What Causes Sleep Apnea?
Factors That Put You at Higher Risk for Sleep Apnea
While anyone can develop obstructive sleep apnea, certain factors can increase your risk for this condition and/or mean you may be more likely to already have it: (7)
Obesity The most common risk factor for obstructive sleep apnea is carrying excessive weight. Some research suggests rates of sleep apnea in people who are obese may be as high as 40 percent.(8) “Fat deposits in the neck and around the tongue and palate make the airway much tighter and smaller,” says Neeraj Kaplish, MD, director of sleep laboratories at the University of Michigan in Ann Arbor. “It becomes much more [closed up] during sleep when you’re lying down.” (It should be noted that thin people can also have obstructive sleep apnea, and that not all individuals who are overweight have the condition.)
Large Adenoids or Tonsils Some people have large tonsils or adenoids, or smaller airways, which can contribute to problems breathing during sleep. Large adenoids and tonsils is the most common cause of obstructive sleep apnea in children, says Ronald Chervin, MD, immediate past president of the American Academy of Sleep Medicine and the director of the Sleep Disorders Centers at the University of Michigan in Ann Arbor.
Jaw Misalignment or Size Some conditions or genetic factors can lead to an imbalance in facial structure that can cause the tongue to sit farther back in the mouth and lead to sleep apnea, says Robson Capasso, chief of sleep surgery and associate professor of otolaryngology and head and neck surgery at Stanford University School of Medicine in California.
For instance, a lower jaw that’s shorter than the upper jaw, or a palate (the roof of your mouth) that’s shaped a certain way and collapses more easily during sleep can contribute to obstructive sleep apnea.
A Family History of Sleep Apnea If obstructive sleep apnea runs in your family, you may be at increased risk for having the condition. How your airway is shaped and your cranial facial characteristics can be inherited from your relatives, which can all play a role in whether and why you develop sleep apnea.
High Blood Pressure (Hypertension) People who have hypertension are more likely to have obstructive sleep apnea, as hypertension can result from untreated sleep apnea. (9) When you aren’t breathing properly, the oxygen levels in your body fall, and your brain sends an adrenaline signal to tell the body to tighten up the blood vessels to increase the flow of oxygen to the heart and the brain. This surge in adrenaline may then continue in the daytime, even when the person is breathing normally, setting the stage for hypertension.
Diabetes A study published in 2013 in the journal Family Medicine found that people who have type 2 diabetes may have a fifty-fifty risk of being diagnosed with obstructive sleep apnea. (10) Doctors think that the link between sleep apnea and diabetes may have something to do with the fact that many people with type-2 diabetes are obese — and being overweight is linked to sleep apnea.
There are still a lot of unanswered questions about how sleep apnea might contribute to type 2 diabetes (or the reverse), but data shows sleep apnea often goes undiagnosed in people with type 2 diabetes. So if you have been diagnosed with type 2 diabetes, it’s a good idea to be on the lookout for sleep apnea, too — which, if left undiagnosed and untreated, could make it tougher to manage your diabetes. (11)
“Upwards of three-quarters of people with diabetes have sleep apnea,” says James Rowley, MD, professor of medicine at Wayne State University School of Medicine in Detroit and a member of the board of directors of the American Academy of Sleep Medicine (AASM). (12)
History of Stroke Stroke is linked to sleep apnea, but it’s not clear which is causing which, Dr. Chervin says. “As many as three-quarters of stroke patients have sleep apnea, and sleep apnea also raises the risk for stroke,” says Chervin. A history of stroke may cause sleep apnea, but sleep apnea may also be the cause of a stroke. (12) Sleep apnea leads to low oxygen levels and high blood pressure, both of which can increase one’s risk of a future stroke.
Chronic Nasal Congestion People who have persistent nasal congestion at night (regardless of the cause) are more likely to develop obstructive sleep apnea, probably because of the narrowed airways.
Smoking People who smoke are at a higher risk of developing obstructive sleep apnea. Smoking leads to inflammation in the upper airway, which can affect breathing as well as how well the brain communicates with the muscles that control breathing.
Alcohol Drinking alcohol can increase the relaxation of the muscles and tissue in the mouth and throat, increasing the risk of obstructive sleep apnea.
Asthma Research has found a link between asthma and obstructive sleep apnea risk. (13) The evidence suggests that patients with asthma are more likely to develop sleep apnea. Also, symptoms of either condition (especially poorly managed symptoms) can make symptoms of the other condition more severe. The relationship between the two conditions works both ways, Chervin explains: “Sleep apnea can make asthma worse and asthma can make sleep apnea worse.”
Heart Failure Both obstructive sleep apnea and central sleep apnea can be found in people who have heart failure. (14) Heart failure can cause retention of sodium and water, and doctors suspect that the excess fluid may enter the lungs at night and lead to obstructive apnea. Heart failure also seems to be linked to problems with the respiratory control system, which may be a cause of central sleep apnea.
Brain Infection, Brain Tumor, Stroke, Conditions of the Spine, or Other Problems That May Affect the Brain Stem Conditions that compromise the brain stem, which is the area of the brain that controls breathing, can increase risk for central sleep apnea.
Medication, Such as Opioid Pain Relievers The neurological communication that happens between the brain and body to regulate breathing can be numbed by benzodiazepines and opioids, says Dr. Capasso. Research published in October 2019 in the journalContemporary Reviews in Sleep Medicinesuggested that opioids may also be linked to obstructive sleep apnea, possibly because these drugs reduce airway muscle activation. (15)
Gender and Age Sleep apnea can occur at any age, but being a male and getting older both put you at increased risk of developing sleep apnea, says Dr. Kaplish. “We don’t really understand why but it may have to do with fat distribution and hormones.” For instance, as we age, fatty tissue may increase in the neck and around the tongue.
Video: Understanding Obstructive Sleep Apnea (OSA)
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