ADHD (attention deficit/hyperactivity disorder)

Inattention and hyperactivity are generally accepted as important consequences of sleep-disordered breathing.

Some sleep experts have made strong recommendations, such as:

"An assessment of sleep patterns and possible sleep problems should be part of the evaluation of every child presenting with behavioral and/or academic problems, especially Attention Deficit/Hyperactivity Disorder (ADHD)."

We more fully discuss the relationship between sleep breathing and childhood ADHD on another page.

Less is known about the relationship between sleep breathing and adult ADHD, but it would not be surprising if sleep played a role there as well.

See Coronary artery disease.

85% of asthma patients complain about being awakened from time to time by their asthma, There is a clear and common tendency for asthma attacks to be more frequent at night.

This raises the question, is it asthma or is it a sleep breathing disorder?

Recently, sleep studies were performed on 22 patients with severe, difficult to control asthma. Surprisingly, 21 of them (95%) turned out to have obstructive sleep apnea. And it wasn't mild sleep apnea -- the average number of apneas and near-apneas was 17.5/hour.

There is suggestive, but not conclusive, evidence that obstructive sleep apnea (OSA) influences atrial fibrillation. A recent review of OSA's role in cardiovascular disease noted:

• In patients with heart failure, atrial fibrillation is more common in those with OSA than in those without OSA.
• After coronary artery surgery, atrial fibrillation is more common in those with OSA than in those without OSA.
• After electric-shock treatment for atrial fibrillation, atrial fibrillation is more likely to recur in those with OSA than in those without OSA.

Persons with atrial fibrillation are far more likely to have symptoms of OSA than are persons without OSA. Finally, in men, the larger the neck, the more likely atrial fibrillation is to occur. (Neck size is a classic risk factor for OSA as well.)

See Coronary artery disease and Stroke.

See ADHD.

According to the International Chronic Fatigue Syndrome Study Group, "Diagnosis of the chronic fatigue syndrome can be made only after alternative medical and psychiatric causes of chronic fatiguing illness have been excluded."

The CFS Study Group lists sleep apnea as a condition that explains chronic fatigue. "Sleep deprivation or experimental disruption of sleep is known to produce many of the features of CFS, including fatigue, impaired cognition, and even joint pain and stiffness."

The reported prevalence of undiagnosed primary sleep disorders (sleep apnea, narcolepsy, and restless leg syndrome/periodic limb movements in sleep) varies from 0% to 50% of CFS patients.

As in fibromyalgia, the distinction between sleep apnea and a lesser difficulty of sleep breathing called "upper airway resistance syndrome," may be important.

Between 10% and 40% of persons with congestive heart failure have obstructive sleep apnea (OSA).

OSA is unquestionably bad for people with congestive heart failure. The deep breaths repeatedly attempted by a person with OSA puts an extra strain on the heart. The release of stress hormones during every apnea and near-apnea also puts an extra strain on the heart.

A recent study found that treatment of OSA, if it exists in a person with congestive heart failure, improves the efficiency of the heart.

A relationship between congestive heart failure and central sleep apnea has been known since 1818, lately under the name "Cheyne-Stokes respiration."

Obstructive sleep apnea (OSA) is an established cause of nighttime chest pains in persons with coronary artery disease (CAD).

In persons with CAD, untreated OSA is associated with a higher rate of death from cardiovascular causes, compared to persons with CAD and no OSA.  A recent review concluded that this "argues for the recognition and treatment of any sleep apnea in these patients" (i.e. patients with coronary artery disease). 

Does OSA make it more likely that coronary artery disease will develop? Viewed alone, OSA is associated with a greatly increased risk of having CAD. How much risk OSA adds to blood pressure and diabetic factors is unknown, because those factors are themselves affected by OSA.

Poor sensitivity to the hormone insulin is the root problem in many persons with diabetes, particularly obese persons. Weight loss generally improves insulin sensitivity.

Now, however, there is increasing evidence that treating sleep apnea can improve the body's sensitivity to insulin, independent of any change in weight. 

Because diabetes and sleep apnea often occur together, this discovery has major implications. It suggests "the presence of a potentially treatable risk factor for cardiovascular disease in the diabetic population."

A recent review of obstructive sleep apnea in epilepsy concluded:

Obstructive sleep apnea can affect an individual with epilepsy profoundly. These relatively common disorders can coexist and potentially exacerbate each other. The identification and appropriate treatment of OSA may have far-reaching consequences in improving a patient's quality of life and recurrence of seizures.

They also noted that a reduction in seizures has been seen in both adults and children with epilepsy who have had their OSA treated.

A recent study found that 27 of 28 women with fibromyalgia had limitations on airflow during sleep breathing. Only one of these women had obstructive sleep apnea. The others had a related condition called upper airway resistance syndrome. Eighteen of the 28 women snored at least occasionally.

Gastro-esopheageal reflux (GERD) is commonly found in persons who snore or have obstructive sleep apnea (OSA). A recent study found that 73% of such persons had symptoms of GERD, with no significant difference between persons with OSA and those with snoring alone.

Treating OSA has been shown to reduce the severity of GERD symptoms.

See Gastro-esopheageal reflux.

Before a heart attack, coronary artery disease is the major concern.

After a heart attack, congestive heart failure is the major concern.

See Congestive heart failure.

See Hypertension.

It is widely agreed that sleep apnea causes at least some cases of hypertension.  

This discovery has been called "profound."

In 2003, the foremost panel of hypertension experts in the United States did two remarkable things:

1. They put sleep apnea at the top of the list of identifiable causes of hypertension, and
2. They specified that the evaluation of all persons with hypertension should consider the possibility of sleep apnea.

These experts did not dictate how the evaluation should be performed because this is not presently known.

A few studies have shown that treatment of OSA can lower blood pressure, particularly when OSA is more severe.

Ultimately, you and your doctor (and perhaps your insurance company) will decide how a sleep apnea evaluation will be done. Information about your snoring can influence this decision.

A person with classic sleep apnea is sleepy during the day and falls asleep very quickly upon going to bed.

But not every person with sleep apnea has a classic case. A recent study showed that half of sleep apnea patients have significant insomnia complaints.

The American Academy of Sleep Medicine recommends testing for a sleep-breathing disorder when treatment of insomnia fails.

See Epilepsy.

Multiple studies show that snoring is associated with a higher risk of stroke.

Four studies have found that 60% to 80% of stroke survivors have sleep apnea.

No doubt some strokes specifically affect the muscles keeping the airway open during sleep breathing. One would expect a very high percentage of survivors of such strokes to have obstructive sleep apnea (OSA). Thus, snoring that newly appears after a stroke is of particular concern, as it may signal the appearance of OSA.

The cause of some strokes is unknown (these are "cryptogenic strokes"). Occult right-to-left shunting is sometimes posited in such cases. Of note, apneic episodes in OSA can provoke right-to-left shunting through a foramen ovale that does not normally permit shunting.

One authority summarizes: "Regardless of whether OSA precedes or follows a stroke, it is associated with unfavorable clinical outcomes after stroke, including early neurologic worsening, delirium, depressed mood, poor functional status, and impaired cognition"