Sleep disordered breathing is a common chronic condition in the general population world wide. In 2008, Punjabi estimated the prevalence of Sleep Apnea Syndrome (SAS) is in the range of 3% to 7%, with certain components of the population at higher risk. Recent estimates, however, by the American Journal of Epidemiology indicate a substantially higher prevalence of SAS of 26 percent in adults between the ages of 30 and 70 years in the United States and, according to the World Health Organization (WHO), the problem also effects over 100 million others worldwide. It is thought that the reason for this increase, particularly in the US, is the current obesity epidemic. Factors that increase the possibility of SAS include age, male sex, obesity, family history, menopause, craniofacial abnormalities, and destructive health behaviors such as smoking and excessive alcohol use. The prevalence of sleep apnea among specific disorders is presented in the figure to the left. Obstructive Sleep Apnea Syndrome (SAS) is a clinical disorder where frequent pauses in breathing during sleep occur usually with loud snoring. These breathing pauses shut off the oxygen supply to the body for a few seconds and stop the removal of carbon dioxide resulting in the brain briefly waking up, re-opening the airways and begins breathing again. This issue can re-occur many times during the night resulting in a terrible night’s sleep or no sleep at all. In the daytime, these individuals experience sleepiness, concentration issues or even headaches as a result of breathing issues at night. Part of the SAS disorder is snoring which is not only disruptive to others sleeping in close proximity, but dangerous to the individual.
SAS is diagnosed through polysomnography, which is a method of recording body activity during sleep and pulse oximetry, a measurement of the amount of oxygen in the blood at any particular time. SAS is not a life-threatening condition by itself but often results in serious cardiovascular, cerebrovascular diseases and has been linked to Type 2 diabetes, stroke and depression. While the disorder can greatly impact quality of life, it can be easily managed.
Treatment of SAS
The leading treatment for SAS is Continuous positive airway pressure (CPAP), which forces air through a mask into the airways so that they do not close. Patients wear a face or nasal mask during sleep. The mask, connected to a pump, provides a positive flow of air into the nasal passages in order to keep the airway open. In the US, most insurance companies now fund sleep testing and CPAP treatment.
The National Sleep Foundation finds that the majority of people who use CPAP find immediate symptom relief and are delighted with their increased energy and mental sharpness during the day. Many patients have said, “CPAP changed my life!” But some patients still find CPAP masks uncomfortable, even though it may control their sleep apnea. While many individuals require extra assistance to obtain a mask that fits correctly, the side effects of CPAP treatment are mostly mild and temporary. These effects often include nasal congestion, sore eyes, headaches and abdominal bloating but most people acclimate to CPAP over two-to-twelve weeks. The treatment is so effective that less than one-half of CPAP patients discontinue treatment.
But – Does SAS Contribute to Hearing Loss?
Recently, Chopra (2014) studied almost 14,000 individuals and found that both high and low frequency hearing impairment can be linked with sleep apnea. He stated that “our population-based study of 13,967 subjects from the Hispanic Community Health Study/Study of Latinos, found that sleep apnea was independently associated with hearing impairment after adjustment for other possible causes of hearing loss.”
All of Dr. Chopra’s subjects participated in a successful in-home sleep apnea study and an on-site audiometric test at baseline. Sleep apnea was assessed with the apnea-hypopnea index (AHI), which indicates sleep apnea severity based on the number of apnea (complete cessation of airflow) and hypopneas (partial cessation of airflow) per hour of sleep. Sleep apnea was defined as an AHI ≥ 15 events/hour. High frequency hearing impairment was defined as having a mean hearing threshold of greater than 25 decibels in either ear at 2000, 3000, 4000, 6000 and 8000 Hz, and low frequency hearing impairment was defined as having a mean hearing threshold of greater than 25 decibels in either ear at 500 Hz and 1000 Hz.
Among his 13,967 subjects, 9.9% had at least moderate sleep apnea with an AHI ≥ 15. Within this group, 19.0% had high frequency hearing impairment, 1.5% had low frequency hearing impairment, and 8.4% had both high and low frequency hearing impairment. Hearing impairment was more common among individuals of Cuban and Puerto Rican descent and among those with a higher body mass index, self-reported snoring and/or sleep apnea. In his study, Dr. Chopra also reported that sleep apnea was independently associated with a 31% increase in high frequency hearing impairment, a 90% increase in low frequency hearing impairment, and a 38% increase in combined high and low frequency hearing impairment when adjusted for the variables of age, sex, background, history of hearing impairment, external noise exposure, conductive hearing loss and other factors. The researchers also noticed that as higher AHI was associated with a higher prevalence of high frequency, but not low frequency hearing impairment.
Of course a single study does not insure that the results really are correlated with the increased incidence of hearing impairment, these data put audiologists and otolaryngologists worldwide on notice that hearing loss may also be correlated with SAS.
Note added January 9, 2017: Medical professionals use a sophisticated series of questions to assess stroke before the obvious symptoms of slurred speech, drooping of an arm or a side of the face. There is an evaluation called the NIH Stroke Scale. Now there is a guide for NIH Stroke Scale which can by clicking on the logo to the right.
ACLS Medical Training (2016). NIH Stroke Scale Guide. Retrieved January 9, 2017.
Chopra, A. (2014). Sleep apnea tied to hearing loss in large study. Science Daily. Proceedings of the American Thoracic Society. ScienceDaily, 20 May 2014. Retrieved December 15, 2015.
Punjabi, N. (2008). Epidemiology of adult obstructive sleep apnea. Proceedings of the American Thoracic Society, Volume 5(2), pp 136-143. Retrieved December 14, 2015.
World Health Organization (2015). Obstructive sleep apnea syndrome. Retrieved December 14, 2015.
Group, E. (2015). 5 ways sleep apnea affects health. Global Healing Center. Retrieved December 14, 2015.
Healthy Sleep (2015). Presence of sleep apnea in comorbidities. ResMed. Retrieved December 15, 2015.
Rosarian, R. (2014). Researchers say that Hispanics with sleep apnea may also have hearing loss. dot physical blog/Queens, NY Retrieved December 14, 2015.
Widex (2014). Hearing loss and sleep apnea, could there be a link? Listen Now Retrieved December 14, 2015.
Khan, A. & Stravens, S. (2013). Obstructive Sleep Apnea Syndrome. Health Channel TV. Medical Media. Retrieved December 14, 2015.