see also:

• obesity and weight management
• noisy breathing
• snoring
• physiology of sleep

• characterized by loud snoring followed by periods of silence when breathing stops or nearly stops which usually occurs at least five times during every hour of sleep
• affects 2-4% of adults
• snoring associated with sleep apnoea is least likely to occur in stages 3 & 4 (deep sleep) and is most likely in REM sleep
  • only when obstructive sleep apnoea becomes very severe and uniform throughout the night will deep non-REM stage 4 sleep be affected because light and REM sleep become so fragmented by apnoeas that the sufferer is not able to reach the point of descent into deep sleep, and it ceases to feature
• these apnoeas will splinter REM sleep with awakenings that permit the noisy recovery breaths and so start to erode the normal configuration of sleep staging across the night
• where REM alone is affected it can lead the sufferer to be chronically but specifically REM sleep deprived with a consequent propensity to fall into this particular state of sleep during the day otherwise, to fall from wakefulness directly to REM sleep is only normal in young babies
• sedatives may aggravate snoring associated with sleep apnoea by depressing the respiratory system, reducing deep non-REM sleep, and increasing light sleep at the expense of REM sleep.
• OSA tends to be worse during summer and winter, with severity increasing by 8–19% compared to spring and autumn ¹⁾
  • higher temperatures in summer disrupt sleep and lead to lighter sleep stages which is associated with worse OSA
  • longer sleep and later wake up times in winter, increase time spent in REM sleep, which is also linked to more frequent apnea events

• many people, especially those aged under 60 yrs, mainly get OSA on weekends due to tendency for late nights, sleeping in during the morning, alcohol and cigarette smoking combined with reduced use of OSA Rx
• sleeping an extra 45 minutes or more on weekends increased the risk of worse sleep apnea by 47%, especially in men
• this weekend surge in sleep-disordered breathing may heighten the risk of serious health conditions including heart disease, depression, dementia, and extreme fatigue and motor vehicle and other accidents ²⁾

• poor sleep causing daytime sleepiness and difficulty concentrating, poor attention span
• morning headaches
• sore throat upon awakening
• may cause polycythaemia due to episodes of hypoxia
• increased risk for the development of hypertension, cardiovascular diseases, stroke, diabetes, neurocognitive deficits, depression, and mood disorder
  • apneas and hypopneas in REM sleep have been found to be linked with non-dipping of nocturnal blood pressure and incident hypertension whereas unrecognized OSA (ie, patient categorized as no OSA because the overall AHI < 10 events/h, but the AHI in REM sleep ≥ 20 events/h) has an independent association with hypertension
  • alter cellular exosome secretion and content³⁾
    • altered plasma exosomes trigger endothelial cell aging and dysfunction, accelerating atherosclerosis
    • exosomal miR-20a-5p damages hippocampal neurons, worsening cognitive impairment
    • adipose tissue-derived exosomes with miR-155 induce insulin resistance
    • exosomal miR-421 promotes non-alcoholic fatty liver disease (NAFLD) by inhibiting liver cell pathways
• may affect your partner's sleep

• clinical polysomnography (PSG):
  • apnea-hypopnea index (AHI) = average number of apnea and hypopnea events per night
  • complete closure of the upper airway is called apnea, whereas a partial closure is called hypopnea
• home monitoring options:
  • type 1 incorporates standard PSG
  • type 2 uses both sleep stages and respiratory measures with at least seven channels
  • type 3 and type 4 use only respiratory measures (at least three respiratory channels in type 3 and at least one respiratory channel in type 4) without any provisions for sleep stages and hence may under-estimate the extent of the more critical REM sleep OSA events
  • potential future devices which analyse the sound quality of snoring to ascertain REM vs NREM OSA snores using just audio recordings seem to have >80% accuracy ⁴⁾

• see also Rx of snoring
• consider passive EPAP devices
• consider mandibular advancement devices
• consider tongue-retaining devices
• consider powered CPAP devices if obstructive sleep apnoea (OSA)
• consider surgery for severe cases