When you think of sleep apnea, you might associate it with overweight, older men, who snore loudly and incessantly. Their bed partners suffer beside them, unable to sleep through the noise, crying out for someone, or some way, to stop the snore.
However, this is not always the case. Granted, a huge proportion of older and overweight men do suffer from sleep apnea, but in reality, it can actually affect anyone, at any age. This includes young, lean and fit men, women and children too, especially those with pre-existing chronic pain conditions.
A quick review of sleep apnea
Obstructive Sleep Apnea (OSA) is caused by the muscles in your throat relaxing at night and blocking your airway. This impairment to breathing causes the levels of oxygen in your blood to reduce. When you stop breathing, your brain is triggered to wake you from sleep, and the breathing and oxygen levels are restored through snorting, snoring, choking, or gasping to encourage better airflow. Sleep apnea can also occur without any obstruction in airflow, which is referred to as central sleep apnea. Learn more about sleep apnea here.
The STOP-Bang questionnaire is a validated screening tool for measuring Obstructive Sleep Apnea (OSA) in young people. The four measures are BMI, Age, Neck circumference, and Gender (BANG) which help determine the severity of OSA when compared to a patient’s symptoms: Snoring, Tiredness, Observed apnea (apneas are the pauses in breathing), and High blood Pressure (STOP).
In addition to the questionnaire, it has been advised that younger people also undergo pain intensity and psychiatric screenings. Some symptoms or warning signs include:
- High blood pressure
- Pain caused by diabetes
- Personality changes such as being moody, hyperactive, cranky or irritable
- Post traumatic stress and substance abuse disorder
- Tiredness during the day
- Falling asleep at your desk or at school
- Lack of motivation to play sports or with friends
- Night sweats
- Frequent urination at night
- Choking during sleep
What causes sleep apnea in young adults (18-30 years)?
Studies have found that young adults with high blood pressure or “hypertension’ have a high prevalence of obstructive sleep apnea. This can be due to several factors, including a sedentary lifestyle. A lot of young adults spend hours each day sitting at their desk or computer and as a result many have an increased BMI or gain weight as a result. Increased day to day stress at work or home, pressure to ‘burn the candle at both ends’ or a struggle to balance hectic schedules have also been shown to cause increased stress and hypertension. For these reasons, more exercise and an improved diet can help to reduce or prevent high blood pressure in young adults.
Interestingly, however, young, lean men are also at risk. The presence of OSA is sometimes associated with insulin resistance and a rise in insulin secretion to maintain normal glucose levels. One study showed that OSA may increase the risk of type 2 diabetes independently of traditional risk factors such as obesity and OSA may adversely affect glucose metabolism at a very young age.
Other research has shown that young adults with OSA are more likely to suffer from moderate to severe pain. Because of the high prevalence of chronic pain in younger adults, this study highlights the need to understand the impact of OSA diagnosis and treatment on pain intensity and how this might improve their quality of life.
What causes sleep apnea in teens (13-18 years)?
Little research has been performed on the prevalence of OSA during the transitional stage of adolescence. Teens are often seen as having trouble sleeping at night and as being sleepy during the day which means their symptoms are often overlooked.
However, some studies have shown that the risk for serious complications gets worse relative to the severity of the teenager’s sleep apnea. Strong risk factors for severe OSA include a higher body mass index as teens grow and develop, a narrower upper airway, the size of tonsils and adenoids and a family history of apnea. In addition, teenagers already have various hormonal imbalances as they are going through puberty, and underlying sleep apnea can wreak even more havoc on this. The continual sleep disturbances put teens at risk for depression, atopic dermatitis, high blood pressure, pulmonary stroke, heart disease, and congestive heart failure. Another concern is weight gain, which will make the OSA and accompanying health risks worse.
What causes sleep apneain children (3-12 years)?
This type of sleep apnea is commonly called pediatric obstructive sleep apnea (pediatric OSA), and it is estimated that between 1% and 5% of young children have it. Most of these children are between the ages of two and eight, but OSA can occur at birth. Up to 25% of children with pediatric OSA have reduced concentration, hyperactivity, or irritability; symptoms that mimic attention-deficit/hyperactivity disorder (ADHD).
As previously discussed, for adults the main contributing factors of sleep apnea are weight, neck circumference and age, whereas for children the most common cause is enlarged tonsils and/or adenoids. If these tissues are enlarged, they can contribute to difficulty breathing during the day and even more so when they are relaxed at nighttime, in the same way OSA occurs in adults. Childhood obesity is also a risk factor for older children and teens, aged 12-18 years. The more fatty tissues in the throat, the more likely that breathing will also be impaired.
In this blog, we have only really scratched the surface of the importance of treating sleep apnea. However, one thing is clear — the earlier the diagnosis, the better the prognosis. Leaving this disease unmanaged can result in a much reduced quality of life, a plethora of other secondary health issues, a lack of motivation or productivity in work or school and can be detrimental to personal or family relationships.