Quality of life, co‐morbidity and obstructive sleep apnoea

Obstructive sleep apnoea (OSA) and the symptomatic obstructive sleep apnoea syndrome (OSAS) is now a well–characterized and common disease with significant health consequences. Depending on age and gender, OSA occurs in 3%–20% of the adult population, and at least 2%–4% of the adult population suffers from OSAS. Several studies have documented that OSAS is a strong independent risk factor for later development of cardioand cerebrovascular disease and has serious effects on family, social and professional life. The association between OSAS and later cardiovascular complications shows a dose-dependent pattern. OSAS are also very commonly found among patients with metabolic syndrome and pulmonary cardioand cerebrovascular diseases. The cardiac risks are likely due to significant changes in haemodynamic, autonomic, immunological and other risk associations. Diagnostic and treatment procedures are well-known, including the best practice polysomnography or simpler ambulatory cardiac polygraphy as an acceptable but less expensive alternative. Apart from lifestyle changes, the best treatment is still CPAP treatment, with some alternative treatment options like dental devices or surgical treatment in selected patients. CPAP treatment reduces cardioand cerebrovascular risk with reduced morbidity and mortality (1). Despite these acknowledgements, OSA is still highly underdiagnosed, e.g. in most Western countries, less than one-fourth of the potential sleep apnoeic population are diagnosed, and consequently a significant proportion is left untreated. Furthermore, the diagnosis is often delayed, and as a potential consequence, intervention and treatment are less effective, as potential consequences like hypertension, stroke and myocardial infarction have already presented. It is therefore incomprehensible that there are limited established standards for diagnostic evaluation of patients at risk for OSA; for example, patients with obesity, hypertension, diabetes, and heart or stroke disease. Furthermore, there is evidence that OSAS causes significant impact on quality of life, social and family life and can involve traffic accidents. Interestingly, this association is not strongly associated with sleep apnoea severity, thus, other factors (e.g. obesity, sleep disturbances, co-morbidity and social) than sleep apnoea are involved in these consequences (2). In this issue of the journal demonstrated a significant aspect of the OSAS. Patients may also have potentially sexual problems (3). The study has primarily addressed men and knowledge of women is modest. The study is important because it focuses on a problem often overlooked in clinical settings, namely the importance of sexual function in patients. There was no correlation between apnoea severity and sexual (dys-)function. This is in line with studies of quality of life. There may be several reasons for this surprising lack of relation. Patients with OSAS often suffer from other risk association including the influence of confounders as obesity, genetic predisposing, co morbidities, etc. There is reason to be aware of sexual problems in patients with sleep apnoea, and the professionals should, with respect, dare to ask the patients about these issues. Further research should include female OSAS patients and include further detailed analysis of the association, co-factors and co-morbidities, causes, endocrine and autonomic relations, etc.