Explained: Obstructive Sleep Apnea, the medical condition which has been in the spotlight since Bappi Lahiri’s death

Singer and music composer Bappi Lahiri (69) passed away Tuesday night following complications from Obstructive Sleep Apnea (OSA), bringing attention to a widely prevalent but under-diagnosed medical condition. OSA is a disorder in which a person’s breathing stops and starts repeatedly in their sleep.

After hearing news of the singer’s demise, the husband of a 45-year-old woman insisted that she go to a doctor and was diagnosed with OSA on Thursday. In fact, several Delhi doctors have reported an increase in queries about the condition.

What is Obstructive Sleep Apnea or OSA?

Obstructive sleep apnea occurs when muscles in the throat and upper airway relax intermittently during sleep and block the airway. “It usually happens in obese men, less commonly in women but it does happen. When a person is obese, they develop extra fat on their larynx and pharynx (muscles in the throat) that can close off their airway in sleep. The muscles start relaxing in sleep and it is a garden hose like situation, you know, when there is no water, it flattens out and no air can go through,” said Dr Nevin Kishore, head of the bronchology department at Max Hospital, Saket.

He said, “When no air enters the lungs, the oxygen saturation starts falling. When it is critical, the brain wakes the person up. They wake up subconsciously, the breathing restarts. And this cycle keeps repeating through the night.”

Although the condition doesn’t kill by itself, it can lead to heart attacks and strokes due to the low oxygen level. In the long run, it can also result in increasing blood pressure, abnormal heart rhythms, and other metabolic disorders. It further leads to an increase in obesity, compounding the problem.

OSA also leads to a lot of road traffic accidents as people with OSA tend to doze off while driving. “OSA is the most common cause of road accident in the US,” said Dr G C Khilnani, former head of the department of pulmonology and sleep medicine at the All-India Institute of Medical Sciences and currently the chairperson of PSRI Institute of Pulmonary, Critical Care and Sleep Medicine.

It may also lead to depression.

How common is it? And is it under-diagnosed?

The prevalence of OSA is 4% among women and 13.4% among men, said Dr Khilnani.

The prevalence in people younger than 40 years of age is about 10% and in those over age 40 is 17%. “It is quite common. A hospital the size of, say, 300 to 500 beds, probably sees around 12 to 15 cases every day, especially in places like Delhi where awareness is higher. More cases might be seen in hospitals with dedicated departments for sleep medicine. In fact, at any given time, around 40 of the patients in my ICU have OSA along with other conditions,” said Dr Sumit Ray, Head of the department of critical care at Holy Family Hospital.

However, it is underdiagnosed. Dr Khilnani, said, “OSA as a medical condition has been recognised only for 40 or 50-odd years. When I was a medical student, we did not study about it. When we were young, we used to say whoever is snoring is enjoying a good sleep. But that is not the case.”

“It is under-diagnosed, especially in smaller cities. Also, most of the symptoms such as snoring and choking are usually noticed by the partner, but many Indian wives do not even complain about it,” he added.

When should you go to a doctor?

Snoring is one of the most common symptoms of OSA, but not everyone who snores has it. Dr Kishore says nine out of 10 persons who snore do not have the condition, but you should definitely check in with the doctor if you feel groggy or sleepy in the morning and doze off during the day.

To check whether someone has OSA, doctors look for something they call the ‘STOP BANG’.

“S – Do you SNORE while you sleep? T – Are you TIRED on waking up or for most part of your day? (This happens because patients of OSA have a very unrefreshing sleep) O – Has anyone OBSERVED you having choking spells while you were asleep? P – Do you have high blood PRESSURE,” says Dr Abhishek Tandon, who specialises in pulmonary and sleep medicine from AIIMS Jodhpur, on Twitter.

He adds, “B – Is your BMI (Body Mass Index) >35? A – Is your AGE >50 years? N – Is your NECK circumference >40 cm? G – Is your GENDER a male or are you a post-menopausal woman? If your answer to >5 of the above listed 8 questions is a YES, you are on a high risk for having OSA!”

If you suspect you have the condition, visit your general physician or ENT specialist.

Whether you have OSA is determined by doing a sleep study either at a hospital or even at your home. The test is available at most big hospitals and costs Rs 10,000 to Rs 20,000.

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How can OSA be treated or controlled?

The prevalence of OSA in India is going up hand in hand with increasing obesity, and doctors believe the best way to reduce symptoms of OSA is to lose weight.

“Studies have shown that a 10% increase in body weight increases the incidence of OSA six-fold. However, if the patients shed 10% weight, the incidence goes down by 20%,” said Dr Ray. Drinking alcohol also increases the symptoms and should be avoided at night by those who have OSA.

As for treatment, the best method is to use a CPAP (Continuous Positive Airway Pressure) therapy. “It is akin to letting the water run in the garden hose to help it maintain the structure,” said Dr Kishore. The sleep test also tells the doctors how much pressure is needed to maintain the airway.

In addition, some surgeries may be offered if there are structural anomalies in the mouth. “The Uvulopalatopharyngoplasty (surgery to open the upper airways by taking out extra tissue in the throat) doesn’t really treat sleep apnea, it just reduces the snoring,” said Dr Kishore.

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