OSA impacts more than sleep: a whole-patient perspective

The body and systemic health risks
OSA is a multisystem disorder with significant physical health implications:

• Cardiovascular disease: OSA can increase a patient’s risk of hypertension, arrhythmias, coronary artery disease, stroke and heart failure. Prevalence of OSA is as high as 40-80% in patients with hypertension, heart failure or diabetes.¹
• Metabolic dysfunction: there is a very strong association between OSA and type 2 diabetes and hyperlipidemia.²
• Impaired immunity: chronic sleep disruption can weaken a patient’s immune defenses, increasing their susceptibility to infections.³
• Fatigue and physical performance: persistent tiredness can limit activity, worsen comorbidities and reduce a patient’s quality of life.³

If a patient presents with resistant hypertension, recurrent atrial fibrillation or metabolic syndrome, you may want to consider evaluating them for OSA, even if they don’t report classic sleep complaints.

The mind and cognitive and emotional impact
OSA’s effects on the human brain are profound and often under-recognized:

• Cognitive impairment: patients may experience memory lapses, poor concentration and slower processing speed. Cognitive impairment is present in up to 37% of adults with OSA, and prevalence increases with OSA severity.⁴
• Mood disorders: untreated OSA is linked to depression, anxiety, irritability and emotional instability.⁵
• Work and safety: cognitive deficits can impair job performance and increase the risk of accidents, especially in safety-sensitive roles.⁶

If your patient is reporting “brain fog,” mood changes or declining work performance, consider OSA as a potential underlying cause (even if they’re not complaining about their sleep).

Relationships and quality of life
OSA can disrupt social functioning and relationships:

• Social withdrawal: daytime sleepiness and low mood can lead to isolation and reduced participation in social activities.⁶
• Strain on relationships: partners might be affected by the patient’s snoring or apneas, leading to disrupted sleep and/or relationship tension.³
• Reduced engagement: fatigue and cognitive changes can diminish a patient’s motivation and enjoyment of life.⁶

Ask your patient about any changes they’ve experienced in social engagements, relationship dynamics and overall life satisfaction; these can be subtle indicators of untreated OSA.⁶

Philips resident sleep physician Dr. Teofilo Lee-Chiong shares six easy ways that you can take action for your patients:

1. Consider OSA in your differential diagnosis: don’t limit your OSA assessment to patients with classic symptoms; consider OSA in those with unexplained fatigue, resistant hypertension, metabolic syndrome, mood changes or cognitive complaints.
2. Educate your patients: help them understand that OSA is a whole-body condition and its effects go beyond sleep, impacting their heart health, mental clarity and relationships.
3. Collaborate across disciplines: work with your colleagues in cardiology, endocrinology, mental health care and primary care to identify and manage OSA in at-risk populations.
4. Address barriers to diagnosis and treatment: discuss the benefits of diagnosis and therapy, including addressing risk factors, to help your patients overcome any stigma or misconceptions about sleep disorders.
5. Monitor and follow up: OSA is a chronic condition, and regularly assessing treatment adherence, symptom improvement and evolving comorbidities can make a real difference in your patient’s outcomes.
6. Advocate for whole-patient care: recognize and communicate that treating OSA can improve your patient’s sleep, but also potentially their cardiovascular, metabolic, cognitive and psychosocial health.¹

OSA isn’t just a sleep problem; it’s a whole-patient health issue. By looking beyond sleep and considering the full spectrum of OSA’s impact, we can make a profound difference in our patient’s lives.