What damage did sleep apnea do to me?
[Jerry replies to a question from "Charles"] You wrote that you may have had apnea for 10 years and wonder what damage might have been done before you started treatment.
I assume you meant obstructive sleep apnea, and that you are using some form of CPAP for treatment each night. A related question would be, now that I am being treated, will the damage be halted? will it be reversed?
These are interesting and complex questions. The most important thing to know is that if you have gotten the apnea under control, and continue treatment, you will experience less fatigue, much better overall health, halt any further damage, and possibly enable the reversal of some effects.
Just as the list of effects of apnea is long, so the effects of treatment are many, and the results are various. I have seen research reports on some of the impacts of apnea and there is no general rule about reversal of damage. Some kinds of damage will be halted by treatment, other areas may recover, either immediately or over time. For example, in many instances excessive daytime fatigue and depression respond almost immediately to treatment. For a partial list of signs and symptoms of apnea that will give you an idea of the various impacts of untreated sleep apnea, see http://www.healthyresources.com/sleep/apnea/question/quiz.html
The areas I would want to have answers on would include:
fatigue: is treatment permitting normal alertness during wake?
emotional: was there depression or other abnormal emotional state, and has it resolved with treatment?
blood pressure: was it high before treatment and has it normalized with treatment? (and the correlates of high blood pressure, like heart attack, stroke)
intellectual/pyschological: many dimensions by which psychologists or neurologists assess mental states, capacity for functions like executive function, memory (several aspects), etc. Unless one is tested before apnea, during apnea status but before treatment, and after treatment, it is speculative for an individual.
You might think that scientists would want to know the answers. But doing the research in the American statistical study method has a problem. You would want to take a fairly large number of people and study them at 3 points in time: 1) before symptoms; then on the population that does develop apnea: 2) before treatment and 3) after treatment. This would be a non-trivial and expensive undertaking, and there are ethical issues: since CPAP is such an effective treatment for apnea, doctors can't withhold treatment in order to study the effects of the untreated disease. This is the kind of issue that confronts researchers trying to do a critical evaluation of CPAP treatment: they need to have untreated patients to compare with the treated ones. Other methods of research can be used, but may not have the same methodological strength.
It would be an interesting article to develop an overview, but I haven't done it yet! If you want to pursue it, here's how I would suggest starting.
Our book, Sleep Apnea: the Phantom of the Night gives a broad overview of the mechanisms of sleep apnea and how it affects various systems of the body. That could be the basis for research into results of treatment. http://www.healthyresources.com/sleep/apnea/phantom/index.html
You may get a fair degree of information searching Google, but for reliable info you need to dig down to the professional journals--which are not perfect but the peer review process at least assures you are reading consensus information. (The trouble with the consensus system of peer reviews is that a truly innovative idea may languish). Unfortunately a lot of the journals charge a subscription or per-article fee. You can glean the general trends however by reading abstracts. A great source is free from the NIH, PUBMED:
http://www.ncbi.nlm.nih.gov/entrez/query/static/overview.html
to start a search http://www.ncbi.nlm.nih.gov/sites/entrez?db=PubMed
free, full text of articles http://www.ncbi.nlm.nih.gov/sites/entrez?db=pmc
An hour or two spent online using these tools will give you a lot of good information, and at least give you a sense of what is known on these issues.
I know this can't really answer your question, but I hope it gives you a context for going forward.
Syndicate
Comments
Frustrated by A Decade of Missed Diagnosis
Thank you for your helpful response. Another comment: I am upset that my primary care doctors did not diagnose the sleep apnea problem sometime over the last 10 years. I had informed my docs about the night sweats, headaches, depression, ED, GERD, frequent nighttime bathroom visits, snoring, fatigue, etc. and eventually I diagnosed myself by doing internet research. I have had annual physical exams and it seems criminal that all doctors are not required to have patients do a comprehensive computer symptom analysis which in my case would have surely pointed to the possibility of OSA. (sorry -- just blowing-off some vented-up frustration).
Patient, Diagnose Thyself!
Charles, you did well to figure out what was causing your problems. You mention several symptoms that should cause a doctor to at least consider sleep apnea. While each taken alone might have another cause, apnea is famous for causing such a wide variety of symptoms.
I share your frustration, and struggle to understand why people with sleep apnea have to educate themselves and identify their own problems, when we have experts who are supposed to know how to identify health problems: doctors!
Health care is an extremely dysfunctional system that may take decades to integrate new knowledge. Bill Dement, one of the founders of sleep medicine, ran a study in a few primary care offices/clinics. One part of the study was to interview patients when they came in for their appointments; questions were to pinpoint likely sleep problems. A lot of patients had indications of treatable sleep problems.
The other part was to look at the records of the patients. Typically *no* or a very few instances of sleep disorders were found in the records.
A sample of people whose questionnaires suggested a sleep problem were given overnight sleep studies to confirm that the questionnaires were picking up actual sleep disorders.
Doctors were missing almost all cases of sleep disorders.
After decades of scientific understanding of common sleep disorders like apnea, sleep medicine is not taught in a serious way in most medical schools; and doctors still neglect to ask a few questions that would pinpoint sleep disorders.
So it is not surprising that your list of complaints tracks the known symptoms of sleep apnea. And that your doctors never thought to suspect a sleep problem.
As to the use of a computerized screening process: people have worked on such systems which make sense, to me at least, as a complement to a good physical workup and talking with the doctor who knows how to listen. Clinical diagnosis may be just too complex, with too many variables, for most humans to manage--why not use a computer to assist?
But for finding possible cases of sleep apnea, the job can be easier. Apnea can cause a wide variety of seemingly unrelated symptoms, as you have experienced. While each of the symptoms might not be related to apnea, a cluster of them should be easy to spot. Since 1992, Phantom of the Night has contained a "Quiz to Identify Sleep Apnea Syndrome" http://www.healthyresources.com/sleep/apnea/question/quiz.html with the idea of encouraging people with common apnea symptoms to seek medical evaluation.
A primary care physician with a rudimentary grasp of sleep disorders should be able to accurately identify people with sleep apnea, and refer them on for professional evaluation. There are condensed presentations in "doctorese" designed to help the busy primary care physician identify sleep apnea in their patients.
I hold that it might take a determined effort by patients to help educate and motivate physicians to pay attention to apnea and other sleep disorders.
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