Is Sleep Apnea a Disability?

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Today, over 18 million people in the United States suffer from obstructive sleep apnea, and some government studies indicate that it may be even be 50 million. Understanding the dangerous medical risks  that come with a diagnosis are important for many people who are either directly impacted or may be impacted in the future (OSA has a possible strong genetic basis). Visiting a certified sleep apnea doctor like the professionals at the Michigan Head & Neck Institute is the best way to see if you may have this potentially debilitating condition.

 

Disability Status

So, is Sleep Apnea a disability? The short answer is no. But the facts of the matter are much more complicated than that. The Social Security Administration does not classify sleep apnea as a claimable source of disability, but many of the problems that are associated with sleep apnea could qualify under the categories of heart problems, breathing disorders, or even the resulting mental deficit that accompanies Sleep Apnea’s impact on oxygen levels in the brain. Over a billion dollars are lost annually from business whose employees have OSA.  If you feel tired after sleeping or are known to snore a lot, a sleep apnea test is the best way to see if you have sleep apnea or are at risk for these complications.

One of the most dangerous risks with Sleep Apnea is the development of chronic pulmonary hypertension, which can change IQ, personality, and even lead to chronic mental disorders and death. These symptoms and conditions can severely impact a person’s ability to work properly and can be qualifying factors for disability through the SSA. While it is not considered a common result of sleep apnea, cases do exist, and you should monitor your condition with the help of a professional.

Probably the most widespread link to  Obstructive Sleep Apnea that can lead to disability from Social Security is “residual functional capacity.” If you can still work but only in a limited capacity, your RFC will reflect this. The SSA will look at your capabilities and consider if you are still able to perform your work or not, within reason. For example, a pilot or a machinist could be severely impacted at work by daytime sleepiness and typically cannot continue in that field. An accountant’s secretary can continue to work since their mistake is not deadly to anyone.

 

Treatment Options

Consult a professional for proper sleep apnea treatment, but there are plenty of ways to mitigate the effects. One of the best ways is to lose weight if you have these extra pounds. Being overweight is a major risk factor for sleep apnea, and other conditions associated with being overweight are linked to sleep apnea as well as diabetes and large neck size. Treatment usually involves the addition of a continuous positive airway pressure device or “CPAP” machine to your sleep routine. A CPAP machine facilitates proper breathing and restores adequate oxygen levels by providing airflow while you sleep. Other times, positional therapy provides patients with a way to sleep on their sides in a position that allows unobstructed breathing. In some cases, surgery could also remove some of the obstruction in the form of parts like tonsils or adenoids, or by modifying the jaw, soft palate, or tongue. For those who do not want the CPAP, an Oral Appliance (mouthpiece) can bring your jaw down and forward causing the collapse in the back of the throat to remain open for breathing in and exhaling out. The majority of people in the world can be comfortable with an OA but not with a CPAP. And the National Institute of Health now recognizes the safety and validity of an OA to control OSA.

 

Look at Options With a Professional

If you think your sleep apnea or its side effects are inhibiting your work, consult a physician to see if you qualify for disability due to an aspect of your disorder. They can help assess your residual functional capacity by monitoring your daytime sleepiness and oxygen levels. They can also provide ideas of how to restore your functionality through the addition of a CPAP machine, an Oral Appliance, or if surgery would be beneficial in your case. Usually, they have enough experience to also aid you by providing a diagnosis and reviewing your options for what to claim on a disability form. The professionals at the Michigan Head and Neck Institute have extensive experience diagnosing and treating sleep disorders and a consultation is the natural first step towards recovery or disability assistance.

What Does Sleep Apnea Do to Your Body

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Undiagnosed and untreated OSA (obstructive sleep apnea) can cause many dangerous medical issues, even death.  The lack of oxygen to the brain and body caused by sleep apnea episodes can also contribute to increased chances of stroke, depression, fatigue, weight gain, irritable bowel syndrome, and type II diabetes. Many of the issues that you will read about here are things that you may have never thought had anything to do with OSA, but hopefully by the end of this you will see how everything is related.

what does sleep apnea do to your body

Increased Blood Pressure

OSA episodes produce surges in systolic and diastolic pressure that keep blood pressure levels elevated while you sleep. People that do not have sleep apnea experience a decrease in blood pressure during sleep.  For many, blood pressure remains elevated during the daytime when breathing is supposedly normal. This is why screening for OSA is absolutely necessary when evaluating patients with hypertension.  The use of a CPAP machine has been proven to decrease nocturnal blood pressure surges.

Diabetes Risk

 In 1981, Dr. Rees conducted a study, which reported the high incidence of sleep breathing disorders in diabetics.  Since then, researchers have been able to document the different independent associations between OSA, insulin resistance, alertness, and glucose levels.  Many times treating the OSA will, in turn, control the diabetes. Determining which one is the chicken and the egg is difficult.  Having OSA can lead to diabetes, but many diabetics are also obese, which can lead to OSA. Diabetics have more complicated sleep patterns, as they need to get up to use the bathroom more often than non-diabetics.  Imbalances in hormone melatonin experienced by diabetics also cause irregularities in the sleep-wake cycle.

Increased Blood Sugar

 People with diabetes have higher levels of HbA1c (average blood sugar level over time) than people without diabetes.  When this increase occurs, the risk of heart disease increases. There is a direct link between the severity of the OSA diagnosis and the level of the blood sugar, in that the more severe apnea cases have the highest HbA1c levels and vice-versa.  In addition, multiple studies have proven that when OSA is treated, blood sugar levels improve. These findings hold true regardless of factors such as obesity, age and sex.

A study presented at the American Thoracic Society 2012 International Conference showed that moderate and severe obstructive sleep apnea predicted Type 2 diabetes, and that sleep apnea was associated with HbA1c levels.

Elevated Heart Rate

 OSA causes irregularities in the Sympathetic Nervous System (SNS), which causes instability in the heart rate.  OSA severity can also be linked to the Parasympathetic Nervous System (PNS), as it is directly affected by the circadian system. PNS activity is higher in non-REM sleep, which is noticed in non-OSA patients, but is much more predominant in OSA patients. This suggests that the higher the PNS activity, the greater the oxygen saturation fluctuations are.  To measure the time interval between heartbeats, non-invasive methods can be utilized.  Changes in HRV (heart rate variability) can be monitored to help predict future problems.

 Reduced Blood Oxygen

Having an extremely low level of oxygen in the blood is known as hypoxemia, which over time, leads to hypertension and diabetes. Oxygen desaturation is an immediate consequence of OSA. Patients suffering from OSA experience oxygen desaturation in addition to periods of apnea and hypopnea. During these apneic periods, patients suffering from OSA are not receiving air delivery to the body system.  If a patient cannot comply with a CPAP (recommended for Oxygen saturation levels below 90%) then oxygen therapy/ administration may be an option.

Increased Fatty Acids

OSA causes increases in nocturnal FFA (free fatty acids) that may be a catalyst to an underlying heart condition.  Increases in FFA can cause insulin resistance and vascular dysfunction, and repeated exposure to these increases can promote cardiovascular disease and diabetes. Many studies have shown that supplemental oxygen will prevent the FFA elevations, thus the CPAP can be utilized here as well.

Vascular Stiffness

 OSA is associated with arterial stiffness, depending on severity in diagnosis, that adds to cardiovascular risk.

Arterial stiffness determines how quickly the pulse wave of the heart travels to the edge and then comes back. How stiff the walls are (or not) directly correlate to the blood pressure oscillation. Patients with OSA have this arterial stiffness during the daytime as well as overnight.  Vascular stiffness can be increased with OSA for many reasons – changes in elastin, endothelial dysfunction, oxidative stress and/or inflammation.  Endothelial dysfunction occurs when the inner lining of the blood vessels are imbalanced and can lead to hypertension, diabetes, and many associated inflammatory diseases.

Cardiovascular Disease

 *The National Commission on Sleep Disorders Research estimated that sleep apnea is probably responsible for 38,000 cardiovascular deaths yearly, with an associated 42 million dollars spent on related hospitalizations.

As stated above, OSA can cause hypoxemia and very low oxygen saturation levels, causing disrupted sleep cycles.  After repeated apneic episodes, blood pressure levels are increased, causing stress to the heart. The nocturnal apneas cause cardiac disease. Even though OSA and cardiovascular disease have common risk factors, studies prove that sleep apnea increases the risk for cardiovascular disease independently of other characteristics and/or risk factors. This link is further validated by the fact the CPAP treatment is proven to reduce blood pressure and improve ventricular function.  Failure to control the sleep-related breathing problems can lessen the effectiveness of treatments for heart failure and result in accelerated deterioration of heart function.

*One of the largest epidemiologic studies conducted to date, the Sleep Heart Health Study sampling 6,424 community-dwelling individuals who underwent home polysomnography, documented increased risk of coronary artery disease, congestive heart failure, and stroke among patients with severe sleep apnea.

A few Additional Facts about Sleep Apnea:

  • Left untreated, sleep apnea increases one’s risk of heart attack and stroke
  • 90% of those who snore exhibit sleep apnea tendencies
  • Hypertension is present in approximately 50% of patients diagnosed with OSA
  • Over long periods, uncontrolled sleep apnea results in memory deterioration
  • Sleep apnea can cause high blood pressure, as well as heart and lung problems
  • Psychiatric issues, such as anxiety and depression can result from sleep apnea
  • Uncontrolled sleep apnea can lead to muscular pain and exaggerated fibromyalgia
  • Drowsiness is blamed for 200-400,000 auto accidents annually, costing $50-100 billion
  • Thousands of jobs are lost annually due to OSA, costing U.S. production $60 billion

At Michigan Head & Neck Institute, we exclusively offer treatment for OSA that consists of creating a custom-fit oral appliance (mouthpiece) which is comfortable and can be adjusted to meet the requirements of each patient. Each patient that chooses an oral appliance (OA) as their treatment plan will receive follow up sleep studies (either at-home or a in a sleep lab) which will ensure that the OA is positioned accordingly. There are over 100 different types of oral appliances, and Dr. Klein works with each patient to provide the best options for their specific treatment.  Please visit our website here for more information.

References:

 *The National Commission on Sleep Disorders Research. Wake up America: a national sleep alert. Washington DC: US Government Printing Office; 2002.

 Dopp JM1, Reichmuth KJ, Morgan BJ. Obstructive Sleep Apnea and Hypertension: mechanisms, evaluation, and management. Curr Hypertens Rep. 2007 Dec; 9(6):529-34.

 Pamidi S, Tasali E. (2012). Obstructive Sleep Apnea and Type 2 Diabetes: Is There a Link? Frontiers in Neurology, 3, 126.

http://doi.org/10.3389/fneur.2012.00126

*Shahar E, Whitney CW, Redline S, Lee ET, Newman AB, Nieto FJ, O’Connor GT, Boland LL, Schwartz JE, Samet JM. Sleep-disordered breathing and cardiovascular disease: cross-sectional results of the Sleep Heart Health Study. Am J Respir Crit Care Med. 2001 Jan; 163(1):19-25.

Johns Hopkins Medicine. “Untreated sleep apnea shown to raise metabolic and cardiovascular stress.” ScienceDaily, 31 August 2017. www.sciencedaily.com/releases/2017/08/170831101454.htm

Chopra S, Rathore A, Younas H, Pham LV, Gu C, Beselman A, Kim IY, Wolfe RR, Perin J, Polotsky VY, Jun JC. (Sept 2017) Obstructive Sleep Apnea Dynamically Increases Nocturnal Plasma Free Fatty Acids, Glucose, and Cortisol During Sleep, The Journal of Clinical Endocrinology & Metabolism, 102(9), 3172–3181.

Zhang W, Si L. (2012). Obstructive Sleep Apnea Syndrome (OSAS) and Hypertension: Pathogenic mechanisms and possible therapeutic approaches. Upsala Journal of Medical Sciences, 117(4), 370–382.

Johns Hopkins Medicine. “What a few nights of sleep apnea can do to the body”.

Posted by Chanapa Tantibanchachai-Johns Hopkins September 6th, 2017. Journal of Clinical Endocrinology & Metabolism,

http://www.futurity.org/sleep-apnea-1534552/

Seetho IW, Parker RJ, Craig S, Duffy N, Hardy KJ, Wilding JPH. OSA is Associated with Increased Arterial Stiffness in Severe Obesity. J Sleep Res. 2014 December; 23(6):700-708.

Landsberg R, Friedman M, Ascher-Landsberg J. Treatment of Hypoxemia in Obstructive Sleep Apnea. Am J Rhinol. 2001 Sept-Oct; 15(5):311-13.

Kufoy E, Palma JA, Lopez J, Alegre M, Urrestarazu E, Artieda J, Iriarte J. (2012). Changes in the Heart Rate Variability in Patients with Obstructive Sleep Apnea and Its Response to Acute CPAP Treatment. PLoS ONE, 7(3), e33769.

http://doi.org/10.1371/journal.pone.0033769

Jean-Louis G, Zizi F, Clark LT, Brown CD, McFarlane SI. (2008). Obstructive Sleep Apnea and Cardiovascular Disease: Role of the Metabolic Syndrome and Its Components. Journal of Clinical Sleep Medicine : JCSM : Official Publication of the American Academy of Sleep Medicine, 4(3), 261–272.