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Michael Breus, PhD, says the vast majority of obstructive sleep apnea cases begin with snoring and get worse over time.
By Tariq Kamal
Not everyone who has obstructive sleep apnea (OSA) snores and not everyone who snores has OSA, but there is little doubt that the two conditions are inextricably linked. Michael Breus, PhD, says that up to 80% of OSA patients started off as snorers. In the remaining cases, he says, the cause is “purely anatomical”—the jaw may be placed too far forward or the patient may have large tonsils, for example.
Unfortunately, there is little chance that a newly diagnosed OSA patient’s symptoms will “plateau”; instead, the symptoms are likely to worsen as they age.
“Once you have a mild case, you slowly become more sleep-deprived,” says Breus (pronounced “Bruce”), a board-certified sleep specialist and member of Sleep Review’s editorial board. “Your body can’t get into deeper stages [of sleep], and it gets progressively worse.”
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MichaelBreus, PhD
The increased frequency of apneas further exacerbates the patient’s condition by promoting obesity, a key anatomical cause of OSA. In his 2011 book, The Sleep Doctor’s Diet Plan: Lose Weight Through Better Sleep, Breus outlines the connection between sleep deprivation and weight gain in four steps:
- As patients become more sleep-deprived, their metabolic rate begins to fall.
- Increased wakefulness leads to elevated levels of cortisol, the so-called “fight or flight” hormone.
- This leads to increased levels of ghrelin, the hormone that tells us to eat, and a decrease in leptin, the hormone that tells us we’re full.
- Patients begin to crave high-fat, high-carbohydrate foods, which elevates their serotonin levels.
Along the way, Breus adds, patients become more likely to develop atrial fibrillation, a common form of arrhythmia, and refractory hypertension, a type of hypertension that does not respond well to medication.
Dentists and other sleep medicine providers must remain vigilant after the initial diagnosis, Breus says. Newer CPAP devices automatically collect data, such as apnea frequency, and share it with healthcare providers. For patients with older machines or mild to moderate OSA (which can often be treated with oral appliances, most of which do not currently collect or transmit data), healthcare providers must rely on regular screenings. Reports of more frequent apneas from patients and their bed partners are a sure sign of trouble.
Breus equates the progression of OSA to skin cancer: If a skin growth metastasizes, surgery, chemotherapy and radiation therapy all may be required. Knowing this, doctors and patients keep a close eye on growing or irregular moles. “People have recognized this for skin cancer but not for sleep apnea,” Breus says. “And the reason is that most people don’t know they have sleep apnea.” Regular screening and follow-ups are a must to track patients’ OSA and refine treatment appropriately.
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