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Sleep Disorders

Severe Obstructive Sleep Apnea

09/28/2007

Question:

I was diagnosed with severe obstructive sleep apnea 4 years after I got out of the Marines. Because I did not know the symptoms of sleep apnea (loud snoring, stop breathing during sleep, frequent bathroom visits at night, weigh gain, wake up gasping for air, wake up with headaches, etc.) until 8/2001, I did not go to sick call for those symptoms, all of which I had on active duty. I am trying back date my OSA while on active duty because my ex-girlfriend, friends and family complained to me all the time about the above symptoms while I was on active duty and after I left the Marines. I also had heartburn and insomia. Between 1992 and 2001 I have fallen asleep at stop lights; and while driving at least 20 times. I was lucky to not have run into someone. My question is I how do I get the history on OSA. Clearly this is not something you get overnight. What is the developmental period of OSA. Need help.

Answer:

Obstructive sleep apnea (OSA) is a common condition, affecting roughly 5% of middle aged adults in America. Most individuals with this condition are still not diagnosed and, of those that are diagnosed, many have had it for many years prior to undergoing appropriate testing. In fact, recent research has shown that many individuals with OSA have their symptoms misinterpreted as being due to other conditions (such as depression) and thus their diagnosis may be delayed by a year or two even after seeking help. With increasing awareness of this condition, this will hopefully change in the future.

The risk factors for OSA include obesity and craniofacial abnormalities. If you were overweight or have a history of crowded airways, it's possible that you could have had OSA even during childhood. However, it is also possible that your OSA did not develop (or worsened) until aging or additional weight gain affected your airway anatomy. Infrequently, a traumatic event, such as a broken nose, could be the trigger that leads to the development of OSA.

Without objective testing (a sleep study), there is no way to tell with certainty, based on historical information, when a particular patient's OSA crossed the threshold to become significant enough to justify treatment. In your case, it sounds like you had symptoms for many years prior to your testing. However, a definitive diagnosis can not be made without a sleep study and therefore it would be difficult to provide a particular date after which you more likely than not had a significant case of OSA.

It would probably be a good idea to discuss your case with your primary doctor. Referral to a Sleep Specialist in your area may be useful. They can review your records and may be able to render an opinion based on additional details in your medical history and examination.

To learn more about sleep apnea or other sleep disorders, please visit the American Academy of Sleep Medicine website. In addition to information, the website contains a list of Sleep Centers across the country so that you may locate one near you.

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Response by:

Dennis   Auckley, MD Dennis Auckley, MD
Associate Professor of Medicine
School of Medicine
Case Western Reserve University