Don't Lose Sleep Over Obstructive Sleep Apnea Stephanie Townsend talks to sleep medicine expert Dr. Raghu Upender about obstructive sleep apnea.
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Stephanie Townsend: Welcome to this edition of the Vanderbilt University Health and Wellness Wellcast. I am Stephanie Townsend with Vanderbilt Occupational Health. We are here today to discuss sleep apnea with Dr. Raghu Upender, Department of Neurology, Sleep Disorder Division. Why is getting good sleep so important? Dr. Raghu Upender: Sleep is important because it provides rest and gets the body an opportunity to recover and repair itself. As a neurologist, I will focus on the brain which I think is the most important organ in the body. Sleep provides time for the brain to rest from this high activity level that occurs during the day and it allows the brain to recover its energy stores including important neurotransmitters. Sleep also allows the brain to repair itself. Sleep provides an important function in memory and learning because synaptic connections are the basis for memory and learning. Another important function of sleep is it provides the brain an opportunity to clear itself of toxins. Much like the blood vessels that bring nutrients to the body and remove toxins, there are channels within the brain that perform similar function, and when we sleep, the brain is allowed to remove these toxins. This is one of the reasons why we may feel tired and our concentration is affected and our mood is poor when we are sleep deprived, and that may be one of the reasons why when we sleep well we wake up feeling refreshed, bright, and energetic. Stephanie Townsend: What is sleep apnea, and how can it affect sleep? Dr. Raghu Upender: Sleep apnea is a condition that occurs because of the way that our upper airway functions. Our upper airway allows air to flow from the nasal cavity into the lungs, and this upper airway is very flexible and it is kept open by muscles. When we sleep, the muscles that keep the airway open tend to relax, and when that happens, the airway becomes narrow. In most people, it is not a big problem, but those who have sleep apnea, the airway becomes so narrow that they do not convey enough air flow to the lungs. As a result, oxygen levels drop. When this happens, the brain has to awaken to open the airway to bring back the oxygen levels up and consequence of this is that the sleep becomes very fragmented and becomes non-refreshing. So, one of the most common symptom of sleep apnea is non refreshing sleep and daytime sleepiness. Stephanie Townsend: How can obstructive sleep apnea affect the person’s overall health? Dr. Raghu Upender: You have to think of it in terms of short-term and long-term effects. Short-term effects come from the sleep fragmentation caused by sleep apnea. The symptoms include non-refreshing sleep, daytime sleepiness, poor concentration, irritability, and falling asleep in situations where it is not appropriate like falling asleep at meetings and more dangerously falling asleep behind the wheel. The long-term effects are related to the metabolic changes that occur as a result of sleep apnea. The sleep fragmentation caused by sleep apnea is associated with changes in your metabolism. You can actually slow down your metabolism and cause people to gain weight, and when they gain weight, they increase the risk of more sleep apnea, so the sleep apnea gets worse, which only causes more weight gain and becomes a vicious cycle. Sleep apnea can also lead to chronic medical problems like high blood pressure, heart disease, stroke, and recently, there is evidence that it can even cause dementia like Alzheimer-type dementia, and there is some link between sleep apnea and cancer. So, it is really a serious problem in the long term. The goal of identifying and treating sleep apnea is to help people immediately help them the rest that they need and perform better during the day but also to help them reduce the risk of these long-term medical complications. Stephanie Townsend: Are there risk factors that a person can look forward to see if they are at risk for obstructive sleep apnea? Dr. Raghu Upender: Yes, there are screening tools, but I always tell my patients if they snore and if they are tired they are at risk and they should talk to their primary care physician about the possibility of having further evaluation for sleep apnea. There are more formal screening tools. The one that I like the best is the STOP-Bang tool. It is a tool that was developed by anesthesiologist, but it is easy to do. There are eight items. If you are positive for any one of them, you will get one point, and a score of three or more puts you at risk. So, let me list those risks. For STOP, S is for snoring, T is for tired, O is for obstruction that your bed partner may observe, and P is for pressure as in hypertension, high blood pressure, and then Bang, B is for body mass index greater than 30, A is for age greater than 50, N is for neck circumference greater than 17 inches for men and 16 inches for women, and G is for male gender. So, if you have these items, you get one point for each one, and if you have more than three, then you are at risk for sleep apnea, and of course, in a middle-aged male you who snores immediately has three. We particularly target those who have more than five, but again, if you are tired and you cannot explain why, it is really important to get evaluated. Stephanie Townsend: How would a person find out for sure if they have obstructive sleep apnea? Dr. Raghu Upender: The best way to evaluate sleep apnea is by doing a sleep test in a sleep lab. So, a patient would go to a sleep clinic and see a sleep physician who can determine the various risks of sleep apnea and other sleep disorders that may contribute to some of the symptoms and then decide on testing for sleep apnea. Traditionally, we do an in-lab test, and this involves a patient going to one of our sleep labs and sleeping the entire night. So, a patient would sleep overnight, they will have sensors placed on them by the technologist, and they sleep in their own hotel room and we observe their breathing, oxygen levels, and heart rate and determine if they have apnea. Recently, we are also doing home sleep testing in subpopulation of patients who are at high risk for sleep apnea. Home sleep testing is not as sensitive as the lab test and it does not provide as accurate results as the lab test, but in those who have lot of risk factors for sleep apnea, the home sleep test is a good tool to confirm the diagnosis so that you could proceed with treatment. Seeing a sleep physician is the best way to determine which test is appropriate for you. Stephanie Townsend: What resources does Vanderbilt provide for evaluation and treatment? Dr. Raghu Upender: We have multiple sleep clinics across the campus and off campus. On campus, we have a clinic at TVC with the pulmonologist. We have a clinic in the Children’s Hospital with the pediatricians, and off campus, we have a clinic at 100 Oaks and Edward Curd Lane, and of course, as I mentioned earlier, there are now two sleep labs, one at the Marriott Hotel across from Centennial Park and another in Cool Springs on Bakers Bridge Road at the Hyatt Place Hotel. Stephanie Townsend: Thank you Dr. Upender. Thanks for listening. Please feel free to leave us any comments on this Wellcast on the form at the bottom of this page. If you have a story suggestion, please email it to us at health.wellness@vanderbilt.edu or you can use the “Contact Us” page on our website at healthandwellness.vanderbilt.edu. -- end of recording --
