Stop the Snore and the Not-So-Silent Brain Killer

Obstructive sleep apnea is a common issue in America that has incredible negative impacts on its sufferers. The typical patient is an overweight, older male whose airway collapses while he is sleeping. This collapse makes it impossible to breathe, and the man is startled awake. Although the man will fall asleep again quickly, this momentary awakening disrupts his sleep cycle. With this disruption of sleep happening hundreds of times every night, sleep quality is severely affected, leading to excessive daytime drowsiness and cognitive difficulties. The disorder is also significantly comorbid with severe disorders such as heart failure and stroke. The disease increases risk of death. Besides the effects on the individual, spouses are unable to sleep due to loud snoring or the tossing and turning of the individual waking up. In order to stop these issues, the treatment is continuous positive airway pressure (CPAP). The individual wears a mask attached to the CPAP machine that forces air into the airways, preventing a collapse. The individual can sleep through the night.

Although CPAP is the most common treatment for sleep apnea, it is not without its disadvantages. The machine itself is loud and can potentially keep both the individual and the spouse awake. The treatment is not effective if the individuals are still not sleeping. The mask is also uncomfortable for the wearer. It is difficult to sleep, and the individual wakes up with a sore throat and dry mouth because of the constant air flow. Because of these negative attributes, very few people follow treatment protocol and wear the CPAP machine throughout the night, every night. In an effort to improve treatment, Weaver, Calik, Farabi, Fink, Galang-Boquiren, Kapella, Prasad and Carley (2014) analyzed the effectiveness of new treatments for sleep apnea such as drugs or electrical stimulation. No treatment was as effective as CPAP in treatment. The low adherence to the treatment, however, necessitates a change.

Before and after twelve months of treatment.
Yellow areas represent abnormalities in white matter.

The article "Brain damage caused by severe sleep apnea is reversible" discussing the recent paper "White Matter Integrity in Obstructive Sleep Apnea before and after Treatment"    (Castronovo et. al, 2014) inspires the use of CPAP therapy. The cognitive issues associated with sleep apnea are due to decreased subcortical white matter integrity in areas such as the medial prefrontal area. The study used diffusion tensor imaging and cognitive testing to reveal change in white matter and cognitive ability after three and twelve months of CPAP treatment.  After twelve months, the abnormalities in white matter practically disappeared, and individuals had better executive function stemming from the reversing of white matter irregularities. This study shows the effects of sleep apnea, but also shows that the effects can be completely reversed if individuals adhere to CPAP therapy. Although new, less intrusive technological should be sought, sufferers should adhere to CPAP treatment to improve and save their lives. Individuals can pledge to "Stop the Snore" at www.stopsnoringpledge.org to ensure the health and well-being of those suffering from sleep apnea.


References:
Brain damage caused by severe sleep apnea is reversible. (2014, January 1). Retrieved May 1, 2015, from http://www.aasmnet.org/articles.aspx?id=4988

Castronovo V, Scifo P, Castellano A, Aloia MS, Iadanza A, Marelli S, Cappa SF, Strambi LF, Falini A. White matter integrity in obstructive sleep apnea before and after treatment. SLEEP 2014;37(9):1465-1475.

Weaver, T., Calik, M., Farabi, S., Fink, A., Galang-Boquiren, M., Kapella, M., . . . Carley, D. (2014). Innovative treatments for adults with obstructive sleep apnea. Nature and Science of Sleep, 6, 137-147. Retrieved May 1, 2015, from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4242689/