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Doctors Aim to Better Diagnose Troubling Sleep Apnea

August 13, 2008 at 6:40 PM EST
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Twelve to 18 million Americans suffer from sleep apnea -- many without knowing it. Now, new research suggests that they are more than three times as likely to die from other ailments as people who sleep normally. NewsHour Health correspondent Betty Ann Bowser reports.
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BETTY ANN BOWSER, NewsHour Correspondent: Nate Macapagal is desperate for a good night’s sleep, so the 31-year-old scientist has come to the Sleep Disorders Clinic at Johns Hopkins University Hospital in Baltimore. There, he was recently diagnosed with obstructive sleep apnea.

As shown on the left in this diagram, Macapagal literally stops breathing as he sleeps through the night because his airway collapses, cutting off oxygen to his brain.

NATE MACAPAGAL, Sleep Apnea Patient: I’ve been diagnosed with depression last year. I’m currently on medication for that. Also been diagnosed with high blood pressure. I’d be driving in the morning just like after breakfast, and I’d fall asleep at the wheel, and that’s not good.

BETTY ANN BOWSER: Sleep apnea is one of the most massively underdiagnosed conditions in the U.S. today. The National Institutes of Health estimate 12 million to 18 million Americans have it and think that one-third of the entire population could be suffering from the condition or some other kind of sleep disorder.

And recent studies show people with untreated sleep apnea may be flirting with death. Michael Twery heads the National Center on Sleep Disorders Research in Bethesda, Maryland.

MICHAEL TWERY, National Center on Sleep Disorders Research: Having untreated sleep disordered breathing is associated with a twofold increase risk of stroke, an increased risk of heart failure, a doubling of the risk of diabetes in certain categories of patients.

BETTY ANN BOWSER: A new study published in the August issue of the journal Sleep, one of the most comprehensive ever undertaken, found patients with obstructive sleep apnea were three times more likely to die from any cause than those with normal breathing.

The study was done at the University of Wisconsin on 1,522 men and women over an 18-year period.

To accurately diagnose obstructive sleep apnea, patients like Macapagal have to undergo a sleep study called nocturnal polysomnography.

DOCTOR: This is for your right eye.

BETTY ANN BOWSER: Macapagal was hooked up to a series of sensors that monitored his heart, lungs, brain activity…

DOCTOR: This one goes right here.

BETTY ANN BOWSER: … breathing patterns, arm and leg movements, and blood oxygen levels.

DOCTOR: OK, we can move to the bed now.

Most are unaware of apnea

BETTY ANN BOWSER: And like 70 percent of patients who come to Dr. Nancy Collop at Johns Hopkins, Macapagal came for treatment because his wife couldn't take his snoring anymore.

DR. NANCY COLLOP, Director, Johns Hopkins Sleep Disorder Center: I think the main reason that many people go undiagnosed is because the person that has sleep apnea really has no awareness of the sleep disorder itself.

All they know is that their sleep is not restorative, so they wake up in the morning tired. And unless they have a bed partner or someone that observes them sleeping, they may never know they have the disorder.

BETTY ANN BOWSER: That's why specialists like Dr. Collop say 90 percent of people with obstructive sleep apnea go undiagnosed. And what makes that most disturbing is the growing evidence linking the condition to mortality.

DR. NANCY COLLOP: Apnea means no air, and obstructive means that the airway is actually being obstructed. And eventually the brain gets a signal like, "Hey, we're not getting enough air," and it makes a person wake up.

BETTY ANN BOWSER: But the patient isn't aware he's awake.

So people can wake up and go back to sleep over and over again all night?

DR. NANCY COLLOP: Hundreds of times.

BETTY ANN BOWSER: Hundreds of times?

DR. NANCY COLLOP: Hundreds of times. We have people that have, you know, 500 episodes in a night.

BETTY ANN BOWSER: And are they aware that they have 500 episodes a night?

DR. NANCY COLLOP: They just know that they don't sleep well.

BETTY ANN BOWSER: A patient with obstructive sleep apnea is never able to get to the deep stages of slumber, such as rapid eye movement, or REM sleep, which the body needs to replenish itself.

Sixty-three-year-old telecommunications manager Dick Powell was diagnosed with obstructive sleep apnea three years ago.

DICK POWELL, Sleep Apnea Patient: I would sleep, but wake exhausted. That was bad enough, but then I discovered that I really wasn't sleeping at night. I'd wake up. My ribs would be sore, because my wife had been punching me to wake me up, because I would be gasping for breath. One night I woke up because I just punched my wife, and that really tipped the scales, because...

BETTY ANN BOWSER: You mean you literally punched her in the face?

DICK POWELL: Just like that, yes. I'm glad she didn't kill me, but that made it clear to both of us that there was something going on.

Mask treatment difficult to use

BETTY ANN BOWSER: Studies now show people in middle age are more likely to develop sleep apnea. Another primary risk factor is excessive weight gain. The accumulation of fat on the sides of the upper airway cause it to become narrow and predisposed to closure.

But many patients with sleep apnea are not overweight. Journalist Ramsey Flynn is a fit 51-year-old man, but he's been diagnosed with obstructive sleep apnea. And recently he came back to the sleep clinic at Johns Hopkins to be fitted with a continuous positive airway pressure machine, known as a CPAP. And he didn't like it one bit.

RAMSEY FLYNN, Sleep Apnea Patient: So no reading in bed with one of these?

BETTY ANN BOWSER: CPAP machines are considered the gold standard for treating obstructive sleep apnea, but only about 25 percent of patients are able to get used to them. And even though monitoring showed Flynn slept well -- about six hours with the mask -- in the morning, he was convinced it hadn't been effective.

RAMSEY FLYNN: I did not perceive that I was sleeping better. I did not experience the sensation that this was a more -- this was going to help yet. So to me, it's still jury out.

BETTY ANN BOWSER: Do you think it's because you're still feeling apprehension about the mask?

RAMSEY FLYNN: I certainly didn't like the mask, you know? It's a tough thing to get used to. I just don't like the idea of taking a fancy apparatus, and hooking it up every night, and having another thing that I need to use to maintain health. That's what I don't like about the idea of the mask.

BETTY ANN BOWSER: Across the hall, Nate Macapagal was also trying his first night on the CPAP machine. He was extremely eager to have it work.

Yet in spite of Macapagal's positive attitude, he had trouble.

NATE MACAPAGAL: In the beginning, it was a little tough. The air was pushing against my expiration, so it was like breathing underwater. But I got used to it after a while.

When helpful, mask changes sleep

BETTY ANN BOWSER: And Macapagal is determined. It's been years since his wife has been able to sleep through the entire night with him because of his snoring.

NATE MACAPAGAL: There was a reward this morning that I was able to get some sleep and dream.

BETTY ANN BOWSER: How do you feel right now?

NATE MACAPAGAL: Awake.

BETTY ANN BOWSER: How do you normally feel when you get up?

NATE MACAPAGAL: Groggy, so there's a marked difference.

BETTY ANN BOWSER: Dick Powell thinks most people can get used to the CPAP machine in time. He's been using his for three years.

DICK POWELL: My blood pressure has dropped like a stone. You know, my doctor's thinking maybe I don't even need the medication anymore, which is really good, because it means my heart is healthier. I'm totally rested. I wake refreshed, energized. I can face anything the day can throw at me. It's just an absolutely miraculous change.

BETTY ANN BOWSER: Researchers are hoping, as studies continues, to link obstructive sleep apnea to illness and mortality, more people will realize that when someone sounds like this, it's not just annoying. It may be a cry for help.