Obstructive Sleep Apnea: Sleep Well, Breathe Easy

In the 1830’s, the English novelist Charles Dickens published a series of stories called “The Pickwick Papers”. One character, the larger-than life Joe, was known for his prodigious appetite and large build with an ability to fall asleep quickly and often during the day. In 1956, an astute medical researcher named Burwell and his colleagues published an article in the American Journal of Medicine titled, “Extreme obesity associated with alveolar hypoventilation-a Pickwickian syndrome”. This was the first modern day presentation of a sleep-related breathing disorder now known as obstructive sleep apnea (1).

What is obstructive sleep apnea, also known as OSA?

Apnea means to stop breathing, and in the context of OSA this happens while asleep. That sound you hear is the often loud snoring that accompanies these episodes of breathlessness. The obstructive part is in the upper airway system caused by the inadequate function of the tongue muscles or surrounding muscles that keep the airways open (2).

Before we consider how serious OSA might be, we know that this is the most common sleep-related breathing disorder, affecting an estimated and staggering 936 million people and by far, mostly men, worldwide (3). However, it is estimated that only 1 in 5 cases are diagnosed (4).

Think about it. Is a supposed disorder associated with snoring and maybe gasping for air at night a problem?

Maybe the client is a little tired during the day, even falling asleep often and quickly just like Joe? Think again. Most cases of OSA, diagnosed or not, occur in ages 50 and higher and particularly among the overweight/obese, smokers, and those who may be genetically predisposition to this condition. Untreated OSA can increase the risk of developing everything from Type 2 diabetes to kidney disease and heart failure (5).

We have left the best for last as we answer how OSA is diagnosed and treated.

Polysomnography is a sleep study that can be done in a clinic or at home and will measure a number of things, but most important, the number of times the patient stops breathing (apneas) or reduces breathing (hypopneas) over the course of an hour. If the result is 5-15  apneas/hypopneas per hour (AHI), mild OSA is present. An AHI of 30 or more is severe disease. The risk of complications is that much higher with severe OSA. The good news is that OSA has a number of treatment options that can include weight loss, alcohol reduction or even simply sleeping on your side more often than on your back. For most cases of OSA, the only effective treatment is to keep the airways open by applying continued positive airway pressure (CPAP). Current generation CPAP appliances not only keep the airways clear but provide usage data confirming AHI, oxygen saturation and other metrics that confirm the efficacy of the treatment. These usage data reports can make even severe OSA cases fall into the most favorable underwriting decision categories. For those with suspected OSA, get tested. For those with confirmed OSA, use CPAP, if prescribed. This makes clients, you as an Advisor, and underwriters sleep well and breathe easy.

For more information on this Risk Bit and the underwriting process, contact your local PPI Collaboration Centre.

  1. Ferriss, J. Barry. Obstructive sleep apnea syndrome: the first picture? Journal of the Royal society of Medicine. 102(5) 201-202. May 1, 2009.
  2. Park, John G. Updates on Definition, Consequences, and Management of Obstructive Sleep Apnea. Mayo Clinic Proceedings. 86(6): 549-555. June 2011.
  3. Ling, Vanessa. Sleep Apnea Statistics and Facts You Should Know. National Council on Aging Adviser. October 4, 2023.
  4. Benjafield et al. Estimation of the prevalence and burden of obstructive sleep apnea: a literature-based analysis. Lancet Respir Med. 7(8): 687-698. July 9, 2019.
  5. Ling, Vanessa. Sleep Apnea Statistics and Facts You Should Know. National Council on Aging Adviser. October 4, 2023.

This article is provided by Know the Risk, an educational website that contains underwriting information for insurance professionals, available exclusively to Advisors affiliated with PPI (login required).

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