Expert: Up to 20% of Poles may suffer from sleep apnea

Obstructive sleep apnea is the most common sleep disorder. Nearly a billion people worldwide suffer from it, and in Poland, as much as 20 percent of the population. Dr. Helena Martynowicz from the Medical University of Wrocław emphasized that if left untreated, it increases the risk of heart attack, stroke, and traffic accidents.

In an interview with PAP, the UMW professor noted that most cases of obstructive sleep apnea, as this is the full name of the condition, remain undiagnosed. There are few centers and doctors in the country specializing in this condition. Furthermore, the symptoms most often associated with apnea are often ignored.

"Both patients and their families believe that snoring is harmless, sometimes even amusing, when in reality it can be a sign of a serious illness. If it is accompanied by frequent urination at night, excessive daytime sleepiness, obesity, and hypertension, the likelihood of developing sleep apnea is very high," she noted.

However, not all snoring indicates sleep apnea. "It can be so-called simple snoring, occurring only when lying on your back or after drinking alcohol, for example. However, loud, bothersome, and irregular snoring always requires diagnostic testing for sleep apnea," the expert pointed out.

Obstructive sleep apnea is associated with numerous health complications, 80% of which involve the cardiovascular system. The most common complication is hypertension. As Professor Martynowicz pointed out, approximately half of patients with hypertension suffer from undiagnosed sleep apnea, and half of those with sleep apnea have hypertension.

The disease can also lead to heart rhythm disturbances, primarily atrial fibrillation and atrioventricular block. Atrial fibrillation increases the risk of stroke and heart failure, while atrioventricular block can cause severe fainting and even lead to sudden cardiac arrest.

Sleep apnea also increases the risk of developing atherosclerosis and heart attacks, which in many cases are fatal. "Such events most often occur in the morning, when patients are in REM sleep and experience the greatest drops in blood oxygen levels," explained Professor Martynowicz.

Complications of sleep apnea also include memory and concentration problems, as well as excessive daytime sleepiness. The expert said that, according to estimates, in the United States, up to 40 percent of highway accidents may be related to excessive sleepiness, a typical symptom of sleep apnea. "It's probably similar in Poland. This poses a particular threat to professions such as bus drivers and air traffic controllers," she said.

However, in her opinion, sleep apnea is still underestimated. "Even in medical schools, until recently, it was barely taught, so many doctors have little knowledge about it. Patients also don't take it seriously. They find snoring amusing, perhaps a little embarrassing for their family, but that's all," the specialist noted.

Diagnosing sleep apnea begins with an initial risk assessment, based on simple questionnaires completed, for example, by a primary care physician. If these indicate an increased risk, the patient should be referred for a sleep study.

"We have two options here. The first is polysomnography – the most comprehensive test, recording many parameters (including brain waves, breathing, muscle movements, and oxygen saturation). Unfortunately, it is expensive and difficult to access, as few centers in Poland perform it. For this reason, we reserve it for so-called difficult cases and for research purposes," said Prof. Martynowicz.

The second option is respiratory polygraphy – a method available to everyone, as most clinics have the necessary equipment. Patients are given a special device to take home, where they sleep, and the next day, based on the results, a diagnosis is made. This is not reimbursed by the National Health Fund (NFZ), which explains why it is still performed too infrequently.

The primary treatment for sleep apnea is CPAP devices, also known as air prostheses. "They are worn exclusively for sleeping. They allow for free breathing, lower blood pressure, reduce the risk of heart attack and arrhythmia, and above all, improve quality of life," said Professor Martynowicz.

She noted that 10–15 years ago, CPAP machines were large and uncomfortable, which is why many people are still afraid of using them. In her opinion, this is unnecessarily so, as newer-generation devices are small and patient-friendly.

Some patients with obstructive sleep apnea also qualify for otolaryngological procedures, such as removal of enlarged palatine tonsils. This is particularly true for children and produces excellent results – sleep apnea disappears, and the quality of sleep and life improves significantly.

Last year, a completely new therapeutic option appeared on the market in the form of a drug. "This is an option exclusively for patients with obesity and sleep apnea. The drug, called tirzepatit, has successfully passed clinical trials and is truly remarkable in its effectiveness. It reduces the number of sleep apneas by 50% within 52 weeks, so some people who use it are able to completely discontinue CPAP therapy. This is an absolute breakthrough, and it is also available in Poland," said the specialist.

An alternative for some patients is intraoral appliances, which are used in collaboration with dentists. "They move the jaw forward and clear the airway, which effectively eliminates snoring and is useful for mild to moderate forms of sleep apnea," explained Professor Martynowicz.

As she summarized, obstructive sleep apnea is one of the most common, yet most underestimated, diseases in the world. It is estimated that as many as one billion people suffer from it, and in Poland alone, approximately 20% of the population.

It's generally believed that it affects men more often, but – as the professor pointed out – this is because women go undiagnosed because their symptoms are less specific. "Women snore more quietly and, above all, are less likely to admit it, for example, they hide it during doctor's visits. In women, the condition can manifest itself as recurring headaches, palpitations, or chronic fatigue. However, importantly, the cardiovascular risk associated with sleep apnea is even higher in women than in men," she emphasized.

Science in Poland, Katarzyna Czechowicz (PAP)

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