Sleep condition affecting millions is linked to higher stroke risk

Britons with obstructive sleep apnoea may be at a significantly higher risk of death or major cardiovascular problems than those without the condition, a new study has found.

New findings indicate that individuals with the breathing disorder – known as OSA – could be 71 per cent more likely to experience events such as heart attacks and strokes, or to die from any cause.

As excess weight is the leading cause of OSA, experts say the results – due to be presented at the European Congress on Obesity in Turkey next month – ‘underscore the need for effective obesity management’.

According to the Sleep Apnoea Trust, around 10 million people in the UK may be living with OSA. It is the most common type of sleep apnoea and causes breathing to stop and start repeatedly during sleep.

The NHS says symptoms of the condition include loud snoring, gasping, snorting or choking noises during sleep, and frequent waking in the middle of the night.

Researchers from Imperial College Health Partners analysed the health records of more than 20,000 adults in north-west London with OSA and compared them with around 100,000 people without it.

Despite similar levels of obesity in both groups, around 26 per cent of people with OSA experienced a cardiovascular event or died in their study of four years, compared with 17.5 per cent of those without the condition. 

After accounting for factors such as smoking and existing health conditions, researchers found a 71 per cent higher overall risk of cardiovascular events or death among people with OSA. 

The study also found that people with OSA were more likely to go on to develop conditions including diabetes, osteoarthritis and anxiety.

In 2020, figures released by the Sleep Apnoea Trust claimed that a third of adults aged 30 to 69 were living with obstructive sleep apnoea (OSA). 

The condition can cause people to wake up to 40 times a night, frequently with a snort or gasp. But by 2035, that figure is predicted to reach 45 per cent.

People who are obese tend to have more fatty tissue in their necks, which presses on the airway and makes it narrower and more likely to collapse. They are also at greater risk of high blood pressure and heart problems.

Treatment involves using a mask called a continuous positive airway pressure (CPAP) machine, which keeps airways open during sleep.

Last year, an international research team calculated that 54 per cent of men aged 30 to 69 will have OSA in Britain by 2050 – up from 39 per cent now. In women of this age, 49 per cent are projected to have OSA by 2050, up from 36 per cent now.

That means the number of people in the UK living with the condition will increase from about 7.7 million to 11.9 million.

Heather Fitzke, from Imperial College Health Partners and co-author of the study said: ‘In adults, obstructive sleep apnea is linked to higher risk of cardiovascular events or all-cause mortality, especially among those with obesity, even after adjusting for confounders. 

‘These findings underscore the need for effective obesity management and highlight the importance of early screening and timely diagnosis. To our knowledge, this is the largest matched case-control study of obstructive sleep apnea outside the U.S. to date.’

The NHS say it can be ‘hard to tell if you have sleep apnoea’ on your own, and suggests asking someone to observe you while you sleep to check for symptoms.

They advise that losing weight and exercising regularly are key steps in managing the condition.

Keeping a consistent sleep routine and ensuring your bedroom is dark and quiet can also help, as can sleeping on your side.

The NHS also warns against smoking and recommends avoiding alcohol. Sleeping pills should also not be used unless advised by a doctor.

If left untreated, OSA – and sleep apnoea more broadly – can lead to serious complications including high blood pressure, type 2 diabetes, and depression or mood changes.

Because the condition often causes persistent fatigue, people with OSA may also be at greater risk of accidents linked to tiredness, as well as difficulties with concentration. 

The study which uncovered the new findings was sponsored by Lilly, the manufacturer of obesity and diabetes medications, including Mounjaro. 

The effects of untreated OSA can be serious, leading to anxiety, daytime tiredness that increases the risk of accidents and low productivity.

OSA has also been tied to an increased likelihood of heart attack, high blood pressure and stroke.

Sleep apnoea also puts a person at risk of entering a state of hypoxia, the result of insufficient oxygen levels in the blood, sometimes to dangerously low levels.

The brain wakes the sleeping person up when it happens, but repeated bouts of hypoxia can reduce focus while awake, kill brain cells and cause dizziness, headaches, impaired judgment and memory problems.

People with sleep apnoea also often drool in their sleep because, as they repeatedly stop breathing, they may resort to breathing out of their mouth instead of their nose to get more air, which allows saliva to pool and escape.