Is Your Fatigue More than Lack of Sleep? UAB Experts Discuss Sleep Apnea

Sleep is important for overall health. According to the National Heart, Lung, and Blood Institute, sleep improves brain performance and mood and helps maintain physical health, including the heart and circulatory system, metabolism, respiratory system, and immune system. Sleep conditions such as sleep apnea are more common in the United States than one might think. In 2021, the Centers for Disease Control and Prevention found that three in four adults suffer from sleep disorder symptoms.

According to Brian Kinard, DMD, M.D., an associate professor in the University of Alabama at Birmingham School of Dentistry, sleep apnea is diagnosed when an individual stops breathing throughout the night or breathes insufficiently while they are sleeping.

The National Council on Aging states that 94 percent of sleep apnea patients experience snoring, making it the most common symptom of sleep apnea. Kinard says many patients will experience excessive daytime fatigue; but often, a patient’s partner will be the first one to notice the warning signs.

“The patient’s bed partner is often the biggest indicator of sleep apnea,” Kinard said. “They may notice their partner snoring or temporarily stop breathing in their sleep.”

There are two different types of sleep apnea, central and obstructive sleep apnea. Central sleep apnea, or CSA, is when the brain temporarily stops sending the body signals to breathe throughout the night. Obstructive sleep apnea, or OSA, is the most common form and occurs when the throat muscles relax and completely or partially block the throat.

Risk factors and preventionThere are many risk factors that cause sleep apnea that are both in and out of the patient’s control. The most common risk factors are excess weight gain and age. Other less known risk factors include a narrowed or small throat, family history of sleep apnea, enlarged tonsils or tongue, and peri- or post-menopause.

Patricia Patterson, M.D., medical director of UAB’s Sleep/Wake Disorders Center, says individuals can prevent or decrease their symptoms by making small lifestyle changes.

“Keeping a healthy weight, regularly exercising, sleeping on one’s side and avoiding sedatives are great ways to reduce some sleep apnea symptoms,” Patterson said. “Obesity is a major cause of obstructive sleep apnea, and weight management can be helpful in preventing sleep apnea in some patients.”

Patterson says males, obese patients, older adults and individuals with smaller jawlines have an increased risk of OSA. The much rarer sleep apnea is CSA. Risk factors and potential causes of CSA include severe congestive heart failure, stroke, atrial fibrillation, and opioid or narcotic use, as well as high altitudes.

Treatment and long-term effects

Obstructive sleep apnea can have many complications if left untreated, including fatigue, sleepiness, cardiovascular issues, stroke, glaucoma, poor diabetic control, mental health complications and behavioral disorders. Many of these complications have outside contributing factors, such as increased weight or sedentary lifestyle.

Recent research found that race may play a role in these risk factors. The UAB Reasons for Geographic and Racial Differences in Stroke study found that white individuals with OSA and provider-diagnosed sleep apnea are at a higher risk for stroke than their Black counterparts.

When evaluating symptoms worrisome for sleep apnea, Kinard says, the first step is to conduct a sleep study in which experts record the number of times the patient stops or slows their breathing per hour.

In most patients with newly diagnosed OSA, professionals recommend a continuous positive air pressure, commonly known as a CPAP, machine along with lifestyle changes such as weight loss and exercise as the first step in treatment. If the CPAP machine is ineffective, the professionals will recommend alternative treatments such as custom oral appliances, positional therapy or evaluation for a surgical procedure.

“CPAP is the first line of treatment,” Kinard said. “For those with elevated body mass indexes, weight reduction is also helpful. If someone is unable to tolerate the CPAP, there are surgical options available.”

Patterson says there are different types of CPAP machines that individuals can use as treatment. Providers at UAB aim to personalize every patient’s treatment to their situation, severity of sleep apnea and lifestyle.

“CPAP therapy, lifestyle modifications, oral appliances and possible surgical interventions are all options in our multipronged approach to patient care,” Patterson said.

“Surgical options are tailored to the patient’s anatomy and sleep apnea severity and can include a hypoglossal nerve stimulator, tonsillectomy, jaw advancement surgery or soft tissue reduction surgeries in the airway,” Kinard said.

Pediatric sleep apnea

While uncommon, sleep apnea can occur in children. Children are more likely to have obstructive sleep apnea rather than central sleep apnea.

The Mayo Clinic has reported that children with OSA experience snoring, inconsistent breath while asleep, restless sleep, mouth breathing and bed wetting at night. In addition, children with OSA might perform poorly in school, be hyperactive and have trouble paying attention throughout the day.

Children who are suspected to have pediatric sleep apnea will receive a physical exam before a treatment plan is developed. Physicians often remove the tonsils and adenoids first before moving on to more invasive treatments.

“First-line treatment is to have their tonsils and adenoids removed, or to have jaw advancement surgery in those whose OSA is caused by their small jaws.” Kinard said.