Published on October 01, 2015

Neurological Symptoms and Obstructive Sleep Apnea

The temporary lack of airflow due to Obstructive Sleep Apnea alters sleep patterns and is known to have long-term negative health effects. Health risks commonly associated with sleep apnea include cardiac disease and hypertension but physicians should also recognize the association of stroke, aggravation of cognitive dysfunction in dementia, mood disorders and parasomnias with OSA.

The repercussions of poor-quality sleep can be detrimental to optimal neurologic function. OSA interferes with the normal progression of sleep stages, which are necessary for proper encoding of new experiences and knowledge into longer-term memories. It also influences the emotional associations of those memories.

Abnormal Manifestations

Scott Shorten, MD, a neurologist with Meritas Health Neurology, says, “Some patients are harder to diagnose with OSA because they don’t manifest daytime sleepiness or are unaware of snoring. Less common symptoms such as difficult-to-treat hypertension, poor cognitive function or work performance, or generalized fatigue may also suggest OSA.” Women in particular are less likely to present with sleepiness but may complain of depressed mood or an inability to stay asleep. Often, patients’ self-perception of their normal state of alertness also changes over time, and so the slow progression of symptoms leaves many sufferers unaware of the decline.

Dr. Shorten reports that OSA is about 2-3 times as common in men as women, until after menopause when the numbers start to equalize. It is estimated that 15% of men and 5% of women of all ages suffer from OSA.

Factors associated with higher risk for OSA:

  • Increasing age
  • Ethnicity: craniofacial structures in Blacks result in the highest prevalence
  • Neck circumference: Men >17” or Women >16”
  • Obesity: BMI >30. Of this population, 63% of men and 22% of women
  • Retrognathia
  • Acute nasal congestions
  • High Friedman score (a measure of airway crowding)

“Sleep is a cornerstone of good general health and optimal neurological function,” Dr. Shorten says. While many neurological disorders can only be slowed down, Dr. Shorten is excited about the treatments for OSA, which can successfully reverse negative health effects and optimize patient performance. “OSA can be completely relieved with current therapies without risk of medication side effects, and results in improved quality of life and reduced long-term risk of chronic disease.”

When to Refer

When primary care physicians suspect that a sleep disorder may be contributing to a patient’s symptoms, they can refer patients to Dr. Shorten for further evaluation and treatment.

“When the specific sleep disruption is not clear, I evaluate patients for other conditions as well, such as periodic limb movement disorder, various parasomnias, or nocturnal seizures disorder."

"Neuromuscular disorders such as myasthenia gravis or ALS, and neurodegenerative disorders such as Parkinson disease, can also predispose to certain sleep disorders.”

Clinical and In-Home Sleep Studies

Sleep apnea tests can be conducted at home or in the sleep lab. “In-home studies are more convenient for the patients and less costly,” Dr. Shorten explains. “However, they monitor fewer parameters than the in-lab study, and so they tend to underestimate the severity of a person’s sleep apnea.”

If the home test is negative but a high suspicion remains, the patient can be referred for an in-lab sleep study at the Diagnostic Sleep Center on the campus of North Kansas City Hospital or at the Green Hills Road location. The study measures a series of parameters during an overnight stay, and a technologist is present to record the findings.

Therapy Chart

Treatment Options

Patients should be encouraged to be evaluated for treatment, as there are many options. While continuous positive airway pressure (CPAP), is often the most effective treatment for OSA, it is not the only option, especially for otherwise healthy patients whose condition is mild to moderate in severity.
Current therapies:

  • CPAP
  • BiPAP
  • Oral appliances
  • Provent strips
  • Uvulopalatopharyngoplasty (UPPP) surgery

Emerging therapies

“Treatment can greatly improve a person’s quality of life,” Dr. Shortens says. “Many patients say they feel like a new person and are excited about their new energy levels . That is very rewarding.”

Scott Shorten, MD

Scott Shorten, MDDr. Shorten, MD, earned his medical degree from The University of Kansas School of Medicine. He completed his residency in neurology at The University of Kansas Medical Center and a fellowship in sleep medicine at Vanderbilt University. He practices general neurology with a specific interest in sleep medicine.

To learn more, call 816.472.5157.