Often joked and laughed about, snoring could be a sign of a high risk health issue – sleep apnea. It is a condition in which breathing starts and stops many times during sleep, resulting in poor supply of oxygen to brain. Although no study has been carried about regarding prevalence of sleep apnea in Kashmir, Prof Rafeeq Ahmed Pampori, noted ENT surgeon asserted that the problem was quite common in Kashmir. “It is under reported and under-diagnosed mainly due to low awareness among doctors as well as masses,” he said. Due to these reasons, the disorder was neither diagnosed adequately, nor treated, resulting in continued hidden problem that can risk life of the patient. Last week, the doctor said, a middle-aged obese man rammed his car into a parked vehicle. Probing of the freak accident revealed that the man had fallen asleep suddenly on his steering resulting in loss of control of vehicle. “All over the world, a number of cases have been reported where a person suffering from apnea has knocked off while driving, resulting in injuries or deaths,” Prof Pampori said. The cause of sleep apnea could either be an obstruction created in relaxed muscles of throat known as obstructive sleep apnea. It could also be caused by a “snag” in signals sent by brain to the muscles controlling breathing: central sleep apnea. It can also be a combination of the two called complex sleep apnea syndrome. Although sleep apnea can affect anyone at any age, a hospital-based study at Government Medical College (GMC) Srinagar found that over 80% of people diagnosed with sleep apnea were obese while over 82% of them had hypertension. The 2016 study, titled ‘Obstructive sleep apnea: an experience’ by Dr Syed Suriya Arajmand Farooq highlighted that all the patients had symptom of snoring. About 70% of the patients complained of dry mouth following sleep, while about 65 percent had excessive day-time sleeping.
The other symptoms of apnea include gasping for breath during sleep, morning headache, insomnia, daytime sleeping, excessive night time urination and irritability. Sleep apnea has far more reaching consequences than is assumed, Prof Pampori said. “When oxygen saturation goes low during night, the patient is prone to getting myocardial infarction, stroke, hypertension, sleep disorders and other disorders,” he said. Dr Naveed Nazir Shah, head department of Pulmonology at the GMC said that majority of patients are refereed for sleep disorder diagnosis by endocrinologists, neurologists and cardiologists and psychiatrists. He said that it was important to create awareness about sleep apnea in order to prevent initiation or aggravation of other diseases. “At our hospital, we have a questionnaire to screen for sleep apnea and those found positive are administered sleep study,” he said. Sleep study is an overnight study to measure heart rate, oxygen saturation and brain waves of the patient. Obstructive sleep apnea can be corrected surgically by an ENT surgeon while in some cases, equipment called CPAP (continuous positive air-pressure) is recommended. An expert evaluation by an ENT surgeon and a pulmonologist can help in complete or near complete resolution of the problem, Prof Pampori said. A number of studies have highlighted the graveness of sleep apnea and the potential problems it can cause. A research titled Prevalence of obstructive sleep apnea in pregnancy: A hospital based study by M Ismail of department of medicine at the GMC was carried out on pregnant women. The study found that over 13% of them were at a high-risk of sleep apnea. This condition put them in a danger, and that of their unborn babies, pushing doctors to recommend screening of pregnant women for the disorder so that treatment at the appropriate time period of pregnancy may improve the maternal and fetal outcome. The problem of under-diagnosis of sleep apnea is not restricted to pregnant women only. A recent study by three departments of two premier healthcare institutes of Kashmir, SKIMS and GMC Srinagar, had some shocking data. Among diabetics, over 95% had abnormal sleep study test. “The findings of our study suggest that sleep apnea is highly prevalent in diabetes and is largely unrecognized in the primary care setting. Most of the clinicians do not suspect this important co-morbidity of diabetes in the beginning resulting in delayed diagnosis,” the study concluded. In addition, sleep apnea also contributes to depression among affected. A study titled Relationships between body mass index and depressive symptoms in patients with obstructive sleep apnea: A study from northern part of India, Kashmir, by Dr Sheikh Shoaib and others concluded that depressive symptoms were more common and more severe in women with OSA than in men and that there was a definite relationship between obesity and depressive symptoms in patients with obstructive sleep apnea. Dr Shah said that all snoring is not sleep apnea but snoring is an important symptom of the problem. “People must not rubbish snoring as a joke or a social problem only. It has far-reaching health consequences,” he said.