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Can Severe Sleep Apnea Cause Brain Damage

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What Was The Research About

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People who have a traumatic brain injury, or TBI, often have sleep apnea. Sleep apnea causes the upper airway to become blocked during sleep. It can make TBI symptoms worse and make recovery difficult. Screening helps identify who is at risk for sleep apnea. Then, doctors use tests to diagnose sleep apnea.

In this study, the research team compared ways to screen for and diagnose sleep apnea in people receiving hospital rehabilitation for moderate or severe TBI. For screening, the team compared

  • The STOP-Bang survey
  • A wristband that tracked total sleep time

To diagnose sleep apnea, the research team compared

  • A standard sleep test with a trained technician monitoring the patient in a sleep lab, which doctors consider the gold standard, or most reliable, test
  • A sleep test using portable equipment, which is easier to do and costs less

The research team wanted to learn if using portable equipment wasnt worse at diagnosing sleep apnea than the standard test.

Sleep Apnea Changes How The Brain Works

A February 2016 study published in the Journal of Sleep Research by the UCLA School of Nursing investigated the injury caused to the insular cortex of the brain by sleep apnea. They studied levels of two important brain chemicals, called neurotransmistters: glutamate and gamma-aminobutyric acid, known as GABA. Unlike previous studies, we actually found substantial differences in these two chemicals that influence how the brain is working, said Paul Macey, the lead researcher on the study and an associate professor at the UCLA School of Nursing.

It is rare to have this size of difference in biological measures, Macey said. We expected an increase in the glutamate, because it is a chemical that causes damage in high doses and we have already seen brain damage from sleep apnea. What we were surprised to see was the drop in GABA. That made us realize that there must be a reorganization of how the brain is working.

Macey says the studys results are, in a way, encouraging. In contrast with damage, if something is working differently, we can potentially fix it.

Memory Recall And Smell Recognition

Loss of short term memory and general performance are often reported later in sleep apnea. Theyre a sign of damage to the mammillary bodies in the brain. They also control odor and smell memories, which are linked to long-term snoring.

Mammillary bodies also shrink in heart failure and chronic alcoholism. The same changes have been found in people with chronic snoring and sleep apnea.

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How Sleep Apnoea Affects Your Brain

There are various conditions that can come as a result ofsleep apnoea and sleep disorders. The lack of oxygen that obstructive sleepapnoea causes can affect the entire body. While you may know about manyof these impacts, as sleep apnoea causes oxygen deprivation, brain damage isone of the more significant risks that can occur.

This article outlines what you need to know about sleepapnoea and brain damage. This includes:

  • The process behind how brain damage can occur.
  • What symptoms to look out for.
  • How continuous positive airway pressures therapy can stop or even reverse brain damage caused by sleep apnoea.

How Sleep Apnoea Causes Brain Damage

The effects of snoring and waking up consistently throughoutthe night can be dangerous. As breathing is restricted and oxygen is prohibitedfrom reaching the brain, this can cause a reduction in brain function and thedamaging of brain cells.

A study investigating the damage caused by sleep apnoeashowed that in particular, two significant brain chemicals were impacted. Thesewere gamma-aminobutyric acid , a neurotransmitter that promotes calmness,and Glutamate, which plays a key role in memory and learning. Patients withsleep apnoea saw a decrease in GABA, forcing the brain to reorganise itsworkings negatively. They also saw an increase in glutamate, causing damage tonerves and neurons.

The Symptoms What to Look Out For

Short term symptoms can include:

  • Memory loss

Long term symptoms may include:

  • Loss of coordination

What Are The Risk Factors For Sleep Apnea

Brain damage caused by severe sleep apnea is reversible ...

You are at a higher risk for obstructive sleep apnea if:

The ASAA estimates that between 1 and 4 percent of American children have sleep apnea.

Although surgical removal of the tonsils and adenoids is the most common treatment for pediatric obstructive sleep apnea, positive airway pressure therapy and oral appliances are also prescribed.

Make an appointment with your doctor if youre exhibiting any of the symptoms of obstructive sleep apnea, especially:

  • loud, disruptive snoring
  • episodes of stopped breathing while sleeping
  • abrupt awakenings from sleep that are frequently accompanied by gasping or choking

Your doctor may refer you to a sleep specialist, a medical doctor with additional training and education in sleep medicine.

Treatment for severe obstructive sleep apnea includes lifestyle changes, therapies and surgeries, if needed.

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Sleep Apnea May Damage Brain Cells Associated With Memory

June 11, 2008 People with obstructive sleep apnea , a common sleep disorder linked to heavy snoring, may lose tissue in brain regions that store short-term memoriesthe type used to recall a recent joke or recognize a person you met at a partysay researchers at the University of California at Los Angeles.

Daytime confusion and memory loss are known symptoms of sleep apnea people with the condition often rouse hundreds of times a night and are tired and forgetful the next day. But a study in the June 27, 2008, edition of the journal NeuroscienceLetters suggests that there may be more to it than just that.

Why sleep apnea may affect memoryMemories are formed in the mammillary bodies, structures on the underside of the brain that resemble small breasts. When UCLA neuroscientists scanned the brains of 43 sleep apnea patients and 66 healthy volunteers using magnetic resonance imaging , they discovered that the sleep apnea patients’ mammillary bodies were nearly 20% smaller than those of the untroubled sleepers.

“People always thought the memory deficit was just because their sleep was disturbed and they felt terrible,” says study coauthor Ronald Harper, PhD, distinguished professor of neurobiology at the David Geffen School of Medicine at UCLA. “But it looks to be that the brain is actually injured, and the particular brain structure that’s damaged is one of several that transfer recent memories into long-term memories.”

Sleep Apnea And Your Brain

Obstructive sleep apnea , the most common type of sleep apnea, causes abnormal muscle relaxation in certain tissues of the throat and mouth. These muscles subsequently block the airway while you sleep, intermittently cutting off your oxygen supply and producing a number of negative effects in your body.

The Sunnybrook Research Institute reports that sleep apnea results in lowered oxygen levels and poor sleep quality, as well as cogntive effects such as:

  • Impaired concentration
  • Increased risk of dementia

Research shows that sleep apnea cuts the amount of deep sleep that a person gets, which may interrupt the body’s natural process of clearing of toxic proteins from the brain during sleep. Specifically, there is evidence demonstrating sleep apnea’s association with the impaired clearing of amyloid-beta, a poisonous protein that concentrates in the brains of Alzheimer’s patients.

The Sunnybrook Research Institute also notes that those with sleep apnea can show shrinkage in certain areas of the brain as well as damage to its white matter, which could negatively impact connections between neurons.

A 2019 study published in Sleep examined the effects of OSA on the hippocampus, a part of your brain that plays an important role in memory function. Since OSA is already associated with shrinkage of the hippocampus, the authors of the study investigated whether the extent of the damage depends on OSA severity.

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Impact Of Different Vbm Analysis Techniques On Grey Matter Loss

It has also been suggested that the magnitude of the changes in grey matter volume that occur in patients with OSA are similar to those seen with ageing, and that apnoea-related changes may be missed if age is not included in an analysis of the covariance model. In both the present study and the previous study by O’Donoghue et al, age was included in the analysis of covariance, replicating this aspect of the analysis model of Macey et al. The use of the 12mm smoothing kernel is also consistent across the present study and previous studies.

Understanding The Link Between Sleep Apnea And Brain Damage

Sleep Apnea: Symptoms, Risks & Treatment

    According to the American Academy of Sleep Medicine, about 26 percent of U.S. adults are living with sleep apnea. Many with sleep apnea do not receive the proper treatment. Untreated sleep apnea is often associated with a number of serious health problems, such as Type 2 diabetes, heart disease, and stroke. However, a lesser-known risk of this sleep apnea is brain damage. If youre wondering, can you get brain damage from sleep apnea, here is everything you need to know.

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    What Can Be Done To Improve Sleep

    Changes in behavior and environment are the first line to treating sleep difficulties.

    Daytime Suggestions

    • Set an alarm to try to wake up at the same time every day.
    • Include meaningful activities in your daily schedule.
    • Get off the couch and limit TV watching.
    • Exercise every day. People with TBI who exercise regularly report fewer sleep problems.
    • Try to get outdoors for some sunlight during the daytime. If you live in an area with less sun in the wintertime, consider trying light box therapy.
    • Don’t nap more than 20 minutes during the day.

    Nighttime Suggestions

    • Try to go to bed at the same time every night and set your alarm for the next day.
    • Follow a bedtime routine. For example, put out your clothes for morning, brush your teeth and then read or listen to relaxing music for 10 minutes before turning out the light.
    • Avoid caffeine, nicotine, alcohol and sugar for five hours before bedtime.
    • Avoid eating prior to sleep to allow time to digest, but also do not go to bed hungry, as this can also wake you from sleep.
    • Do not exercise within two hours of bedtime but stretching or meditation may help with sleep.
    • Do not eat, read or watch TV while in bed.
    • Keep stress out of the bedroom. For example, do not work or pay bills there.
    • Create a restful atmosphere in the bedroom, protected from distractions, noise, extreme temperatures and light.
    • If you don’t fall asleep in 30 minutes, get out of bed and do something relaxing or boring until you feel sleepy.

    Sleep Apnea Related Brain Damage Appears To Be Reversible

    The good news is that studies show that treatment for sleep apnea can reverse the changes in the brain. Researchers have demonstrated that after a year of consistent treatment for sleep apnea, there is reversal of the changes to the brain. Furthermore, they also measured patients cognitive performance. While this was impaired in sleep apnea patients, after a year of treatment, their performance had recovered.

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    Who Is At Risk Of Snoring And Sleep Disorders

    There are many conditions that relate to snoring, sleep apnea symptoms, and sleep disorders. These include:

    • High blood pressure
    • Cheek biting
    • Severe gum disease

    When we use the oral-systemic link, diseases often show signs in the mouth first. As Brian avoids his dental check-up, his reasons for snoring and sleep disorder go unnoticed.

    What Is Sleep Apnea

    Brain damage caused by severe sleep apnea is reversible ...

    Sleep apnea is a sleep-related breathing disorder that is characterized by repeated cessation or near cessation of ventilation during sleep. Subtypes of sleep apnea include obstructive, central or mixed type. Obstructive sleep apnea is diagnosed when there is repetitive collapse or obstruction of the airway resulting in oxygen desaturation and/or disturbance of sleep resulting in sleep fragmentation and non-restorative sleep. OSA is the more prevalent form of sleep apnea that is felt to be under-recognized in the general population. Central sleep apnea is less common and occurs when there is temporal failure of the physiological mechanisms that drive breathing rhythm. This typically occurs with medical disorders , high altitude, brainstem insult or more commonly pharmacologic side-effect from medications that depress respiratory effort . Both are diagnosed with polysomnography with American Academy of Sleep Medicine endorsed practice guidelines for treatment.1,2

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    Short And Long Term Memory

    Sleep apnea is often associated with progressive brain fog and memory loss.

    People with sleep apnea have a decrease in the size of the hippocampus. Its the part of the brain that controls short and long-term memory. Its known to be first damaged in Alzheimers disease.

    Brain imaging confirms that snoring and sleep apnea shrink the hippocampus. These areas can be partially regenerated with CPAP .

    Sleep Apnea Is Linked To Mood Disorders

    The link between sleep apnea and depression is astonishing. One study in 2017 found that 50% of clinically depressed patients had severe sleep apnea, and nearly all of the remaining patients had some level of sleep apnea.

    Poor sleep triggers both clinically significant depression and anxiety. Because sleep apnea actually changes the way our brain works , these conditions are inextricably linked to each other.

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    How Sleep Apnea Changes The Brain

    Thanks in part to the significant success of the Stop the Snore campaign, it is now common knowledge in many spheres that sleep apnea can influence a host of several severe health complications. According to emerging research, another possible negative impact of sleep apnea is a degradation of brain structure and function.

    Sleep apnea happens in one of two waysa relaxation of the throat muscles that block airflow, or the failure of the brain to send the right signals to the muscles that manage the breathing process.

    In either case, this blockage impedes breathing and hinders the flow of oxygen to the brain as well as other body systems. Here, the potential for damage to the brain rises dramatically with every added second of blockage.

    In one 2010 study published in the American Academy of Sleep Medicine, researchers found a significant disparity in the brain matter of subjects with obstructive sleep apnea.

    The study, which involved the neuroimaging of 36 male subjects with a recent obstructive sleep apnea diagnosis, showed explicitly that the participants with the condition had significantly less gray matter concentration in their brain compared to the 31 healthy control subjects.

    According to the results, researchers reported decreased gray matter concentration in the cerebral cortex, the prefrontal cortices, cerebellum, and limbic structures of diagnosed subjects.

    • Men

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    White Matter Brain Damage Reversed By Sleep Apnea Therapy

    Sleep Apnea (Part 4): Treatment Options for Sleep Apnea

    Update Date: Sep 08, 2014 05:29 PM EDT

    Sleep apnea can seriously wreck the brain. However, new research reveals that brain damage caused by the sleep disorder is reversible.

    New research reveals that continues positive airway pressure therapy could help reverse the damage done to the brain’s white matter.

    New research reveals that people with severe, untreated sleep apnea exhibited significant decreases in white matter fiber integrity in many different brain regions. This decrease then leads to impairments in thinking, mood and daytime alertness.

    Researchers found that three months of continues positive airway pressure therapy led to some improvements in damaged brain structures. However, a year of continues positive airway pressure therapy led to an almost compete reversal of white matter abnormalities.

    Researchers said the findings are important as the reversal of white matter abnormalities was linked to significantly improvements in nearly all cognitive tests, mood, attention and quality of life.

    “Structural neural injury of the brain of obstructive sleep apnea patients is reversible with effective treatment,” lead author Vincenza Castronovo, PhD, clinical psychologist at the Sleep Disorders Center at San Raffaele Hospital and Vita-Salute San Raffaele University in Milano, Italy, said in a news release. “Treatment with CPAP, if patients are adherent to therapy, is effective for normalizing the brain structure.”

    The findings were published in the journal Sleep.

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    Treatment Of Sleep Apnea Improves Outcome In The General Population

    Positive Airway Pressure therapy is the American Academy of Sleep Medicines first line of therapy for sleep apnea however, noncompliance can be up to 55% in the general population.35,36 Medicare arbitrarily defines the minimum criterion for treatment as 4 hours/night for greater than 70% of nights.36 Sustained use of PAP has been shown to slow deterioration of cognition, preserve sleep quality, and enhance mood in older dementia patients with sleep apnea.35 A dose-response relationship has been demonstrated between treatment and outcomes in non-TBI sleep apnea.37,38 Partial exposure to PAP enhances outcomes relative to no treatment.37,38 Patients who used PAP at least 4 hours/night showed a variety of positive outcomes: lowered blood pressure, better cardiovascular disease risk profile, better insulin resistance profile, and reduction in markers of inflammation and oxidative stress.39

    Non-adhering patients do not experience these beneficial outcomes.38 At the time of this article, the American Academy of Sleep Medicine posted updated guidelines for public comment40 that have a strong recommendation for educational interventions when initiating positive airway pressure therapy.

    Ultimately, treatment of this comorbidity after TBI may help improve outcomes at a cellular and functional level unlike management of other comorbidities which could change the trajectory of both acute and chronic outcomes after TBI.

    How Obstructive Sleep Apnea Damages The Brain

    Brain maps showing compromised blood-brain barrier function in one person with obstructive sleep apnea and one person with a healthy brain. Regions with yellow-to-red areas represent an intact blood-brain barrier regions with blue-scale colors indicate an altered blood-brain barrier.Image: Courtesy of Dr. Rajesh Kumar

    UCLA researchers have reported the first evidence that obstructive sleep apnea contributes to a breakdown of the blood-brain barrier that plays an important role in protecting brain tissue by limiting harmful bacteria, infections and chemicals from reaching the brain. The discovery could lead to new approaches to treat obstructive sleep apnea, which causes frequent interruptions in breathing during sleep because the airways narrow or become blocked.

    The study was conducted with a magnetic resonance imaging procedure that uses the brains own blood and fluids to measure the breakdown of the blood-brain barrier. In the new study, the researchers found that in patients who recently had been diagnosed with obstructive sleep apnea and not yet treated, the permeability of the blood-brain barrier was significantly higher than it was in healthy people. This suggests that besides improving breathing in obstructive sleep apnea patients, we need to repair or improve blood-brain barrier function, perhaps by using treatments already available for other conditions, Dr. Kumar says.

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