Sleep Apnea Syndrome
In brief
Section titled “In brief”- OSA: airway collapses during sleep → breathing pauses and oxygen drops
- Severity measured with Apnea-Hypopnea Index (AHI): mild/moderate/severe
- Three treatment pillars: CPAP, lifestyle (TKB), and Tirzepatide
- Sleep apnea is a key manifestation of metabolic dysfunction
- Recovery of sleep = recovery of metabolism and brain function
What is sleep apnea syndrome?
Section titled “What is sleep apnea syndrome?”Obstructive sleep apnea syndrome (OSA) is a condition in which the upper airway repeatedly partially or completely collapses during sleep.
Consequences
Section titled “Consequences”- Brief breathing pauses
- Oxygen drops
- Stress responses that disrupt sleep
Over time, this leads to hormonal dysregulation, fatigue, and disruption of metabolism.
Symptoms and signals
Section titled “Symptoms and signals”Nighttime symptoms
Section titled “Nighttime symptoms”| Signal | Explanation |
|---|---|
| Loud snoring | Due to narrowed airway |
| Breathing stops | Visible to partner |
| Restless sleep | Lots of movement, tossing |
| Night sweats | Due to stress responses |
| Dry mouth/headache | Upon waking |
Daytime
Section titled “Daytime”| Signal | Explanation |
|---|---|
| Persistent fatigue | Despite sufficient hours of sleep |
| Concentration problems | Reduced cognitive function |
| Mood swings | Irritability, depression |
| Weight gain | Metabolic dysregulation |
Metabolic connection
Section titled “Metabolic connection”Diagnosis and screening
Section titled “Diagnosis and screening”Sleep study
Section titled “Sleep study”Diagnosis is made via a sleep study (polysomnography or home measurement).
Apnea-Hypopnea Index (AHI)
Section titled “Apnea-Hypopnea Index (AHI)”| Severity | Breathing pauses per hour |
|---|---|
| Mild | 5-15 |
| Moderate | 15-30 |
| Severe | More than 30 |
The higher the AHI, the greater the burden on heart, brain, and metabolism.
STOP-BANG questionnaire
Section titled “STOP-BANG questionnaire”| Letter | Question |
|---|---|
| S | Snoring? |
| T | Tired (fatigued during the day)? |
| O | Observed (breathing stops witnessed)? |
| P | Pressure (high blood pressure)? |
| B | BMI > 30? |
| A | Age > 50 years? |
| N | Neck (neck circumference > 40 cm)? |
| G | Gender (male)? |
Three or more ‘yes’ answers indicate an increased risk of sleep apnea.
The physiology of sleep
Section titled “The physiology of sleep”A healthy sleep consists of cycles of NREM and REM sleep.
| Sleep phase | Function |
|---|---|
| Deep NREM sleep | Body recovery, blood pressure drop, production of growth hormone and testosterone |
| REM sleep | Memory, mood, emotional recovery |
With OSA
Section titled “With OSA”- Deep sleep decreases
- REM sleep is interrupted
- This leads to: fatigue, hunger, fat storage, cortisol dysregulation
Causes and risk factors
Section titled “Causes and risk factors”| Factor | Mechanism |
|---|---|
| Overweight | Fatty tissue around neck and throat |
| Alcohol | Relaxes throat muscles |
| Smoking | Airway inflammation |
| Sleeping on back | Gravity closes airway |
| Anatomy | Narrow throat, large tonsils |
| Sleep deprivation | Worsens relaxation of throat muscles |
| Hormonal disturbances | Insulin resistance, visceral fat |
Treatment — three pillars of recovery
Section titled “Treatment — three pillars of recovery”1. CPAP — immediate breathing support
Section titled “1. CPAP — immediate breathing support”CPAP (Continuous Positive Airway Pressure) keeps the airway open through gentle positive pressure.
| Effect | Explanation |
|---|---|
| Reduces apneas | Direct effect |
| Improves concentration | Through better sleep |
| Lowers blood pressure | Through fewer stress responses |
2. Lifestyle intervention (TKB)
Section titled “2. Lifestyle intervention (TKB)”A low-carbohydrate or ketogenic lifestyle:
| Effect | Mechanism |
|---|---|
| Lowers insulin | Metabolic reset |
| Reduces visceral fat | Less fatty tissue around neck |
| Reduces inflammation | Better airway function |
3. Tirzepatide (GLP-1/GIP agonist)
Section titled “3. Tirzepatide (GLP-1/GIP agonist)”Tirzepatide promotes weight loss and improves insulin sensitivity.
| Study | Result |
|---|---|
| SURMOUNT-OSA (2024) | AHI decreased by an average of 55% in 52 weeks |
The combination with lifestyle intervention gives the strongest effect.
Lifestyle advice
Section titled “Lifestyle advice”| Advice | Explanation |
|---|---|
| Limit alcohol | Especially before bedtime |
| No heavy meals | Late in the evening |
| Sleep on your side | Not on your back |
| Stop smoking | Reduces inflammation |
| Fixed sleep times | Regular rhythm |
| Sufficient daylight | Supports day-night rhythm |
| Daily exercise | Walking, cycling, strength training |
| Eat unprocessed | Protein-rich and low-carb |
| Limit caffeine | After 2:00 PM |
| Stress reduction | Relaxation and rest |
Summary
Section titled “Summary”Veelgestelde vragen
What is sleep apnea syndrome?
Obstructive sleep apnea syndrome (OSA) is a condition in which the upper airway repeatedly collapses during sleep. This causes breathing pauses, oxygen drops, and stress responses that disrupt sleep and lead to metabolic dysregulation.
How do I recognize sleep apnea?
Nighttime signals: loud snoring, breathing stops, restless sleep, night sweats, dry mouth. Daytime: persistent fatigue, concentration problems, mood swings, weight gain. The STOP-BANG questionnaire helps with screening.
What is the treatment for sleep apnea?
Three pillars: 1) CPAP for immediate breathing support, 2) Lifestyle intervention (TKB) for metabolic reset and fat loss, 3) Tirzepatide for obesity or insulin resistance. The combination gives the strongest effect.
Can sleep apnea be cured?
For mild to moderate OSA, a low-carbohydrate lifestyle can lead to remission through fat loss around the neck and reduced inflammation. The SURMOUNT-OSA study showed a 55% decrease in AHI with Tirzepatide.
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Medical Disclaimer: The information provided by Stichting Je Leefstijl Als Medicijn regarding lifestyle, diseases, and disorders should not be construed as medical advice. Under no circumstances do we advise people to alter their existing treatment. We recommend that people with chronic conditions seek advice regarding their treatment from qualified medical professionals.