By Henry Ehrlich
Several correspondents have forwarded articles about a new study in the Journal of the American Medical Association (JAMA) called “Association Between Asthma and Risk of Developing Obstructive Sleep Apnea.” They did this because they are aware that I co-wrote a book with pulmonologist and sleep specialist Dr. Gerard T. Lombardo called Sleep to Save Your Life: the Complete Guide to Living Longer and Healthier Through Restorative Sleep, another title in the Henry Ehrlich catalogue of forgotten non-fiction.
The study was unremarkable—asthma was associated with a greater risk of developing sleep apnea. Missing from coverage, however, is discussion of how asthma can contribute to sleep apnea and why anyone should care particularly. Isn’t “just” snoring? One article (and probably others) based on the study did state the risks thus, “[Obstructive sleep apnea] is associated with adversely affecting health and a higher risk of death. “
I find this kind of bloodless language without larger context kind of hollow. As with allergic diseases, focusing on body counts is just part of the story. What diseases do to the living matters.
So what does sleep apnea do? In Sleep to Save Your Life, we compared it to the scene in Beverly Hills Cop when Eddie Murphy stuffs bananas in the detectives’ tailpipe. You stop breathing as many as 400 times a night because your uvula and/or tongue are blocking your windpipe, triggering the flight or fight response. A surge of adrenaline gives your diaphragm a neurochemical jolt. Your blood pressure surges. Your blood oxygen levels fluctuate wildly. This deprives your body of the rest and restorative functions of sleep. The most immediate consequence is that you feel exhausted all day, every day.
While the JAMA study was done with adults, apnea is a growing problem for asthmatic children who also happen to be overweight. There is already pressure on their airways, and inflammation narrows them still further.
Larry wrote about it in 2011 reacting to a study of apnea, asthma, and obesity:
“Seventy-three percent of obese children were diagnosed with sleep apnea/hypopnea syndrome (SAHS) while none of the adolescents at a healthy weight were diagnosed with SAHS.” Furthermore: “Children who are overweight are nearly 2-1/2 times more likely to have asthma than those who are not overweight.”
As to the effects of the life-saving flight-or-fight response, he said:
Imagine getting an EpiPen over and over throughout the night, or having the Heimlich maneuver performed again and again to unblock your throat. No wonder then that many heart attacks and strokes take place while people are sleeping early in the morning. They have spent the night panicking when they are supposed to be at rest.
Now, imagine that happening to your child. Not only is he at risk for all the complications of high blood pressure and other cardiovascular stress, it actually encourages further weight gain because of the hormonal response to stress. It means that he is going to be worn out and inattentive in school the next day from all that distress. This is a vicious cycle, one will take a severe toll both on quality and longevity of life.
Listen to your child sleep. Does he snore or make grunting noises? Does he wake up often to go to the bathroom? Sleep apnea stimulates frequent urination. If your child has allergic rhinitis and asthma, good control should encourage restful sleep. If she has asthma and weight problems, they compound one another. And if she has sleep apnea, too, the problems compound at an increasing rate. Sleep apnea is already at epidemic levels among adults. That it should be happening to children, too, is a scandal.