The researchers then compared this sleep data with detailed 24-hour temperature information derived from climate models. They also performed health economic modeling using disability adjusted life years, an indicator used by the World Health Organization that captures the combined impact of disease, injury, and premature mortality. The aim was to quantify the welfare and societal burden due to increased prevalence of obstructive sleep apnea from rising temperatures under various projected climate scenarios.The study found that higher temperatures were associated with a 45% increased likelihood that a sleeper would experience obstructive sleep apnea on a given night.

The findings varied by region, with residents of European countries showing higher rates of sleep apnea compared to those living in Australia and the US, which the researchers attribute to the different degree of use of air conditioning.It also found that the increase in the incidence of obstructive sleep apnea in 2023 due to global warming is associated with a loss of about 800,000 years of healthy life in the 29 countries studied. This figure is similar to other medical conditions, such as Parkinson’s disease or chronic kidney disease.Accordingly, the estimated total economic cost associated with the disease was approximately US$98 billion, including US$68 billion from loss of well-being and US$30 billion from loss of workplace productivity (absence from work or reduced productivity at work).

The publication’s senior researcher, Professor Danny Eckert, clarifies that the study was oriented towards countries and individuals with a high socioeconomic level, likely with access to more favorable sleeping environments and air conditioning, and this “may have influenced our estimates and led to an underestimation of the true health and economic costs.”Lead author and sleep expert Bastien Lesa, from Flinders University’s FHMRI Sleep Health Institute, says this is the first study of its kind to describe how global warming is expected to affect breathing during sleep, as well as the world’s health, well-being and economy.

As he adds, “we were surprised by the magnitude of the correlation between ambient temperature and the severity of obstructive sleep apnea.”Researchers warn that sleep apnea will become more common and more severe due to global warming, leading to increased health and economic burdens around the world. Without greater action to slow global warming, it is estimated that the burden of obstructive sleep apnea could double by 2100 due to rising temperatures.

M. KouzinopoulouArticle

source: AMNA

PHOTO CREDIT: Flinders University

Both noise exposure and OSA are known risk factors for adverse health events. Studies have shown that snoring and OSA are recognized risk factors for cardiovascular diseases, such as resistant hypertension, atrial fibrillation, and heart failure (2). In addition, snoring and OSA are risk factors for neurological disorders such as depression, dementia and stroke (3), while there is strong evidence for an association of snoring with metabolic syndrome and its five main components: hypertension, hyperglycemia, decreased HDL cholesterol, high triglyceride levels and abdominal obesity (3,4,5).

Similarly, noise pollution due to snoring above 53 dB(A) has been associated with adverse cardiovascular events in individuals exposed to it over the long term (6).

Snoring Symptoms

The main symptoms of snoring are:

• A vibrating sound coming from the throat or nose that can be very loud or low.
• Waking up with a choking or breathless feeling.
• Waking up with a sore throat and/or dry throat.
• Morning headaches.
• Excessive daytime sleepiness.
• Restless sleep.

Snoring Diagnosis

Snoring is usually first diagnosed by your bed partner. If your partner has told you that you snore then you should consult your doctor. Your doctor will ask you about:

• Your sleep habits.
• Duration of your sleep.
• Whether you wake up during the night.
• Whether you feel sleepy during the day.

Your doctor will also want to know if you are experiencing emotional problems or taking medications that may be interfering with your sleep. If you answer yes to these questions, your doctor will recommend that you undergo a sleep study to determine if you suffer from Sleep Apnea Syndrome.

If you have already visited your doctor and he has recommended a sleep study, you can make an appointment by clicking HERE.

Bibliography

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2. Sorensen M, et al, PLoS One. 2012;7(6):e39283.

3. Babisch W, et al. Arch Environ Health. 1999;54(3):210–216.

4. Ohayon MM, et al., BMJ. 1997;314(7084):860–863.

5. Stoohs RA, et al., Eur Respir J. 1998;11(2):451–457.

6. Young T, et al., N Engl J Med. 1993;328(17):1230–1235.

7. Hoffstein V., et al., Acta Otorhinolaryngol Belg. 2002 Jul;56(2):205-36.

8. Maimon N, Hanly PJ, et al., Clin Sleep Med. 2010 Oct;6(5):475-8.

• Obstructive Sleep Apnea Syndrome (OSAS), which is the most common and occurs when the throat muscles relax and obstruct the flow of air to the lungs.
• Central Sleep Apnea Syndrome (CSAS), which occurs when the brain does not send the necessary signals to the muscles that control breathing.

In order to better understand the SAS, we should give the definition of each parameter related to it. The definitions are as follows (1) :

• Apnea: Reduction in airflow or chest wall mobility to less than 25% of normal and lasting at least 10 seconds.
• Hypopnea: Reduction in airflow or chest wall mobility to less than 75% of normal and lasting at least 10 seconds.
• Hypopnea-apnea index (AHI): The sum of the number of apneas and hypopneas during sleep divided by the number of hours of sleep.
• Desaturation: Decrease in haemoglobin oxygen saturation
• Respiratory effort-related arousal (RERA): The sequence of breaths characterized by increasing respiratory effort by the patient, which leads to arousals, but does not meet the criteria for apnea or hypopnea.
• Respiratory Disturbance Index (RDI): The total number of apneas, hypopneas, and RERAs divided by the number of hours of sleep.

The severity of OSA is categorized based on the hypopnea-apnea index (AHI). The categories are as follows:

• Mild severity (AHI: 5-15/hour)
• Moderate severity (AHI: 15-30/hour)
• Severe severity (AHI: >30/hour)

Epidemiology

Studies have shown that the prevalence of sleep disorders in the community is 20%. A portion of this population experiences repeated episodes of breathing disorder and belong to the category of patients suffering from Sleep Apnea Syndrome (SAS). This percentage amounts to 4-5% of the middle-aged population. The association of sleep apnea syndrome with cardiovascular and cerebrovascular comorbidities is very significant (3). Statistical data from 16 countries and a total of 17 studies showed that the number of people worldwide with mild (AHI: 5-15/hour) and moderate (AHI: 15-30/hour) SAHs amounts to 936 million people, while with severe SAHs (AHI: >30/hour) amounts to 425 million people (4).

Symptoms and Risk Factors for the Occurrence of SAS

The main symptoms of OSAS are snoring, drowsiness and feeling tired during the day, as well as a headache upon waking in the morning. On the other hand, the main risk factors for the occurrence of SAS are:

• Obesity (body mass index -BMI- over 30)
• Neck circumference (over 43 cm for men and over 40 cm for women)
• Hypertension
• Diabetes
• Age and gender (5,6,7)

SAS and Associated Diseases

Multicenter studies have shown that OSAS is directly related to a large number of diseases such as heart failure, stroke, myocardial infarction, arterial and pulmonary hypertension, arrhythmias, atrial fibrillation, hyperlipidemia, diabetes mellitus, quality of life and depression (7).

Diagnosis of Sleep Apnea Syndrome

Polysomnography is the diagnostic test of choice for the diagnosis of SAS (7,8,9). There are two types of Polysomnography Sleep Study, the Polysomnography-PSG or full Sleep Study and the Polygraphy-PG or home Sleep Study (Home Sleep Apnea Test). The recording of both types of Sleep Study includes all the necessary parameters for the diagnosis of SAS syndrome, with the difference that the full Sleep Study includes additional neurophysiological parameters. A home sleep study should be recommended for patients with a strong suspicion of having SAS based on the subject’s sleep history. The advantage of a home sleep study is that it is performed in the home of the person being tested, avoiding admission to a hospital or clinic and possible exposure to viral environments. Also, the cost of a home sleep study is much lower than a full sleep study. In case of a negative result of the home sleep study or with a strong suspicion of the existence of SAS, a full sleep study is recommended (10,11,12) .

Sleep Apnea Syndrome Treatment

Managing SAS is multifactorial, while the effectiveness of therapeutic approaches depends largely on patient compliance. CPAP (Continuous Positive Airway Pressure) is considered the treatment of choice, while other treatment options include weight loss and surgery (removal of parts such as tonsils and replacement of the lower jaw bone). Studies have shown that CPAP therapy contributes to a significant reduction in the number of apneas, hypopneas, and desaturation during sleep (13,14).

Conclusion

If you snore, feel tired every day, wake up with a morning headache, suffer from diabetes, depression, hypertension and if you are overweight, then it is very likely that you belong to the category of patients who have Sleep Apnea Syndrome. Get a Sleep Study now to avoid serious future health problems.

-Dr. Plakia Theodora

Bibliography

1. Κωστίκας Κ. Θ., Λουκίδης Σ., PNEUMON Number 1, Vol. 18, January – April 2005

2. Atul Malhotra, Indu Ayappa, Najib Ayas, Nancy Collop, Douglas Kirsch, Nigel Mcardle,Reena Mehra, Allan I. Pack, Naresh Punjabi, David P. White and Daniel J. Gottlieb, Sleep 2021Jul 9;44(7):zsab030.

3. Jennum, R. L. Riha, European Respiratory Journal 2009 33: 907-914

4. Adam V Benjafield, Najib T Ayas, et al. Lancet Respir Med. 2019 Aug; 7(8): 687–698.

5. Amy S. Jordan, David G. McSharry, Prof. Atul Malhotra, Lancet. 2014 February 22; 383(9918):736–747

6. Davies RJ, Ali NJ, Stradling JR, Thorax 1992;47:101-105

7. Jessica Vensel Rundo, CLEVELAND CLINIC JOURNAL OF MEDICINE VOLUME 86 • SUPPLEMENT1 SEPTEMBER 2019

8. Amy S. Jordan, David G. McSharry, Prof. Atul Malhotra, Lancet. 2014 February 22; 383(9918):736–747.

9. Cheryl R. Laratta, Najib T. Ayas, Marcus Povitz, Sachin R. Pendharkar, CMAJ 2017 December4;189:E1481-8

10. Rafael Golpe, Antonio Jime´nez, Rosario Carpizo, CLINICAL INVESTIGATIONS|VOLUME 122,ISSUE 4, P1156-1161, OCTOBER 2002

11. Rafael Golpe, Antonio Jiménez, Rosario Carpizo. Chest. 2002 Oct;122(4):1156-61.

12. Michael T Saletu, Stefan T Kotzian, Angela Schwarzinger, Sandra Haider, Josef Spatt, BerndSaletu. J Clin Sleep Med 2018 Sep 15;14(9):1495-1501.

13. Heather M Engleman, Katherine E Cheshire, Ian J Deary, Neil J Douglas. Thorax 1993;48:91 1-914

14. Hong-Po Chang1,2 | Yu-Feng Chen3,4 | Je-Kang Du1,5 Kaohsiung J Med 2020;36:7–12.wileyonlinelibrary.com/journal/kjm27