The Tribune

By Dr. Melissa Evans

Among patients and physicians there is a low level of awareness about sleep apnea in the Bahamas, because of this many patients in the country have been left undiagnosed. Extensive studies being conducted in the Bahamas by Bahamas Sleep Solutions with the guidance of the American Academy of Sleep Medicine (AASM) will provide new and unknown data for the region. Presently, the resolution to current sleep apnea issues is based on the improvement of the diagnostic tools used and an increase in knowledge about this sleep related breathing disorder .These two things are needed to efficiently treat and resolve present sleep apnea issues.

To truly understand this ailment which is believed to be as prevalent as asthma in adults, it is important to understand the physical mechanics of what is known as sleep related breathing disorders or Obstructive Sleep Apnea (OSA). It is described as a state where an individual who is asleep has an interruption in their normal breathing pattern (breathing stops). It is common for the bed partner to identify this cessation of airflow which usually follows a snoring or audible vibrating sound. The person resumes breathing as they take a few fast deep breaths followed by a regular breathing pattern. Snoring starts again and the cycle repeats itself.

During what is called “normal breathing”, the air flows freely through a normal airway. When a person has sleep apnea, the air going into the lungs is periodically stopped during sleep. The airway can also close off during sleep due to the tongue falling back or the relaxation of the muscles in the throat. This disruption during normal sleep is very important to the mental status of every person. The increase in accidents due to insufficient sleep can be effectively managed and symptoms like: irritability, fatigue, personality complications and ultimately sudden death can be resolved. Reportedly there is a large number of individuals in the Bahamas whose lives are altered by Obstructive Sleep Apnea.

There is increasing recognition that sleep related breathing disorders like OSA are a major public health burden for both genders and should be recognised and treated”. Cohort studies were performed recently in the Bahamas to establish apnea indices in both genders. These studies produced great differences between males and female as it relates to sleep apnea. The difference in the incidents of sleep apnea in males and females may be primarily due to the obvious and apparent difference in physical appearance. Men seemingly have more vulnerable airways and also have increased pharyngeal length making them more susceptible to central apnea.

It is estimated that 95 out of 100 patients in the country remain undiagnosed and untreated. Studies have also shown that sleep apnea can be directly linked with Trans Ischemic Attacks (TIA) which are also known as small strokes. This higher incidence of stroke is independent to complications of hypertension (high blood pressure), diabetes and serious cardiac complications. In paediatrics it is thought that children with untreated sleep apnea may seemingly be a bit slower both mentally and physically. The child may even have cardiac complications as an adult. In the paediatric patient sleep related breathing disorders and secondary reduction in weight is mostly due to the anatomical structuring of the tonsils and adenoids and is usually corrected after the removal of these problematic structures. If for some reason the paediatric patient remains undiagnosed then the child falls into the category of living sleep deprived. This sleep deprivation can ultimately cause behavioural complications like Attention Deficit Disorder (ADD).

Even in adults, there are proven links between sleep apnea and certain psychological complications. Documented studies report that 32 out of 100 patients with diagnosed sleep apnea turned out to be clinically depressed. In addition these studies described the relationship of certain anti depressants that had interesting affects of different stages of sleep patterns. Besides the effects on the general quality of life in these tested patients, the effects on bed partners and family can be drastic. The bed partner that is also sleep deprived because of loud snoring and continuous cessations in breathing can also become depressed and irritable because of the lack of sleep. These bed partners often relocate to other areas in an effort to get a good night’s rest. All of these complications can cause emotional distress between not only couples but the entire family. Proper diagnosis and treatment can ultimately maintain a happy home environment.