Obstructive sleep apnea (OSA) disrupts your breathing during sleep, causing repeated pauses that can last seconds or even minutes. These interruptions occur when your airway becomes partially or completely blocked, often due to relaxed throat muscles. This condition affects millions worldwide, with prevalence rates ranging from 0.3% to 25% depending on the population. Men face a higher risk, being two to three times more likely to develop OSA than women. Postmenopausal women and older adults also experience increased vulnerability, with rates climbing to 65% in individuals over 65 years. Untreated OSA can lead to severe health consequences, including a sixfold increase in motor vehicle accident risk and heightened odds of depression and cognitive decline.

Have you ever feel always cant sleep enough?
Have you ever feel tired when drive the car?
Have you ever feel headaches when weak up?
Have you ever feel always memory loss?
…

If you have these perplexes, it seems like you are a OSA Patient, this document is very import to you, we will talk about what is OSA, how to known if we have OSA and how to cope with OSA at here.Early diagnosis and treatment improve your quality of life and reduce these risks significantly.

Image Source: CIRCUL SMART RING

Key Takeaways

• Obstructive sleep apnea (OSA) stops normal breathing during sleep. This can cause health problems like heart issues and memory loss.

• Signs of OSA include loud snoring, gasping for air, and feeling very tired during the day. Spotting these signs early is important.

• Being overweight, smoking, and drinking alcohol make OSA more likely.

• Eating healthy and exercising can lower OSA symptoms and boost health.

• CPAP machines are the best way to treat OSA. They help keep airways open while you sleep.

• The Circul Ring is a simple tool to track sleep and oxygen levels. It helps you manage OSA better.

• Seeing a doctor is key to finding the right treatment. This may include lifestyle changes, devices, or surgery.

• Fixing OSA can improve your sleep, energy, and relationships.

What Is OSA?

Definition and Overview

OSA is Obstructive Sleep Apnea. There are different types of sleep apnea, including central sleep apnea, and obstructive sleep apnea is the most common[1].It is a common and serious sleep discorder that causes you to stop breathing during sleep. In many cases OSA is caused by the tissue in the back of the throat collapsing. The muscles of the upper airway relax when you fall asleep. If you sleep on your back, gravity can cause the tongue to fall back. This narrows the airway, which reduces the amount of air that can reach your lungs. This may happen a few times a night, or in more severe cases, several hundred times a night. And this leads to partial reductions (hypopneas) and complete pauses (apneas) in breathing that last at least 10 seconds during sleep. Most pauses last between 10 and 30 seconds[2], but some may persist for one minute or longer. This can lead to abrupt reductions in blood oxygen saturation, with oxygen levels falling as much as 40 percent or more in severe cases. Then our brain responds to the lack of oxygen, it will tell our body to have a brief arousal from sleep so that restores normal breathing.

Why OSA Is a Serious Health Issue

OSA poses serious risks to your health and quality of life. It affects over 20% of the global population, with millions of cases in the United States alone. Untreated OSA contributes to cardiovascular diseases, metabolic disorders, and cognitive impairment. For example, it has been strongly associated with hypertension and stroke, which can develop as complications of the disorder. Beyond health risks, OSA imposes a significant economic burden due to increased healthcare utilization. Epidemiological studies reveal that undiagnosed OSA exacerbates neurocognitive issues and reduces productivity, making it a critical condition to address.

Why Does OSA Happen?

Causes of OSA

Airway Obstructions and Muscle Relaxation

The primary cause of obstructive sleep apnea (OSA) lies in the physical obstruction of your airway during sleep. This obstruction often results from the relaxation of throat muscles, which causes the airway to narrow or collapse. Several anatomical and physiological factors contribute to this condition:

• Structural Factors:

  • Variations in craniofacial anatomy, such as retrognathia (receding jaw), micrognathia (small jaw), or mandibular hypoplasia (underdeveloped jaw).

  • Conditions like Down syndrome, Pierre Robin syndrome, or Marfan syndrome.

  • Enlarged tonsils or adenoids (adenotonsillar hypertrophy).

  • High, arched palates or nasal obstructions, including polyps or deviated septums.

• Dynamic Factors:

  • Increased nasal and pharyngeal airway resistance.

  • The Bernoulli effect, where airflow velocity increases at narrow points, leading to airway collapse.

These factors, combined with muscle relaxation during sleep, create the perfect conditions for airway blockages, leading to repeated breathing interruptions.

Risk Factors

Obesity and Lifestyle Habits

Obesity is one of the most significant risk factors for OSA. Excess fat around your neck and throat can compress the airway, making it more prone to collapse. Studies show that individuals with higher body mass indexes (BMIs) are at a much greater risk of developing OSA.

Your lifestyle choices also play a critical role. Smoking and alcohol consumption can worsen muscle relaxation and inflammation in the airway, increasing the likelihood of obstruction. Research highlights that adopting healthier habits can significantly reduce OSA risk. For instance, a study found that each one-point increase in a healthy lifestyle score reduced the odds of OSA by 33%. This underscores the importance of maintaining a balanced diet, exercising regularly, and avoiding harmful substances.

Family History and Age

Your genetic makeup can also influence your risk of developing OSA. If your family has a history of sleep apnea, you may inherit anatomical traits like a narrow airway or facial structure abnormalities that predispose you to the condition.

Age is another critical factor. As you grow older, your throat muscles naturally weaken, increasing the chances of airway collapse during sleep. Studies show that OSA prevalence rises significantly in individuals over 65 years old. While you cannot control aging or genetics, understanding these risks can help you take proactive steps to manage your health.

How OSA Can Destroy Your Daily Life

Motor vehicle is our most import travel tool, but did you known, motor vehicle accidents (MVAs) are a leading cause of morbidity and mortality worldwide, with approximately 1.19 million deaths resulting from road traffic crashes annually. And did you known, about 30% of fatal MVAs caused by Sleepiness at the wheel (SW), OSA are a well-established risk factor for SW[3].. OSA affects up to 38% of the adult population worldwide when defined by an apnea-hypopnea index (AHI) ≥5.  In the United States, it is estimated that over 800,000 drivers are involved in OSA-related MVAs annually. In a European Sleep report, it show “The average prevalence of falling asleep at the wheel in the previous 2 years was 17%”[4].

In addition to this serious problem, OSA can also have an impact on various aspects of our lives. The common symptoms of OSA include:

• Loud or frequent snoring
• Insomnia
• Morning headaches
• Memory loss
• Impotence
• Dry mouth throat
• Attention Deficit
• Depression moody
• Fatigue
• Nocturia
• Silent pauses in breathing
• Choking or gasping sounds
• Unrefreshing or restless sleep
• More

OSA also influence several diseases, such as:

Hypertensive

In fact, approximately 30–50% of hypertensive patients have OSA, whereas 50% of patients with OSA present hypertension, especially about 80% of patients with resistant hypertension have OSA^[5]. 

Coronary Artery Disease(CAD)

In a research, from over 6000 patients in the Sleep Heart Healthy Study also revealed an independent association between OSA and the incidence of CAD, especially in patients with severe OSA. Another observational study of 1436 patients, found a significant association between OSA and coronary artery events and cardiovascular death, after adjusting for traditional CVD risk factors, including HTN and obesity. Also compared to controls, OSA is associated with a higher rate of worse outcomes in patients presenting with ACS, including higher incidence of cardiac death and re-infarction^[6].

Heart Failure(HF)

According to the American Heart Association 2022 Statistics, over 8 million people 18 years or older will have heart failure (HF) in 2030. The prevalence of OSA ranges from 20% to up to 60% among the HF population^[7]. In a research shows, Approximately 35% of patients with heart failure with preserved ejection fraction, and 30% of patients with HF with reduced ejection fraction, have OSA.

Cardiac Arrhythmias

In a study by Guilleminault et al. on 400 patients with OSA, the authors reported a 48% prevalence of cardiac arrhythmias. Notably, all of the patients (n=50) who had tracheostomy did not have any arrhythmias post-operatively^[8].

Depression

Major depressive disorder(MDD) carries with it an 18% prevalence of associated OSA; OSA has a 17.6% prevalence of MDD. There is a co-linear relationship between OSA and MDD. Both conditions present with common mood symptoms, anxiety, restlessness, fatigue, and poor concentration^[9].

How can we known we are have OSA?

OSA diagnosis is typically based on in-laboratory full-night polysomnography (PSG), which collects multiple types of physiological data during sleep, include brain waves, heartbeat, breathing and movement. Currently, the apnea–hypopnea index (AHI) is used to define and categorize the severity of OSA^[10], with the following severity grades based on the number of obstructive breathing events per hour:

1. Mild: 5 to 15 events per hour

2. Moderate: >15 to 30 events per hour

3. Severe: greater than 30 events per hour^[11]

An objective evaluation of your sleep may be needed before your medical provider can make a diagnosis. Options include:

In-lab overnight OSA study

This type of sleep study requires you to stay overnight at a sleep center, in a bed that may resemble a hotel room. You will sleep with sensors of PSG hooked up to various parts of your body. These sensors record your brain waves, heartbeat, breathing and movement. Medical providers usually recommend this kind of sleep study for more complex cases. An overnight sleep study provides your doctor with the most complete information about your sleep.

This option’s problem is usually It is expensive. And you should book the test, maybe you can not continuous monitoring several nights.

Home OSA test

This type of sleep study lets you sleep in your own home while a small monitor collects data as you sleep. There are two normal monitor device on the market, simple PSG and wristband bound oxygen clamp.

But the simple PSG is difficault to use for normal people, we hard to use it every night . the oxygen clamp on the finger full night is very fell ill.

 

Why CIRCUL RING is better for home OSA test?

CIRCUL RING give you an another option. It is a ring easy to wear. It’s adaptive sizing design will automatically adjusts to your finger size, auto skin fit, ensuring there are accuracy data.

CIRCUL RING Team have over 10 years experience on OSA test, until 2023 we have done clinical cases over 30000, we develop several test devices for medical test, such as CIRCUL+^[12] which already get FDA certification. Now we spend 2 year to develop the CIRCUL RING for normal persons, help them can easy test the OSA at home.

Image Source: CIRCUL SMART RING

We use high accurate PPG sensors to get your oxygen value every second form 100 HZ signal frequency, which allow the standard of AASM oxygen update cycle should less than 3 second. And in struct, the SST^tm sensor struct of our patent make the sensor always fit your skin, can not loss any your body signal.

CIRCUL RING use Oxygen Desaturation Index(ODI) to define and categorize OSA. Follow the definitions of AASM at 2014

“Positive Airway Pressure (PAP) device flow (titration study, or alternative apnea sensor (diagnostic study) for a duration of ≥ 10 s and a ≥ 3% oxygen desaturation from the baseline before the event or an arousal connected to the event

OXYGEN DESATURATION INDEX—(No. of oxygen desaturations ≥ 3% × 60) /TST in min.”

And the relationship between odi and ahi has be proved in several papers. Some researchers believe that oxygen saturation parameters may play a major role in classifying the severity of OSA, and this conclusion might be derived by the fact that, compared to AHI, measurements such as the oxygen desaturation index (ODI) better reflect the degree of hypoxia during sleep^[13]. In 2024 a research show the Range of grading according to AHI, STOP BANG, ESS and ODI as below:

Parameters	Severity	Number	%
AHI	Mild OSA (5–14)	19	10.8
	Moderate OSA (15–29)	32	18.18
	Severe OSA (≥ 30)	125	71.02
ESS (severity of OSA)	Mild to Moderate (9–14)	93	52.8
	Severe (15–24)	19	47.2
ODI	Mild OSA (5–14)	17	9.7
	Moderate OSA (15–29)	35	19.9
	Severe OSA (≥ 30)	124	70.4
STOP BANG predicting Moderate to severe OSA	Low risk (< 3)	11	6.2
	High Risk (≥ 3)	165	93.8

 

In clinical test CIRCUL also have very accuracy with the PSG result,” The ODI was 25.3±24.5 events/h using PSG and 22.2±24.5 events/h using Circul (P<0.0001), with an intraclass correlation coefficient (ICC) of 0.884. CT90 and CT90/TST between the two methods were not different; the MSpO₂ level calculated by PSG was slightly lower than Circul, 95.0% (93.0-96.0%) vs 95.3% (93.9-96.6%), P<0.0001. Circul-ODI had a good correlation (r=0.91, p<0.0001) and close agreement with PSG-AHI (Bland-Altman analysis: Mean Difference 6.4, 95% CI -14.8 to 27.5 events/h). Using a threshold of AHI ≥5 events/h, the Circul had 87% sensitivity, 83% specificity, 5.09 positive likelihood ratio (LR+), 86% accuracy, and 0.929 area under the curve (AUC).”^[14]

How to cope with OSA?（How to Treat It）

1. CPAP(continuous positive airway pressure)

CPAP is a machine that uses a steady stream of air to gently keep your airway open throughout the night so you are able to breathe. You sleep with a mask with a hose that is attached to a machine kept at the bedside. Masks and machines may vary depending on your treatment and comfort needs. CPAP is the frontline treatment for sleep apnea and is recommended for most patients.

2. Oral appliance therapy

An oral appliance is a device that fits in your mouth over your teeth while you sleep. It may resemble a sports mouth guard or an orthodontic retainer. The device prevents the airway from collapsing by holding the tongue in position or by sliding your jaw forward so that you can breathe when you are asleep. Some patients prefer sleeping with an oral appliance over a CPAP machine. A dentist trained in dental sleep medicine can fit you with an oral appliance after you are diagnosed with sleep apnea. Oral appliance therapy is recommended for patients with mild to moderate apnea who cannot tolerate CPAP or simply prefer to try the oral appliance instead of a CPAP device.

3. Surgery

There are a variety of surgical options you can elect to have if CPAP or oral appliance therapy does not work for you. The most common options reduce or eliminate the extra tissue in your throat that collapses and blocks your airway during sleep. More complex procedures can adjust your bone structures including the jaw, nose and facial bones. Weight loss surgery may also be an option. Talk to your sleep doctor about what surgery is right for you.

4. Weight management

In some cases weight loss can help improve or eliminate your sleep apnea symptoms if you are overweight or obese. Overweight people often have thick necks with extra tissue in the throat that may block the airway. There is no guarantee that losing weight will eliminate your sleep apnea, though it may help.

5. CBT(cognitive behavioural therapy)

Recent evidence suggests that CBT-I can be effective and well-tolerated to manage insomnia whether OSA is treated or untreated.  Additional modifications to core components of CBT-I may be considered to best suit the clinical characteristics of patients with COMISA.  Strategies such as motivational enhancement or systematic desensitization can also be integrated with CBT-I to target barriers to PAP adherence^[15].

What option you final choose, good life style is necessary。Continuous monitoring can feed back your heal result, and help you to impove your health.

 

FAQ

What is the difference between obstructive sleep apnea (OSA) and central sleep apnea (CSA)?

OSA occurs when your airway becomes blocked during sleep, often due to relaxed throat muscles. CSA, on the other hand, happens when your brain fails to send proper signals to the muscles controlling breathing. Both disrupt sleep but have different causes.

Can children develop obstructive sleep apnea?

Yes, children can develop OSA. Enlarged tonsils or adenoids often cause it. Symptoms include snoring, restless sleep, and behavioral issues. If you suspect OSA in your child, consult a pediatrician for evaluation and treatment options.

How can I tell if I have OSA without a sleep study?

Common signs include loud snoring, gasping for air during sleep, excessive daytime sleepiness, and morning headaches. While these symptoms suggest OSA, only a sleep study can confirm the diagnosis. Consider home testing options like the Circul Ring for convenience.

Is OSA more common in men or women?

OSA is more common in men, especially younger ones. However, postmenopausal women and older adults also face increased risk. Hormonal changes and aging contribute to this trend. Understanding your risk factors can help you take preventive measures.

Can lifestyle changes alone cure OSA?

Lifestyle changes like weight loss, exercise, and avoiding alcohol or smoking can significantly reduce OSA severity. However, they may not fully cure the condition. Combining these changes with medical treatments often yields the best results.

Are CPAP machines uncomfortable to use?

Modern CPAP machines prioritize comfort with lightweight masks and adjustable settings. While some users need time to adapt, most find significant relief from symptoms once accustomed to the device. Discuss mask options with your provider to ensure a proper fit.

How does untreated OSA affect my heart?

Untreated OSA increases your risk of heart disease, high blood pressure, and stroke. Repeated oxygen drops during sleep strain your cardiovascular system. Addressing OSA can improve heart health and reduce these risks.

Can I monitor my OSA treatment progress at home?

Yes, devices like the CIRCUL Smart Ring allow you to track oxygen levels, heart rate, and sleep patterns. This data helps you assess treatment effectiveness and share insights with your healthcare provider for better management.

Tip: Regular monitoring keeps you engaged in your treatment journey and ensures optimal outcomes.

 

REFERENCE

[1]. What is obstructive sleep apnea? (AASM)[ https://sleepeducation.org/sleep-disorders/obstructive-sleep-apnea/]

[2]. Sleep Apnea(AASM)[ https://aasm.org/resources/factsheets/sleepapnea.pdf]

[3]. Risk of Motor Vehicle Accidents in Obstructive Sleep Apnea: Comparative Analysis of CPAP Versus Surgery[presented at the 2024 AAO-HNSF Annual Meeting][AAO-HNSF]

[4]. Sleepiness at the wheel across Europe: a survey of 19 countries[PMID: 25581328 DOI: 10.1111/jsr.12267][PubMed]

[5]. Obstructive sleep apnea -related hypertension: a review of the literature and clinical management strategy[Hypertension Research volume 47, pages3085–3098 (2024)][Nature]

[6]. Cardiovascular Disease Risk in Obstructive Sleep apnea: An Update [PMCID: PMC5891150  NIHMSID: NIHMS954596  PMID: 29644149][PubMed]

[7]. Obstructive Sleep Apnea in Heart Failure: Current Knowledge and Future Directions[PMCID: PMC9225117  PMID: 35743529][PubMed]

[8]. Guilleminault C, Connolly SJ, Winkle RA. Cardiac arrhythmia and conduction disturbances during sleep in 400 patients with sleep apnea syndrome. Am J Cardiol. 1983;52:490–494. doi: 10.1016/0002-9149(83)90013-9. [PubMed]

[9]. Depression, Obstructive Sleep Apnea and Psychosocial Health[PMCID: PMC5836734  NIHMSID: NIHMS932289  PMID: 29517078][PubMed]

[10]. Polysomnographic phenotyping of obstructive sleep apnea and its implications in mortality in Korea[Scientific Reports volume 10, Article number: 13207 (2020)][Nature]

[11]. Metrics of sleep apnea severity: beyond the apnea-hypopnea index[PMCID: PMC8271129  PMID: 33693939][PubMed]

[12]. FDA clears circul pro Ring as pulse oximeter[AASM]

[13]. Connecting the dots: analysing the relationship between AHI and ODI in obstructive sleep apnea[Sleep Science and Practice | Ausgabe 1/2024][ Sleep Science and Practice]

[14]. Comparison of Ring Pulse Oximetry Using Reflective Photoplethysmography and PSG in the Detection of OSA in Chinese Adults: A Pilot Study[PMID: 36003191 PMCID: PMC9394522 DOI: 10.2147/NSS.S367400][PubMed]

[15]. Cognitive behavioural therapy for insomnia reduces sleep apnoea severity: a randomised controlled trial[ERJ Open Research 2020 6(2): 00161-2020; DOI: https://doi.org/10.1183/23120541.00161-2020][ERS]