VCU news

By Anne Dreyfuss
C. Kenneth and Dianne Wright Center for Clinical and Translational Research

Beth Rodgers, Ph.D., a School of Nursing professor and chair of the school’s Department of Adult Health and Nursing Systems, is widely known for her work in qualitative and mixed methods research with adults experiencing obstructive sleep apnea. She serves on numerous editorial and grant review boards and was a member of the Sleep Apnea Patient Advisory committee of the federally funded Patient Centered Outcomes Research Institute.

March 6–13 is the National Sleep Foundation’s Sleep Awareness Week. VCU News spoke with Rodgers, who is also a registered nurse, about causes, treatment and preventative steps to guard against sleep apnea.

What is sleep apnea?

Sleep apnea refers to the cessation of breathing while a person sleeps.

What is the difference between obstructive sleep apnea and central sleep apnea?

Obstructive sleep apnea occurs when there is a physical obstruction in the airway such that air cannot move into and out of the lungs. Typically, the obstruction is caused by the tongue or other soft tissue in the mouth that relaxes during sleep, thus blocking the airway.

Central sleep apnea occurs when there is a problem with the signals that the brain sends to the body to control breathing.

What are common symptoms of sleep apnea?

Sleep apnea is easy to miss because the affected person often is not aware that he or she has the condition. The most obvious symptom is if a bed partner witnesses the individual stop breathing during the night. In obstructive sleep apnea, which is much more common than central sleep apnea, there may also be snoring or episodes of a choking or gasping sensation. Snoring is not always present, however. While there is a lot of individual variation, other possible symptoms include dry mouth upon waking, morning headaches, problems with attention and feeling unusually sleepy during the day. It is not uncommon for people with obstructive sleep apnea to fall asleep while driving.

Who is at risk for sleep apnea?

Obstructive sleep apnea has a strong hereditary component, so one risk factor is a close family member with OSA. Other risk factors include having a neck circumference of 17 inches or larger for men, and 15 inches or larger for women, as well as having a narrow airway, including enlarged tonsils and adenoids. Males, older individuals and postmenopausal women are at greater risk. Obesity is also considered a risk factor and there is significantly greater incidence of excessive weight in people with OSA. However, people who are not overweight also can be affected by OSA and obesity can be an outcome of untreated OSA.

Central sleep apnea is most common in middle-aged and older individuals with significant heart problems or who have had a stroke.

How is sleep apnea treated?

There are several options for treating OSA depending on individual characteristics. In general, there is a highly effective therapy available using positive airway pressure machines (commonly known as CPAP machines) for continuous positive airway pressure. The device delivers pressure into the airway while the individual sleeps to keep the airway open. It is very effective and generally well tolerated after an adjustment period. Some people also respond well to dental appliances. In mild cases, avoiding certain sleeping positions at night can be effective. There also are some surgical options, but the positive airway pressure machines are the most common treatment.

Central sleep apnea is treated by treating the underlying condition, using supplemental oxygen, or using a variety of ventilation devices including positive airway pressure machines.

What are the risks of not treating sleep apnea?

Sleep apnea can have a devastating impact on health and quality of life. One obvious consequence is excessive sleepiness during the day. This can disrupt work performance and personal relationships, and can lead to depression, irritability and accidents. Physiologically, common consequences of sleep apnea include heart problems such as high blood pressure and stroke, metabolic problems ranging from issues with managing weight to metabolic syndrome and Type 2 diabetes, and liver disease. There is increasing evidence that inflammation caused by sleep apnea aggravates arthritis and may be linked to dementia.

Have there been recent developments or improvements in sleep apnea treatment?

The masks that people wear for positive airway pressure therapy are constantly improving and there are many options, so each person can find something that is comfortable and effective. Some new surgical procedures are also being developed. One of the biggest recent areas of improvement are smart phone apps that allow people to monitor their own therapy and see their progress.

Can sleep apnea be prevented? If so, how?

Maintaining a normal weight can help, but there are many other factors that affect the occurrence of sleep apnea and a lot of people with sleep apnea are at a normal weight. It can be managed very effectively, but other than weight-related apnea, there is not much that can be done to prevent it.

What else should people know about sleep and sleep apnea?

Being sleepy during the day may seem common, but it is not normal and it certainly isn’t healthy. If someone is sleeping an appropriate number of hours, but is not feeling refreshed and rested on awakening, there may be something wrong with the sleep. Ensuring a sufficient amount of quality sleep is critical to health and well-being.

Also, there are many options available for positive airway pressure machines and masks. While it may look uncomfortable, people can adapt and become very comfortable using the machines. After treatment, people often comment that they wished they had not waited so long. Waking up fully refreshed in the morning is a wonderful thing!