The Role of Partners in Screening for Sleep Apnea

By Admin

One question that comes up frequently in discussions about sleep apnea diagnosis is when to test for the disorder. Since symptoms can be mild or even nonexistent in some cases, it is often a partner or a close friend or family member who notices the potential for a sleep disordered breathing diagnosis. In fact, according to a 2019 update on sleep apnea management, bed partners are more accurate than health professionals at screening for sleep apnea. Bed partners correctly suspect sleep apnea roughly 64 percent of the time, while healthcare providers are correct, on average, about 50 percent of the time. This shows how important partners are in the diagnostic process, as they experience first-hand how their partners sleep and breathe on a regular basis, night after night, as well as any daytime behavior that may result from the disorder. Even when there are no other symptoms, a partner will often witness the apnea events themselves, which often go undetected by the patient. In addition, there are a number of risk factors that a partner may recognize before a primary physician makes a recommendation for a sleep test. Along with sleep habit changes, the combined effects of age, weight, diet, and other behaviors or conditions may be more obvious to someone in regular close contact with a patient. In addition, a partner often knows things like family history and daily habits more thoroughly and intimately than a physician, who relies on information given by the patient during interviews. The importance of this first step to diagnosis should not be overlooked, given the high rate of undiagnosed and untreated sleep apnea throughout the world.

Partners Are the First Screeners

According to Dr. Neil Freedman’s OSA Management 2019 Update, medical history alone is not an effective means of identifying a potential sleep apnea condition. While medical history should be considered, other factors such as a bed partner’s history of witnessed events; snoring, or other related symptoms can be a more effective means of spotting the disorder. This does not mean that a bed partner should attempt to diagnose the disorder, but rather, one should keep track of any signs, symptoms, or other risk factors that may suggest a need for further testing. As the first screener in the diagnostic process, a bed partner can let the patient know when it’s time to consult a primary healthcare provider for possible testing or referral to a specialist.

Dr. Freedman, a board certified pulmonary, critical care, and sleep medicine physician, highlights this point in his publication, explaining how difficult it can be for a physician to diagnose the disorder without conducting a complete sleep study, or polysomnography (PSG). This is because many (50 percent) sleep apnea patients do not experience daytime sleepiness, which is often the first thing doctors look for in potential sleep apnea cases. Another issue is that some patients define their symptoms differently. For example, one patient may be very used to daytime sleepiness and define it as normal, while another patient may experience sleepiness in periodically and find them disruptive. A partner will often understand these perspectives and relate to them, whereas a health professional will use a more universal criteria to determine symptomology. Even when a partner is not familiar with the disorder or its common signs and symptoms, the close contact makes it more than likely that an apnea event or related complication will be observed.

The Role of Technology in Screening for Sleep Disorders

One of the difficulties with sleep apnea screening is that, according to Dr. Freedman, no single screening tool consistently identifies patients at high risk for sleep apnea. While some new screening tools, such as the SLIM (Supersparse Linear Integer Models) system of predictive analytics, have shown success rates above those of patient self-reported symptoms in some trials, there are concerns among healthcare professionals that relying on these tools exclusively may not be as safe or as effective as a subjective assessment from someone close. In fact, Dr. Freedman’s report emphasizes that a partner witnessing apnea events and related behaviors such as loud snoring or choking is by far the best historical predictor of sleep apnea. The level of intimacy involved in a relationship, Dr. Freedman explains, gives potential patients a perspective that could not otherwise be achieved through automated screening tools, however efficient.

While recent advancements in sleep apnea screening tools have given patients and providers convenient and effective ways to check for signs of the disorder, the role of technology remains unclear. In most cases, sleep health professionals use automated screening systems as tools rather than as methodologies, using a combination of approaches to assess the likelihood of a disorder.

Sleep Apnea Signs and Symptoms

According to Mayo Clinic, one of the leading health institutions in the U.S., sleep apnea symptoms include the following:

Sleep apnea events: This is the number-one indicator of a sleep apnea disorder. Apneas can be mild to severe, and infrequent to frequent. Every person experiences the disorder uniquely and according to their own health-related circumstances.
Loud snoring, difficulty breathing, or choking.
Dry mouth or headache in the morning (common).
Sleep problems (especially another sleep disorder like insomnia).
Excessive daytime sleepiness (also called hypersomnia or EDS for short, this is often the first symptom observed, but not all people with sleep apnea will experience it).
High blood pressure or heart problems: Sleep apnea tends to cause drops in blood oxygen levels as the breathing is cut off, often resulting in higher levels of blood pressure. This relationship between high blood pressure (hypertension) and low blood oxygen (hypoxemia) can lead to further cardiovascular problems such as heart attacks, stroke, and abnormal heartbeats.
Attention problems, memory problems, or other cognitive dysfunction.
Irritability or mood problems (children may also have learning or behavioral problems that are sometimes difficult to diagnose as SDB related).
Decreased energy or libido (a common early warning sign).

Risk Factors

In addition to signs and symptoms, risk factors can include any associated health condition or related physical, mental, or emotional state associated with the disorder. While this list can be extensive when considering possible comorbid conditions, the following are some of the most common factors listed by Mayo Clinic and other health authorities.

Weight gain: As mentioned above, weight is the number one sign of an OSA condition. The more weight gained, the more likely the condition will develop.
Neck circumference: Sometimes associated with weight gain, thicker necks tend to result in tissue buildup around the airway.
A narrowed airway: Genetics can sometimes play a role as well. Some people are born with a narrow throat, large tonsils or adenoids, or tongue.
Sex characteristics: According to literature on the subject of sleep apnea risk factors, men are two to three times more likely to have sleep apnea than are women. However, women increase their risk if they're overweight, and their risk also appears to rise after menopause.
Age: Sleep apnea occurs significantly more often in older adults.
Family history: Having family members with sleep apnea may increase the risk.
Use of alcohol, drugs, or tobacco: These substances can make breathing more difficult or relax the muscles in your throat, which can worsen OSA. Smoking in particular can increase the amount of inflammation and fluid retention in the upper airway.
Nasal congestion: Difficulty breathing through the nose for any reason can contribute to the development of the disorder or exacerbate a pre-existing condition.
Comorbid conditions: Sleep apnea is often associated with diabetes and other metabolic problems, including insulin resistance and blood sugar problems, but a number of other conditions can be closely associated with sleep apnea and sleep disordered breathing in general, including but not limited to: heart and cardiovascular disease, Parkinson's disease, stroke, clinical depression and mood disorders, hormonal disorders, kidney disease, and chronic lung diseases, as well as high blood pressure and other sleep disorders.
Ethnicity: African Americans, Asians, and Hispanics have high susceptibilities to OSA in particular.

When to Make an Appointment With a Healthcare Provider

If you believe that a partner has sleep apnea or a related sleep-disordered breathing problem, the best course of action is to seek professional guidance. Healthcare providers know that this condition is common and will have the proper referral information available for sleep studies or other screening and diagnostic processes. When one or more of the above symptoms is noticed by an individual or a partner, it should be mentioned to a primary care physician. Oftentimes, loud snoring or daytime sleepiness are the first things noticed, but other cases may be different.

The bottom line: Don’t wait or put if off. Early intervention is key to proper diagnosis and treatment, and it can help to prevent some of the long-term affects of the disease, such the development of comorbid conditions. While untreated sleep apnea can be a threat to health, safety, and others, the prognosis with proper treatment such as CPAP therapy

And if You Sleep Alone?

Note that many of the listed signs and symptoms of sleep apnea are not related to snoring or apnea events. There are many that can be noticed without a partner’s help, such as a dry mouth, sore throat, or headache in the morning, or feeling tired during the day. Insomnia or other sleep problems can also be an indication that apnea events are occurring, or if you have difficulty focusing or concentrating, particularly in the morning hours. Sometimes simply feeling not quite right can be a sign of something wrong during sleep hours. You may have low energy, low libido, or have problems at work that you haven’t experienced before, like forgetting things or finding it difficult to perform certain tasks. The goal, from a proactive perspective, is to test for sleep problems if any such disorders are suspected. The cliche of being better safe than sorry is quiet true in this case, as the events often occur in the deepest states of sleep, but can do lasting damage if not addressed.

A Combined Approach

Without question, a multifaceted approach to sleep apnea screening, diagnosis, and treatment is always prefered over any one system or protocol. The more tools you have at your expense, the better your chances will be for a proactive and effective treatment plan. And this is also true for treatment adherence. A partnership gives a patient an advantage because it allows for teamwork, immediate support, and a constant witness to whatever symptoms may arise. In this way, a partner can be an important part of a comprehensive, multi-disciplinary approach to screening and managing the disease.

Experts in the field of sleep medicine use novel screening approaches such as electronic health records and artificial intelligence to assess the risk of disorders, but a combined approach using social support as a primary screening strategy can be even more effective. Currently, 1 billion people live with sleep apnea worldwide, including 22 million in the U.S. and up to 80 percent left untreated, but prevalence rates may still be on the rise as populations age and obesity increases. With these numbers in mind, the subject of sleep apnea screening should not only be a team effort among friends, family, and loved ones, but should also be a national and global imperative.