Loud, obnoxious snoring and excessive daytime sleepiness are common symptoms for many individuals. While these issues may be a nuisance, they are often an indication of significant sleep problems like sleep apnea. Night-time breathing strips, mouth appliances, and CPAP machines may bring necessary relief to the sufferer, but it is also important to understand the bigger picture of sleep breathing disorders.
Sleep apnea affects an estimated 26 percent of the adult population in the United States. However, experts believe this number to be much higher. The American Heart Association estimates that 40-80% of patients with high blood pressure, atrial fibrillation, coronary artery disease, heart failure, and stroke are affected by obstructive sleep apnea.
Sleep apnea is related with loud snoring when sleeping on your back, which lessens when you sleep on your side. You may awaken abruptly gasping or choking for breath. High blood pressure, dry mouth or sore throat upon awakening, and increased neck size are also related to sleep apnea. Your spouse may witness periods of apnea when you stop breathing during your sleep. You don’t have to have snoring problems to have sleep apnea.
Additional symptoms of sleep-disordered breathing may occur. These include excessive sleepiness, morning headaches, night-time urination, decreased libido and erectile dysfunction, memory loss, depression, irritability, night-time chest pain, and fatigue.
Sleep breathing disorders affect your work performance, increase risk for accidents and adversely affect many aspects of your health.
Obstructive sleep apnea (OSA) is the most common form of sleep apnea where your throat tissues and upper airway collapse when you breathe in. Other forms include central sleep apnea (CSA) syndrome where nerves in the brainstem fail to send adequate signals to the respiratory muscles, or a combination of OSA and CSA and other types of sleep disordered breathing.
Sleep fragmentation, diminished recovery, and increased wear and tear are disruptive to your daily life, but chronic sleep-apnea is destructive to your health. The greatest concerns relate to the intermittent hypoxia or lack of oxygen to the brain and the associated oxidative stress throughout your body.
Sleep Apnea Impacts Cardiovascular Health
Sleep apnea is an independent risk factor for cardiovascular disease and high blood pressure. Obstructive sleep apnea activates your sympathetic (fight/flight) autonomic nervous system in response to tissue hypoxia and oxidative stress. It leads to endothelial dysfunction, increased coagulation effects, and deregulates metabolism.
Negative effects of sleep apnea are linked with high blood pressure, coronary artery disease, atrial fibrillation and other heart rhythm disorders, heart failure, stroke, diabetes and metabolic syndrome, and increased mortality.
You can learn more about the effect of endothelial and coagulation stress in the article Is Stress Affecting your Heart Health?
Sleep Apnea: One Size Fits Does Not Fit All
Increased body mass index (BMI) and obesity is considered the one major modifiable risk factor of OSA. Alcohol use, tonsil and adenoid enlargement from allergies and upper respiratory infection, tobacco use, and some medications also contribute to snoring and sleep apnea.
Although these factors increase risk, men, women, and children without these concerns, may also experience sleep disordered breathing. This is where a deeper understanding of health of your mitochondria, the power centers of your cells, helps you understand more about sleep apnea and its adverse effects.
Sleep Apnea and Mitochondria
In recent years, scientists have discovered that OSA and sleep breathing disorders are related to mitochondrial dysfunction. Studies suggest that those who don’t fall into the classic risk factors for obstructive sleep apnea or have OSA, may have underlying or associated mitochondrial dysfunction.
Research proposes at least a two-fold issue with mitochondria. The first involves underlying primary mitochondrial disorders that lead to sleep disorders. The second issue relates to acquired mitochondrial injury from the intermittent loss of oxygen and re-oxygenation stress that occurs with sleep apnea.
Primary Mitochondrial Disorders
In situations of primary genetic mitochondrial dysfunction, researchers have found that children and adults with eye/optic nerve issues and/or muscle disorders with poor exercise tolerance, weakness, nocturnal leg cramps, restless legs syndrome, and/or periodic limb movement disorder are more apt to have sleep breathing disorders. Evidence also links sleep-onset and maintenance insomnia with mitochondrial optic neuropathies. These genetic concerns are found in individuals with fragile health.
Sleep Apnea and Acquired Mitochondrial Injury
Acquired mitochondrial damage is much more common than primary mitochondrial disorders. We experience mitochondrial injury and breakdown with age, stress, trauma, poor diet, lifestyle, and drugs, etc. In the case of sleep apnea, the tissue stress from the breathing changes also contributes to mitochondrial injury.
Several recent studies show that intermittent breathing disruptions during sleep apnea stress mitochondria. As a result of tissue oxygenation disruption, higher amounts of free radicals are produced that injure mitochondria. As a result, increased systemic inflammatory reactions and accelerated aging occurs throughout your body.
In biopsies completed from soft palate tissues in adults with obstructive sleep apnea, microscopic mitochondrial changes are seen. The soft palate is the soft tissue and muscles at the back of the roof of your mouth. Biopsy analysis showed abnormal mitochondrial dynamics and function, decreased capillary supply, and evidence of muscle dysfunction reflective of mitochondrial oxidative stress in the area.
Another study measured mitochondrial DNA levels in the blood stream of healthy adults and those with sleep apnea. Results showed those with sleep apnea had less mitochondria DNA and increased oxidative stress.
Remarkable research published March 2021 showed that intermittent hypoxic effects of sleep apnea caused observable marked changes to the endothelial lining in blood vessels. The hypoxic effects of sleep apnea caused an increase in ROS free radicals circulating through blood vessels. This injured mitochondria and caused apoptosis or cell death of the endothelial cells.
The endothelial lining is a very dynamic and delicate one cell thick lining inside all blood vessels. In response to endothelial damage, inflammation increases and cholesterol is laid down to protect and stabilize vascular tissues.
Sleep Apnea, Mitochondrial Dysfunction, and Your Brain
A discussion about sleep apnea and mitochondria must also include some mention about brain health. Sleep apnea effects lead to heart disease, failure and rhythm disorders and is also linked with molecular changes in the brain and decreased cognitive ability. Many individuals with cardiovascular challenges and obstructive sleep apnea go on to experience neurodegenerative changes with Alzheimer’s disease and Parkinson’s disease.
Studies in animals with sleep apnea show death of brain cells in the cerebral cortex because of intermittent hypoxia mitochondrial stress. MRI studies of the elderly who have a long-standing history of sleep apnea showed brain edema/swelling and atrophy.
Other findings showed sleep apnea decreased blood flow to the hippocampus, the memory center of your brain, reflecting impaired mitochondrial activity and repair. Studies have shown increased build-up of protein fragments and hyperactivated microglial cells, indicating brain stress and neurodegenerative changes. Microglial cells are the neuroimmune cells that work to manage cell debris and inflammation clean-up within your brain.
If your spouse keeps nudging you to roll over at night because of snoring, or you have chronic morning headaches, excessive yawning and daytime sleepiness, get evaluated for sleep apnea. A healthy body weight, exercise, stress management and a clean, whole foods diet are the fundamentals to minimize your risk and improve your daily health and mitochondria function.
Additional resources for mitochondrial health may be found at: