How To Proceed: If you suspect that you are a candidate for OSA: (1) Educate yourself about OSA and screening; (2) Ask your physician to screen for OSA or locate a sleep center through the link below; (3) Follow-up with the diagnostics and treatment solutions that your clinician advises.

Obstructive Sleep Apnea (OSA)

OSA Introduction

By now, many of us have heard about obstructive sleep apnea (OSA), or just "sleep apnea" as it is commonly referred to in public dialogue. OSA is a condition in which the flow of air pauses or decreases during breathing while you are asleep because the airway has become narrowed, blocked, or floppy. A pause in breathing is called an apnea. Impacts from OSA are widespread, including straight-forward dangers related to reduced oxygen delivery and it's impact on the mechanics of the heart, to less intuitive impacts such as the onset or exacerbation of diabetes, obesity, and mental and emotional health disorders by virtue of secondary mechanisms.

The trouble with limiting public discussion of OSA to formal definitions of apneas and their mechanical causes is that many people assume that they do not have sleep apnea because they would know if they stopped breathing during sleep. That is not the case.
Our body overcomes and even anticipates upper-airway resistance— of which snoring is a prime indicator, by setting in motion repeated patterns of increased neuromuscular "vigor" around the upper airway to keep the airway open. The problem is that effort does not always wake you into full-fledged consciousness but it still sets in motion adverse effects from OSA, including hypertension, blood sugar problems and cognitive impairment.

It is hard to imagine— but true— that repeated bouts of tiny nerve and muscle signals can have such adverse effects on basic health, including driving persistent hypertension, obesity, and diabetes. After all, these episodes may happen literally hundreds of times per night and we may not even be aware of them. Nonetheless, they disrupt our basic sleep architecture, which means that we do not enter deep, restorative stages of sleep. When that happens, more adverse effects ensue for our mental and emotional health.

Common Cluster

Traditionally, the common medical disorders that cluster under umbrella terms such as "metabolic syndrome"— including hypertension, obesity and diabetes— were considered simply associations of completely independent disorders in a particular subset of patients, or a possible outcome from obesity and it's causal lifestyle. Now it is understood that the relationship of these common disorders is often deeper and more highly integrated than a mere observation of association. Core mechanisms causally relate common sleep disorders such as obstructive sleep apnea (OSA) to this same disease cluster.

Sleep apnea leads to intermittently reduced blood oxygen, which, in turn, sets in motion nervous system discharges that have widespread implications for metabolic, hormonal, and cardiovascular health.
Although sleep is, at root, a crucial component of our natural physiology, it is, in practice, the component that we pay heed to the least. The consequence of sleep's crucial role for our emotional, cognitive and metabolic wellbeing is that today's common sleep patterns and common disorders routinely give rise to disease states and medical disorders outside the realm of sleep— such as diabetes, cardiovascular disease, and obesity. These relations are at the heart of a vicious cycle driving many of today's health issues. But like all vicious cycles, the flip-side is that although the downward snowballing is a dangerous momentum accelerating toward very significant health issues, that same integration at the core of the cycle can be used to stop or slow the momentum and utilize the connections to support greater movement toward health and wellness. Before that can happen, however, we must recognize the severity of the problem.

All Hypertensives

At least 35% of hypertensives have OSA yet many do not know it. Source: (Sjostrom et al, Thorax).


Type 2 Diabetics

At least 50% of diabetics have OSA. Source: (Einhorn et al, Endocrine Practice); IDF: "Test all Type II Diabetics."


2-Med Hypertensives

80% treatment-resistant hypertensives have OSA. Source: (Logan et al, J. Hypertension). Drug-resistant HBP is rising.


Still Untreated OSA

Over 80% of population thought to have OSA still untreated. Source: (AASM, 2016; T. Young, SLEEP)

See also OSA Screening Button

OSA General Prevalence

OSA prevalence varies according to specific subsets of the population. Apart from the co-morbidities listed above, OSA becomes more prevalent as we age, with some elderly cohorts that have been diagnosed with cardiovascular and metabolic conditions approaching 80% prevalence of OSA. Although associated with the male gender, women are not immune to OSA, particularly obese women, post-menopausal women, and women that present with polycystic ovarian syndrome (PCOS).

The rates of mild OSA are often projected to be approximately 26% or more of the population, with significantly higher numbers associated with particular subsets of the population with co-existing medical conditions (see graphic above). For more severe forms of OSA (moderate to severe), traditional estimates for sleep-disordered breathing are 10% among 30–49-year-old men; 17% among 50–70-year-old men; 3% among 30–49-year-old women; and roughly 9% among 50–70 year-old women in general, though studies also suggest that specific cohorts of post-menopausal women may have higher rates. Epidemiological studies identify male sex and older age, along with comorbidities such as obesity, hypertension, diabetes, heart failure and stroke to be significant predictors when combined with sleep symptoms such as loud snoring and additional symptoms such as waking up gasping for air or choking and coughing, and specific anatomical indicators such as a neck circumference of 17 inches or more for men and 16 inches or more for women. Interestingly, excessive sleepiness may appear to be the telltale "rubber meets the road" determinate that is indicative of an important functional impact (which is required for other sleep disorder diagnoses for example), but a number of factors make sleepiness an unreliable and even misguided indicator. Firstly, studies have demonstrated that many individuals with OSA do not report excessive sleepiness. Secondly, women tend to report 'fatigue' as opposed to 'sleepiness'. Finally, and most importantly, the adverse physiological mechanisms that OSA insidiously invokes are at play to advance the march toward obesity, diabetes, hypertension, cardiac arrhythmia and heart failure even for individuals who never self-report excessive sleepiness.

Obesity is a principle driver of OSA, but it turns out, many of the mechanisms that link obesity to cardiovascular disease and diabetes are themselves driven by core OSA mechanisms. These mechanisms have been shown to occur independent of obesity. Not every obese person has OSA nor is every person with OSA obese. Nonetheless, the rise of obesity is central to to the rise of OSA, but we often dismiss OSA as secondary to obesity when in fact it is precisely OSA-invoked mechanisms in obese individuals that contributes significantly to the co-existing rise of diabetes and heart disease.

Understanding the core set of pathological mechanisms that OSA and disrupted sleep staging initiate brings home the point more forcefully that chronic short sleep and sleep-disordered breathing can cause or exacerbate such a wide array of cardiovascular and metabolic diseases. These links are often confused with simple lifestyle associations between disorder clusters.

Select the Impacts link for a description of the mechanisms that arise from sleep-disordered breathing (SDB). Aside from obstructive sleep apnea, SDB includes primary snoring and opioid-induced central sleep apnea. The same core mechanisms discussed on that page evolve into cardiovascular disease and metabolic disorders. Screenshot samples are also presented. The Screening link provides specific information about the OSA screening process, while the Treatment link provides a schematic overview of OSA treatment modalities that candidates suspected of having OSA may discuss with their physician.

Educate Yourself.


Existing Medical Conditions

Individuals with diabetes, hypertension, cardiac arhythmmia, heart disease, obesity, heart-failure, stroke; and women with PCOS are significantly more likely to have OSA or some other form of SDB.


Older Versus Younger

Due to a number of factors that include the penchant for weight-gain and reductions in the stiffness of the upper-airway musculature, individuals over 50 (and post-menopausal women) are at increased risk.


Men Versus Women

Males are significantly more likely to have OSA, however post-menopausal women approach the rate of men overall and women with PCOS are at significantly higher risk for OSA than women in general.


Signs & Symptoms

Aggressive snoring is a major indicator for upper-airway resistance and OSA. Body mass index (BMI) is also a good indicator but for some populations neck circumference is a better indicator that abdominal fat.

The current healthcare structure seeks to utilize primary care physicians as the gateway to treatment of OSA, including screening, diagnostics and oversight of compliance. Primary care physicians are increasingly aware of the adverse cardiometabolic and psychological impacts associated with common sleep disorders such as OSA and poor sleep quality, but PCP's are not trained specifically in sleep disorders. If you need to find a sleep specialist associated with a sleep center, you can use the sleep center locator from the American Academy of Sleep Medicine (AASM): locator.

Although Nourish Sleep is a non-clinical entity, we do not operate outside of a responsible care pathway. Nourish Sleep screening does not constitute confirmation of a sleep disorder or lack thereof. Only a face-to-face clinical evaluation with a clinician or board certified sleep physician can affirm the necessity for further diagnostics or treatment. Our role is to educate you and provide you a rigorous, but highly tailored and comprehensive understanding of your specific sleep quality. Although we work collaboratively with a diverse array of clinical and educational resources to fulfill that mission, Tri-Nourish Inc and Nourish Sleep constitute non-clinical entities offering non-clinical services. Our goal is to assist your sleep quality in a pre-pathological (preventative) approach that takes into consideration domains that impact health and wellbeing before they transition into common sleep, mental or physiological disorders. Poor sleep quality radically impacts productivity, performance, health, emotional resilience, and safety— well before the sleep disorder threshold has been breached.