Abstract:
In the last century major death toll was due infections
and communicable diseases, but at present major
causes of death are non-communicable diseases like
cerebrovascular diseases, ischemic heart diseases,
chronic respiratory diseases and cancer. Etiology of
these listed disorders is multifactorial. Snoring and
obstructive sleep apnea was considered as social
problem, studies revealed obstructive sleep apnea is
important risk factor of life threatening diseases.
Morbidity, quality and cost of life depends on good
quality sleep which is fragmented by obstructive sleep
apnea.
Introduction:
Obstructive sleep apnea (OSA) is the most common
sleep-related breathing disorder and is characterized
by recurrent episodes of complete or partial
obstruction of the upper airway leading to reduced
or absent breathing during sleep. These episodes are
termed “apneas” with complete or near-complete
cessation of breathing, or “hypopnea” when the
reduction in breathing is partial. In either case, a fall
in blood oxygen saturation, a disruption in sleep, or
both, may result. A high frequency of apneas or
hypopneas during sleep may interfere with the
quality of sleep, which – in combination with
disturbances in blood oxygenation – is thought to
contribute to negative consequences to health and
quality of life.
1
The terms obstructive sleep apnea
syndrome (OSAS) or obstructive sleep apnea–
hypopnea syndrome (OSAHS) may be used to refer to
OSA when it is associated with symptoms during the
daytime (e.g. excessive daytime sleepiness, decreased
cognitive function).
At present about 85% of adult deaths were due to
non-communicable diseases, with ischemic heart
disease (21.1%), stroke(22.1%) and chronic respiratory
disease(16.4%) comprising about 60% alone among
the 65% of community death reporting in
Bangladesh
1
. Almost all of the causes of death (COD)
due to non-communicable disease are related or very
much influenced by obstructive sleep apnea. But
unfortunately we are unaware about this problem.
Methods:
PubMed and Google Scholar were searched using
the keywords obstructive sleep apnoea without
limiting the years of publication. In PubMed 42148
article was found with key ward obstructive sleep
apnea (OSA). Most recent articles were reviewed in
this article.
Results and discussions:
Prevalence of obstructive sleep apnea: Prevalence
of obstructive sleep apnea (OSA) ranged from 9% to
38% and it is higher in men. It increased with
increasing age and, in some elderly groups, was as
high as 90% in men and 78% in women
2
.
Hypertension and OSA: According to a report from
American Heart Association prevalence of HTN in
the United States adults was 45.6% and OSA is
estimated to have a prevalence of 30% to 50% in
patients with hypertension
3
.
OSA causes Stroke: Stroke is directly influenced by
OSA. In a study it is determined that 91.2% of the
patients had OSA in the acute stage of ischemic
stroke, and 70% of the patients had moderate to severe
OSA
4
. Apneic and hypoxemic episodes initiate the
process of inflammation and there is a cascade of
inflammatory markers such as IL, 1, IL 6, TNF a, and
interferon g. These inflammatory markers damage the
endothelial lining of the blood vessels, and there is
an increased aggregation of platelets which lead to
further oxidative stress and vascular endothelial
damage. This repetitive oxidative stress and vascular
damage in OSA patients along with fluctuation of
blood pressure due to sympathetic activation can
cause CVD and stroke.
Pabna Medical College Journal Vol. 2, No. 2 November, 2023
Type-2 Diabetes and OSA: Sleep fragmentation and
intermittent hypoxemia causes sympathetic
activation, oxidative stress, inflammation, and
neuroendocrine dysregulation which alter glucose
homeostasis. Type-2 diabetes has been estimated to
be 15% to 30%, with higher prevalence in those with
severe OSA
29
5
.
OSA causes hypogonadism: It is reported an
association between sleep disorders and plasma
testosterone levels and estrogens and progesterone
impact on upper airway stability and respiratory
control during the menstrual cycle. Sleep
fragmentation, disorganization of sleep cycles and
stages, sympathetic activation, intermittent
hypoxemia and systemic inflammation has a direct
central effect on neurotransmitters, with disturbances
in the normal production of hypothalamic pituitary
hormones and as well as gonadal functions
.
Conclusions:
Obstructive sleep apnea is emerging health problem
in developing countries when nutritional deficiency
disorders and communicable diseases are near to
erased. OSA is important risk factor or predisposing
condition of major life threatening non-communicable
diseases. To prevent cerebrovascular diseases,
hypertension, ischemic heart disease and diabetes
OSA management is crucial. Hypo-gonadism, hypo
fertility and infertility are also associated with OSA,
which is newer problem in our community. So
obstructive sleep apnea is not only a social problem
and cannot be ignored to achieve healthy life.