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If you snore loudly, someone has seen you stop breathing in your sleep, or you are so sleepy during the day that you feel like dozing off even while driving, go to a hospital for a sleep study to check for sleep apnea, and if it is moderate to severe, wear a breathing machine at night

  • Moderate value
  • Evidence A
  • Saves time
  • Disputed
  • Costs a lot
  • Takes some hours
  • Long-term effort

In plain words

Sleep apnea means that after you fall asleep your breathing keeps stopping or getting shallow, you wake up gasping, and you are sleepy during the day. With a breathing machine, daytime sleepiness clearly eases and crashes while driving fall by about 70%. But trials did not find that it prevents heart disease or lets people die less; you wear it to be alert during the day.

Cost

Start at a hospital's sleep clinic, respiratory department or ENT department. Diagnosis takes one night of sleep monitoring, either sleeping at the hospital or borrowing the device to wear at home. If you need a breathing machine, you generally have to buy it yourself, which is not a small expense. The hard part is sticking with it: you have to wear the mask every night, it feels strange for the first few weeks, and many people take it off after a few hours.

What you get

The American Academy of Sleep Medicine's 2017 diagnostic guideline spells out who is more likely to have the moderate-to-severe form. Being very sleepy during the day on most days, plus at least two of the following three. One, loud snoring often. Two, someone has seen you stop breathing, gasp or wake up choking while asleep. Three, high blood pressure has already been found. The guideline requires a sleep study to confirm the diagnosis, not just a questionnaire. Breathing stopping or getting shallow 5 or more times an hour, with symptoms, counts as the disease. With or without symptoms, 15 or more also counts. The American Academy of Sleep Medicine's 2019 systematic review pooled 38 randomized controlled trials. Compared with no treatment, people on a breathing machine had a self-rated sleepiness score 2.4 points lower (95% CI 1.9โ€“2.8, the plausible range). This score is the Epworth Sleepiness Scale, out of 24 points, and the higher the sleepier. Counting only people who were not sleepy to begin with, 5 trials found a drop of 1.0 point, which the authors consider not clinically meaningful. The same review pooled 10 before-and-after treatment studies. After starting the machine, the crash rate was 0.3 times that before treatment (RR 0.3, 0.2โ€“0.4), about 70% lower. A 2010 analysis pooled 9 similar studies and got RR 0.278 (0.22โ€“0.35). It also said that daytime sleepiness eased clearly after just one night of use, and simulated driving performance improved within 2 to 7 days. A 2009 analysis by the same group of authors said that untreated patients have roughly 1.21 to 4.89 times the risk of a crash compared with other people. Now the heart and lifespan. The SAVE trial enrolled 2717 people aged 45 to 75 with moderate-to-severe disease, all with coronary disease or a previous stroke. After random assignment they were followed for an average of 3.7 years. Cardiovascular and cerebrovascular events occurred in 17.0% of those wearing the machine and 15.4% of those not. There was no difference between the two groups (HR 1.10, 0.91โ€“1.32). Those who wore it averaged only 3.3 hours a night. Their snoring, daytime sleepiness, quality of life and mood improved. A 2017 analysis pooled 10 randomized trials with 7266 people. Total mortality also showed no difference (RR 1.13, 0.99โ€“1.29). A 2019 estimate said that about 176,000,000 (1.76ไบฟ) people aged 30 to 69 in China have this disease, 23.6%. Of these, moderate-to-severe cases are about 65,520,000 (6552ไธ‡), 8.8%, the largest number of any country in the world.

Notes

Disputed. Randomized trials did not find that the machine prevents heart disease or lets people live longer. Most people in SAVE were not very sleepy and wore it little. But the 2017 analysis, split by hours of use, also found no difference. The crash figures come from before-and-after comparisons, not random assignment, and the people in the studies may simply have become more careful after treatment. The figure for China is only extrapolated from a 2005 study of 3648 people, and that estimate was funded by a breathing machine manufacturer. The U.S. Preventive Services Task Force said in 2022 that for screening people without symptoms, the benefits and harms are unclear. So people who don't snore and aren't sleepy during the day needn't get checked specifically. The benefit is rated medium as a judgment: the sleepiness score dropped 2.4 points, and how many more hours a day of alertness that means was not measured. Which department to go to is the author's experience (grade C) and differs by hospital. If you are sleepy while driving, pull over first; see ยง1.9 (pull over and rest when sleepy). For people who need to sleep long in the daytime, see ยง2.37 (a nap over an hour: find out why). For long-term insomnia, see ยง3.26 (long-term insomnia). The people who benefit are mainly you, and also the people in your car and on the road.

Evidence grade
A : Specific numbers from meta-analyses, large cohorts or randomized trials; for law and policy, the statute or official text.
Sources
  1. Kapur VK, Auckley DH, Chowdhuri S, ็ญ‰ (2017). Clinical Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea: An American Academy of Sleep Medicine Clinical Practice Guideline. Journal of Clinical Sleep Medicine, 13(3):479-504. https://doi.org/10.5664/jcsm.6506
  2. Patil SP, Ayappa IA, Caples SM, Kimoff RJ, Patel SR, Harrod CG (2019). Treatment of Adult Obstructive Sleep Apnea With Positive Airway Pressure: An American Academy of Sleep Medicine Systematic Review, Meta-Analysis, and GRADE Assessment. Journal of Clinical Sleep Medicine, 15(2):301-334. https://doi.org/10.5664/jcsm.7638
  3. Tregear S, Reston J, Schoelles K, Phillips B (2010). Continuous positive airway pressure reduces risk of motor vehicle crash among drivers with obstructive sleep apnea: systematic review and meta-analysis. Sleep, 33(10):1373-1380. https://doi.org/10.1093/sleep/33.10.1373
  4. Tregear S, Reston J, Schoelles K, Phillips B (2009). Obstructive sleep apnea and risk of motor vehicle crash: systematic review and meta-analysis. Journal of Clinical Sleep Medicine, 5(6):573-581. https://pubmed.ncbi.nlm.nih.gov/20465027/
  5. McEvoy RD, Antic NA, Heeley E, ็ญ‰ (2016). CPAP for Prevention of Cardiovascular Events in Obstructive Sleep Apnea. New England Journal of Medicine, 375(10):919-931. https://doi.org/10.1056/NEJMoa1606599
  6. Yu J, Zhou Z, McEvoy RD, ็ญ‰ (2017). Association of Positive Airway Pressure With Cardiovascular Events and Death in Adults With Sleep Apnea: A Systematic Review and Meta-analysis. JAMA, 318(2):156-166. https://doi.org/10.1001/jama.2017.7967
  7. Benjafield AV, Ayas NT, Eastwood PR, ็ญ‰ (2019). Estimation of the global prevalence and burden of obstructive sleep apnoea: a literature-based analysis. The Lancet Respiratory Medicine, 7(8):687-698. https://doi.org/10.1016/S2213-2600(19)30198-5
  8. US Preventive Services Task Force (2022). Screening for Obstructive Sleep Apnea in Adults: US Preventive Services Task Force Recommendation Statement. JAMA, 328(19):1945-1950. https://doi.org/10.1001/jama.2022.20304

Mentioned in

Translated from the Chinese original. Original book, section 3, tip 27. Content may be out of date and rules differ by place. When you actually deal with an agency, a doctor or a court, follow what local officials, doctors and lawyers tell you. Disclaimer