Ask the Pharmacist

Q) I have heard a couple of references to sleep apnea on the television recently. Are their new developments that I should be aware of?

A) Sleep apnea is a medical condition that causes people afflicted with it to stop breathing for short periods of time as there airways become blocked during sleep when the associated muscles around them relax. These periods are referred to as apneas and tend to last somewhere between 10 to 30 seconds in duration. This occurs multiple times for anyone with even a mild case of apnea and in severe cases, this can repeat literally hundreds of times a night.

It is a very common condition as statistics from 2017 indicated that 6.4% of Canadians reported they had been diagnosed with this condition by a health care professional. This number, of course, does not include the tens of thousands of us who have this disorder but have never been formally diagnosed.

Some researchers estimate that up to 85% of sleep apnea disorders are undetected. It has been well established that left untreated, sleep apnea has been linked to both quality of life implications and long-term health complications. In the short-term, people with sleep apnea are sleep deprived and thus tend to be constantly fatigued, have problems thinking clearly and are more likely to be involved in motor vehicle accidents.

In the long-term, it has been associated with high blood pressure and heart problems as the sudden drops in blood oxygen put a real strain on your entire cardiovascular system. It also has been linked with type 2 diabetes, issues with your liver (in particular non-alcoholic fatty liver disease) and with increased challenges in undergoing surgery as the likelihood of complications in breathing while undergoing anaesthesia rises.

All in all, people with an apnea score of 20 or higher have an 8 year mortality rate of 37% versus less than 4% in people with an apnea index of less than 20. In short, sleep apnea kills.

Also, not to be taken lightly, people with apnea tend to be loud snorers which can negatively impact the relationships you have with the people who share your domicile.

The good news is that there is an effective non-drug treatment. It’s called a CPAP machine (continuous positive airway pressure device) and it is essentially a device that forces your airways open via a stream of air delivered into your nose and or mouth through a mask. For many, using a CPAP is a game changer. They feel more energetic virtually within days, are thinking clearer than they have in years and their partner suddenly likes them again.

But many do not feel a significant difference from using the CPAP and stop using the device shortly after starting treatment due to a variety of reasons such as skin reactions and discomfort from the mask, symptoms of nasal congestion and dryness as well as eye irritation. Others stop using it due to feelings of claustrophobia or for other psychological reasons.

Some studies have suggested that despite all the known health benefits, as many as 37% of people diagnosed with sleep apnea wind up being non-compliant when it comes to treatment. However, there are two new studies that just might serve to change the minds of some of those non-adherents.

The first is a retrospective study out of the States where more than2.7 million recipients of Medicare had their data assesses for the incidence of sleep apnea, their use of CPAP therapy and their likelihood of being diagnosed with some form of dementia later on in life. When the data was pooled and assessed, people who were treated for apnea (as opposed to those who were diagnosed with it but did not continue their treatment over the long term) had a 22% reduced odds of being diagnosed with Alzheimer’s disease, a 31% reduced odds of being diagnosed with dementia (whose cause is not otherwise specified) and 18% reduced odds of being found to be mildly impaired cognitively.

This new data falls in line with previous studies that established that those with sleep apnea tended to have a younger age of onset of Alzheimer’s or mild cognitive impairment. There are several theories for this link including the possibility that the disruption of sleep might lead to an increased production or decreased clearance of amyloid and tau or perhaps heightened the sensitivity of neurons to hypoxia (a lack of oxygen).

The other study was conducted in the United Kingdom and it concluded that patients who have been diagnosed with sleep apnea seem to be more at risk of suffering from further complications or dying as a result of having been infected with the coronavirus. This is not considered to be a major surprise since it is believed that the infection results in an increase in oxidative stress & inflammation all while impacting the bradykinin pathways which are all mechanisms within the body that are also affected by sleep apnea.

While the scientists acknowledged that more research is needed before we can definitively add individuals with sleep apnea to the list of vulnerable groups, they did feel it was important for these patients to be aware that they may well face additional risks if they contract COVID-19.

There is, however, a modicum of good news as well. The review suggested that treatment of apnea with a CPAP machine did provide some beneficial effects on these individuals. So, for those of you with apnea that you have chosen to ignore and the many more who snore nightly but have never bothered to see a doctor about it, you have two additional powerful reasons to start paying attention to this disorder. The masks or nasal prongs do take some of us a while to adjust to, but the potential rewards in a longer and healthier life are well worth the effort. For more information about this or any other health related questions, contact your pharmacist.