment of sleep apnea in heart failure. Am J Respir Crit Care Med. 2006 Jun 15;173(12):1300-8. doi: 10.1164/rccm.200511-1745PP. Epub 2006 Mar 9. PMID: 16528015.

    [19] Woehrle H, Oldenburg O, Stadler S, Arzt M. Schlafapnoe als Komorbidität bei Herzinsuffizienz [Comorbidities of heart failure: sleep apnea]. Internist (Berl). 2018 May;59(5):428-438. German. doi: 10.1007/s00108-018-0412-7. Erratum in: Internist (Berl). 2018 Aug;59(8):871-872. PMID: 29637238.

    [20] Muraki I, Wada H, Tanigawa T. Sleep apnea and type 2 diabetes. J Diabetes Investig. 2018 Sep;9(5):991-997. doi: 10.1111/jdi.12823. Epub 2018 Apr 14. PMID: 29453905; PMCID: PMC6123041.

    [21] Couch ME, Senior B. Nonsurgical and surgical treatments for sleep apnea. Anesthesiol Clin North Am. 2005 Sep;23(3):525-34, vii. doi: 10.1016/j.atc.2005.02.007. PMID: 16005828.

    [22] Hudgel DW, Patel SR, Ahasic AM, Bartlett SJ, Bessesen DH, Coaker MA, Fiander PM, Grunstein RR, Gurubhagavatula I, Kapur VK, Lettieri CJ, Naughton MT, Owens RL, Pepin JL, Tuomilehto H, Wilson KC; American Thoracic Society Assembly on Sleep and Respiratory Neurobiology. The Role of Weight Management in the Treatment of Adult Obstructive Sleep Apnea. An Official American Thoracic Society

    [23] Clinical Practice Guideline. Am J Respir Crit Care Med. 2018 Sep 15;198(6):e70-e87. doi: 10.1164/rccm.201807-1326ST. PMID: 30215551.

    [24] Deleanu OC, Pocora D, Mihălcuţă S, Ulmeanu R, Zaharie AM, Mihălţan FD. Influence of smoking on sleep and obstructive sleep apnea syndrome. Pneumologia. 2016 Jan-Mar;65(1):28-35. PMID: 27209838.