Sleep Apnea, The Villain Hidden In Plain Sight

What is an article on a sleeping disorder doing on a platform dedicated to lung health? It turns out there’s plenty of overlap. Respiratory health is impacted by many factors. Some, like smoking, are in our control. Others, like our pre-existing respiratory conditions, may not be. Despite this, it’s just as worthwhile to identify and then keep these conditions in check. This article intends to acknowledge that there are other dangers to keep in mind in regard to respiratory health besides the usual suspects like smoking or vaping. In short, sleep apnea is easy to miss. Don’t let the symptoms get ignored!

Sleep apnea is becoming increasingly known to the public as a rather common sleeping disorder that causes breathing to cease intermittently during sleep. This often manifests as seemingly vague symptoms like daytime tiredness or loud snoring at night tend to occur. However, there’s another detail that is often less frequently considered: it’s a common comorbidity for a range of other respiratory conditions. In other words, it’s bad by itself, and it’s synergistic (i.e., worse) with other conditions. Either way, it can be a massive burden on daily life. Perhaps, one of the nastiest aspects about sleep apnea is that it’s a hidden epidemic. An accomplice to other respiratory conditions that you may not even realize are there.

Your Lungs While You Sleep

Let’s back up to the beginning.

The more commonly encountered type of sleep apnea is obstructive sleep apnea (OSA), where the upper airway physically collapses during sleep, causing a narrowing of the throat that restricts air flow. At the same time, central sleep apnea (CSA) also exists, where the brain does not properly send signals to the muscles involved in breathing. A mixed type of the condition involving features of both OSA and CSA also exists. Regardless of the specific type, the immediate effect on the lungs is already clear. With restricted air flow, oxygen levels within the blood decrease as well as pressure in the chest cavity. Plainly put, it’s suffocation. Of course, your brain is functional enough to wake you up before you actually suffocate, but waking up several times (even dozens of times) during the night without even realizing it isn't ideal for sleep quality. So, from a direct perspective, unaddressed sleep apnea is already substantially intertwined with respiratory health.

Its hidden nature makes sense too. The symptoms are often quite subtle things that can be easily attributed to other causes. Someone who feels tired during the day might consider a myriad of potential factors before suspecting an underlying sleep disorder. The fatigue may not even be something that feels necessary to bring up to a primary care physician. Someone excessively irritable could be that way for any number of reasons. Loud snoring or gasping at night can easily be missed if no one is observing the individual’s sleep patterns (e.g., they’re in another room, also asleep, etc.). Mayo Clinic even lists a factor like insomnia as a possible symptom. The main signs to look out for are ultimately anything related to excessive and unexplained daytime tiredness, or signs of respiratory abnormalities during sleep. You may also decide how appropriate this article is to you by evaluating the common risk factors. Sleep apnea disproportionately affects individuals with obesity and men, as well as those with other less frequently encountered risk indicators. Family history and smoking also play a part (yet another reason not to smoke!). However, none of these factors are required for an individual to have sleep apnea, and should not be considered necessary for the occurrence of the condition.

A last remark, as alluded to previously, sleep apnea seems to make other respiratory conditions worse. An individual with a history of asthma, COPD, or general long term conditions affecting breathing may find it especially important to make certain that they don’t have sleep apnea. A study in 2022 by Bouloukaki et al. concludes that the presence of this overlap does increase the risk of poor health outcomes, or even mortality, compared to just having one respiratory condition alone.

Who Cares?

The short of it is: sleep apnea is incredibly underdiagnosed and estimated to be highly common. One estimation in a study by Iannella et al. (2025) puts the number of impacted individuals at 936 million (nearly a billion) worldwide. In the United States alone, estimates show that around 20 million people are affected, with 90% of those undiagnosed as of 2009 (so, 18 million people unaware), or more recently a suggestion of 50 million people affected, with 80% going undiagnosed (see the study by Finkel et al, 2009). The chance that you or someone you know is affected and undiagnosed is extremely possible given these percentages! Sleep is the foundation of performing well during the day, whatever that task may be, and being unable to function or operate day after day at your best can be both difficult and discouraging.

There are plenty of respiratory issues out there that aren’t necessarily tobacco or nicotine-related at all, yet still, posing a threat to many of us today. Choosing not to engage in behaviors that actively harm lung health, such as smoking or vaping, is highly encouraged and a large part of what For Future Lungs NY is all about. However, the story does not end there, especially for those with pre-existing respiratory conditions. Delving into these often-overlooked consequences is the primary focus of this article.

What Can You Do?

Monitor for suspicious symptoms as seen above. Keep the risk factors above in mind as well. In reality, it is entirely possible that sleep apnea is not relevant to you. However, a family member, friend, or someone else in your life may find this information relevant. If there is even the slightest indication that there is relevance, the main course of action is then for the affected person to simply bring it up to their primary care physician or a sleep specialist. Once again, this is not a call for a perfectly healthy individual to fear having a condition that they definitely don’t have, it’s a call for those who put off consulting a physician because they don’t feel their symptoms are important or specific enough. If the symptom inconveniences your life, it’s ultimately worth bringing up.

For the sake of completeness, it is worth noting that detecting sleep apnea typically involves a sleep study, which is just a diagnostic test evaluating how the body (e.g., heart, brain, respiratory system) behaves during sleep and, consequently, the quality of that sleep. This is the part that’s ordered by a physician. By this point, there is nothing more to do than be medically compliant and follow the treatment laid out which, at least in the case of OSA, broadly involves keeping the airway open. CPAP machines are a common example, however, delving further into this subject extends beyond the scope of this article.

If any of the signs of sleep apnea seem familiar to you or someone you know, keep in mind that it can get better, and that there are solutions available at your disposal!