A friend of mine, a 69-year-old pulmonologist in Port Arthur, Texas, who had OSA, died of a heart attack during sleep on July 13, 2015.

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1 SINCE U.S. Associate Justice Antonin Scalia, 79, a guest at the Cibolo Creek Ranch, a 30,000-acre luxury resort in West Texas, was found dead in his bedroom, speculation started that he could have died from Obstructive Sleep Apnea (OSA), since the CPAP (Continuous Positive Airway Pressure) machine he was using for his OSA was found not plugged to the wall outlet, and there was no evidence of foul play. A friend of mine, a 69-year-old pulmonologist in Port Arthur, Texas, who had OSA, died of a heart attack during sleep on July 13, He did not use his CPAP machine when he went to bed the night before. And I have heard or read a number of about deaths during sleep that were very suspicious of OSA. Prolonged breath-holding from OSA can deprive the person and his organs of oxygen and lead to a heart attack/stroke. A significant number of heart attacks during sleep are actually caused by undiagnosed/untreated OSA. 1 / 7

2 One of the commonest causes of unexplained death during sleep is OSA, which is a condition afflicting more than 30 million persons in the United States, a condition often under-diagnosed because many persons who snore (who most likely have OSA, especially if they are overweight) refuse to undergo a Sleep Study to determine whether they have OSA or not. What is OSA? Obstructive Sleep Apnea is a condition where the individual, usually a snorer, stops breathing momentarily while asleep, and the breath-holding episodes could occur 20 up to more than 100 times during the same night. This causes hypoxemia (dangerously low level of oxygen for the body), sleep impairment and rest deprivation. The person usually wakes up startled gasping for breath following each episode, because each long pause (20 seconds or longer) in breathing deprives the person of oxygen. The victim is oblivious to all this. As a result, the individual with sleep apnea does not get a satisfying sleep every night and wake up feeling tired and sleepy during the day, some developing a headache and poor concentration while driving or at work. There have been countless deaths during sleep reported among persons with untreated sleep apnea. How common is OSA? 2 / 7

3 About 9 percent of the adult population in the United States or 30 million have this life-threatening Obstructive Sleep Apnea, and a significant number of them are undiagnosed. Many persons who never woke up from sleep (death usually happens between midnight and 6 a.m.) were most likely triggered by OSA, where the oxygen deprivation led to suffocation and heart attack/stroke in bed. Twenty-five to 45 percent of obese patients have sleep apnea, 72 percent of normal weight patients with type 2 diabetes and 86 percent of obese diabetics have sleep apnea. What actually happens in sleep apnea? In some people, especially after middle age and who are obese, the muscles of the upper airways in the back of the throat, like the soft palate (the back end of the roof of the mouth), the uvula (tiny appendage that hangs down), tonsils, adenoids, become flabby and vibrate with the airflow, causing the various classical noises of snoring. These structures could also cave in and out (like a floppy valve) with respiration, blocking the upper airway and causing sleep apnea and oxygen deprivation, leading to suffocation. Weight reduction could help some individuals. Could fatigue be due to OSA? For persons who have unexplained fatigue and daytime sleepiness, it is most probable (after all other medical reasons having been eliminated) that they could have undiagnosed Obstructive Sleep Apnea. 3 / 7

4 Millions are walking around not knowing they have this treacherous condition that is potentially deadly. What is the impact of OSA? Obstructive Sleep Apnea is more common than we think and more dangerous than it is perceived. OSA is a benign condition and easy to treat (not as startling a diagnosis as heart attack or cancer) but left untreated, it could kill faster and surreptitiously like a thief in the night. Otherwise healthy victims are testament to unfortunate preventable premature deaths, wasted lives, which proper prompt diagnosis and treatment could have saved. Healthy people with OSA also have a much higher risk to develop high blood pressure, diabetes, depression, poor mental acuity, poor job performance, driving accidents, heart attack, stroke, Alzheimer s and even cancer. How is OSA diagnosed? To confirm the diagnosis is sleep apnea, a Sleep Testing (Polysomnography) is performed, where the patient sleeps overnight in a Sleep Laboratory, attached to a brain, heart and blood oxygen monitors, with a video cam showing sleep activity, body movements, etc. All these data are then analyzed the following day. 4 / 7

5 If the patient stops breathing for 10 seconds or more at least five times every hour while asleep, the diagnosis is confirmed. Are snore stoppers or the Airing gadget effective? Snore aids as advertised in the various media, such as Airing gadget, nostril clips, mouth guard, nasal or throat sprays, magnetic wrist bands do not work to stop snoring, much less cure sleep disorders. One contraption, the jaw sling alone, which prevents the jaw from dropping (and snoring) while the person is asleep, does not prevent suffocation from OSA. The manufacturers of these gadgets may one day be sued for false advertisement and negligence in cases of deaths from sleep apnea while using their product. What is the non-specific therapy? Weight loss for those who are overweight can minimize the episodes of sleep apnea. Avoidance of sleeping pills, sedatives and alcohol, all of which increase the frequency and duration of sleep apnea, is most essential. Lying flat on the back induces sleep apnea for a lot of people. This could be avoided by placing a pillow at the back and lying on the side. 5 / 7

6 But these are only helpful aids, not really treatment. What is the specific treatment for OSA? Before treatment could be prescribed, a Sleep Study is needed to confirm the diagnosis first and also to titrate and measure the effective positive pressure needed to keep the airway open for each individual patient. The gold standard in the management of OSA is with the use of Continuous Positive Airway Pressure (CPAP). When is surgery needed? Surgery removes tissues, like nasal polyps, adenoids, tonsils and any oro-pharyngeal deformities that cause obstruction to airflow. Fortunately, the use of the CPAP machine has been found to be most effective in managing Obstructive Sleep Apnea. Unbelievable at it may seem, the use of CPAP is really comfortable and unobtrusive, and provides a restful sleep and a great sense of security that some users even get addicted to it. Death from OSA is totally preventable today. Indeed, having sleep apnea is a serious warning and nothing to snore about. 6 / 7

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