Sleep Apnea and Mortality

By Admin

High profile events like actress Carrie Fisher’s death from sleep apnea in 2016 attract a lot of media attention, but also tend to stir up some confusion regarding the disorder and how it leads to early mortality. When people hear about sleep apnea and mortality, they sometimes misunderstand the cause of death, assuming it was an apnea event, a moment of lapsed breathing, that led to the mortality. While this is a possibility, it is much more likely that mortality will result from complications brought about by repeated apnea events, often affecting the heart and metabolism. Determining a precise cause of death can be difficult with sleep apnea sufferers, as there may be multiple health conditions getting progressively worse over time, but affects on the heart are a number-one killer for those diagnosed with the disorder. In the interest of clearing up any misconceptions and explaining the sometimes complicated relationship between sleep apnea and mortality, we offer a brief overview of how the disorder can contribute to fatalities in a number of ways.

How Sleep Apnea Causes Mortality

You may have heard that sleep apnea events do not necessarily cause mortality, due in part to a reaction within the nervous system that wakes you up to breathe. While this is a common conception among online commenters, it is also a misunderstanding. On one hand, the notion itself is untrue. While deaths resulting from single sleep apnea events are indeed rare, they do occur, and one can easily choke from a severe event and die as a result. This, in a sense, is what may have happened to Carrie Fisher, who was having apnea events prior to her death. On the other hand, it isn’t necessarily a single apnea event that is the threat. The effects of multiple apnea events over time can kill just as easily. This is the path to mortality for a number of common diseases and disorders. Metabolic conditions such as diabetes, for example, lead to complications that eventually shut the body down. One would not assume that diabetes itself cannot cause mortality. Of course it can, but it is often a process that involves the impairment of multiple systems in the body. In the end, the result is the same. So It is true that the body will react against singular apnea events, waking you to gasp for air when the oxygen is not received for a prolonged period, but each apnea event is damaging to the body, affecting its metabolism, blood pressure, heart, and brain. Each event reduces the amount of oxygen entering the blood, and in turn causes buildup of carbon dioxide, leading simultaneously to hypoxemia and hypercapnia. Buildup of fluids can further complicate these conditions and lead to the development of acute respiratory distress syndrome (ARDS), which, like sleep apnea, has been linked to high body mass index (BMI). Sudden drops in blood oxygen levels can also heighten blood pressure and strain the cardiovascular system. Some estimates claim that at least 38,000 people die every year from heart disease related to sleep apnea. And the risk of stroke is at least 2 to 3 times higher for those with an OSA or CSA diagnosis. While the relationship between sleep apnea and cancer is not completely understood, studies have identified strong correlations between the two. From a holistic perspective of the long-term effects of these many developments, it is clear how mortality, or more specifically, premature death, can occur in high numbers among sleep apnea patient populations. The more severe the condition, the higher the risk of mortality, often occurring during sleep or late evening hours. There is much we do not understand about these constant disruptions to the sleep-wake cycle and how they affect our health and bodily functions, but we do know the risks. If left untreated, sleep apnea patients are much more likely to die prematurely, as well as in their sleep.

A Word About Comorbidities

While the Los Angeles County coroner’s office listed the chief cause of death for Carrie Fisher as sleep apnea, there were a number of other conditions that affected her health, including the use of a combination of both prescription medications and other controlled substances. Comorbidities can be related in complicated ways, but in a general sense it is true that more conditions, especially more severe conditions, means a higher risk of mortality. But even in the absence of comorbidities, sleep apnea poses many risks that should never be overlooked. Treating sleep apnea effectively is one way to avoid the exacerbation of other potential conditions, as the symptoms themselves often lead to other health problems. While the existence of comorbidities is a highly significant factor in patient health and mortality, the risk of premature death is evident with sleep apnea alone, especially when untreated.

Prevention, Mortality, and Longevity

Surprisingly, some studies have seen excess mortality in younger sleep apnea patients, leading researchers to speculate that “if relatively more patients aged >50 yrs were treated, it would reduce their apnea severity and consequently also reduce mortality.” Other studies have supported this conclusion, associating sleep apnea with a risk of cardiac-related death over 5 times higher when left untreated. For anyone with a sleep apnea diagnosis, especially those with concerns about mortality, the most important consideration is proper treatment. If a long, active, and healthy life is something you value, preventing the deteriorating effects of sleep apnea should be an immediate concern and a long-term goal. For most sleep apnea patients, this means getting used to continuous positive airway pressure (CPAP) therapy. The gold standard of sleep apnea treatment, CPAP has been known to do much more than stop apnea events, often improving sleep to such a degree that patients become reinvigorated and more involved with their lives. Relationships, as a result, can show great improvement as the noise and fears of the apnea problem are reduced. Learning to adapt to the routine of CPAP therapy can be difficult for some new patients, but the payoffs of continued treatment are nearly guaranteed. No one knows for sure how many years may lie ahead, but a successful treatment such as CPAP can not only promote longevity, but lead to a higher quality of life.