Obstructive Sleep Apnoea: The Snoring That Damages Your Heart
Sleep & Fatigue

Obstructive Sleep Apnoea: The Snoring That Damages Your Heart

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Snoring is treated as a joke or a marital inconvenience. When it comes with breathing pauses and daytime sleepiness, it is obstructive sleep apnoea, a condition that raises blood pressure, drives atrial fibrillation, worsens diabetes and causes road accidents. It is common, under-diagnosed, and very treatable.

What happens during an apnoea

During sleep the muscles of the throat relax. In susceptible people the airway narrows or closes completely. Breathing stops, oxygen falls, carbon dioxide rises, and the brain briefly wakes enough to reopen the airway, usually with a gasp or snort. The person does not remember any of this.

This can repeat dozens or hundreds of times a night. Sleep architecture is destroyed, and each event produces a surge of adrenaline and a spike in blood pressure.

An apnoea is a complete pause of at least 10 seconds; a hypopnoea is a partial reduction. The apnoea-hypopnoea index, AHI, counts them per hour: 5 to 15 mild, 15 to 30 moderate, above 30 severe.

Symptoms at night

  • Loud, habitual snoring, usually reported by a partner
  • Witnessed breathing pauses, gasping or choking
  • Restless sleep, frequent position changes
  • Waking to pass urine, often blamed on the prostate
  • Night sweats
  • Dry mouth or sore throat on waking
  • Insomnia, particularly in women
  • Acid reflux at night

Symptoms by day

  • Unrefreshing sleep, waking tired despite enough hours
  • Morning headache
  • Excessive daytime sleepiness: dozing while reading, watching television, in meetings, or at traffic lights
  • Poor concentration and memory
  • Irritability, low mood
  • Reduced libido and erectile dysfunction
  • Falling asleep while driving, which is a medical emergency in the sense that it kills people

The Epworth Sleepiness Scale, eight questions about dozing in common situations, is the usual screening tool, and the STOP-BANG questionnaire estimates risk.

Who is at risk

  • Overweight and obesity, especially neck circumference above about 43 cm in men and 38 cm in women
  • Male sex, though risk in women rises sharply after menopause
  • Increasing age
  • Large tonsils and adenoids, the main cause in children
  • Retrognathia, a small or set-back lower jaw
  • Nasal obstruction, deviated septum, allergic rhinitis
  • Family history
  • Alcohol, sedatives and opioids, which relax the airway
  • Smoking
  • Hypothyroidism, acromegaly
  • Supine sleeping

South Asian populations develop sleep apnoea at lower BMI than European populations, so a normal weight does not exclude it.

Why it matters

Untreated moderate to severe apnoea is associated with:

  • Resistant hypertension, often with loss of the normal night-time blood pressure dip
  • Atrial fibrillation and other arrhythmias
  • Heart failure, heart attack and stroke
  • Worsening insulin resistance and type 2 diabetes
  • Fatty liver
  • Pulmonary hypertension
  • Depression and cognitive decline
  • Road traffic accidents, with risk increased several fold
  • Complications during surgery and anaesthesia

Treating it improves blood pressure control, glycaemic control and quality of life, and reduces accident risk.

Diagnosis

Polysomnography in a sleep laboratory is the reference standard, recording breathing, oxygen, airflow, effort, brain waves, eye movement, muscle activity, heart rhythm and position.

Home sleep apnoea testing is simpler, cheaper and adequate for many adults with a high probability of moderate to severe disease.

Overnight pulse oximetry alone can support suspicion but misses milder disease.

Consumer wearables may raise suspicion. They do not diagnose it.

Treatment

CPAP, continuous positive airway pressure, is the most effective treatment. A machine delivers pressurised air through a mask, splinting the airway open. Benefits often appear within days: refreshed mornings, no headache, alertness returning.

The usual obstacle is tolerance, and it is solvable. Mask fit is the single biggest factor, so trial different types including nasal pillows, nasal masks and full-face. Humidification helps dryness. Ramp settings ease the start. Treat nasal blockage. Most people who persist for two to four weeks adapt. Modern auto-adjusting machines are quieter and more comfortable than their reputation.

Mandibular advancement devices, custom-made by a dentist, hold the lower jaw forward. Good for mild to moderate disease and for people who cannot tolerate CPAP.

Weight loss is genuinely disease-modifying. A 10 percent reduction in weight can reduce AHI substantially, and large reductions can resolve mild disease.

Positional therapy for people whose apnoea occurs mainly on the back, using devices that discourage supine sleep.

Surgery: tonsillectomy and adenoidectomy, which is first-line in children; nasal surgery to improve CPAP tolerance; and in selected adults, airway or jaw surgery. Hypoglossal nerve stimulation is available in some centres.

Avoid alcohol in the evening, sedatives and opioids, and treat nasal allergy.

In children

Snoring in a child is not normal. Sleep apnoea in children presents as snoring, restless sleep, mouth breathing, bedwetting, poor growth, and often as hyperactivity and inattention rather than sleepiness, which means it is sometimes mistaken for ADHD. It is usually caused by enlarged tonsils and adenoids and is curable.

Driving

If you fall asleep at the wheel or have severe untreated sleepiness, do not drive until treated. This is a legal as well as a medical issue in most places, and it is the aspect of this condition most likely to kill someone.

This is general information. Loud snoring with daytime sleepiness should be assessed with a proper sleep study rather than treated with over-the-counter snoring remedies.