The passing of legendary composer Bappi Lahiri, at the age of 69, has given rise to discussion on an inherently dangerous health complication where a person’s breathing halts for a few seconds before it starts all over again while he or she is sleeping.
Lahiri, the musician who popularised disco music in Hindi cinema, died of Obstructive Sleep Apnoea (OSA) on February 16 in Mumbai. Though he had multiple health issues over the last few years, OSA, in particular, was bothering Lahiri since 2021, after which he was regularly visiting hospitals.
According to a recent study, close to 70 lakh Indians are suffering from OSA. There are different kinds of sleep apnoea, but OSA is the most common. It occurs when your throat muscles recurrently block your airway during sleep.
Said Dr Shyam Kalyan N., an ENT surgeon in Noida, “Though OSA is mainly seen in obese, middle-aged men, it can also occur in children. When a person is affected with OSA, oxygen levels in the blood drop, which then leads to the brain being alerted and the person waking up, leading to normal breathing.”
Kalyan said OSA is seen in people who have excess neck fat. “It is also seen in people who lead a sedentary lifestyle, have deviated noses and bulky tongues. Some of it is inherited via genes from parents.”
Preventing OSA, he said, involves maintaining a healthy lifestyle with body weight appropriate to the height. “It is important to keep a person’s weight within the Body Mass Index (BMI) range [18.5 to 25 kg/m2]. If you are a habitual snorer, you should visit an ENT surgeon and get a sleep study done. Simple snoring is not dangerous but it can lead to OSA left untreated,” said Kalyan.
Dr Asha M. Sasidharan, a Kochi-based ENT surgeon, had some months ago come across a middle-aged man who was diagnosed with mild OSA. “He was tall, obese and visited my clinic with issues of snoring and disturbed sleep. On examination, the patient’s BMI was 30.5. He had a short, bulky neck. Our examination revealed a deviated nasal septum. We conducted a sleep study that revealed an AHI [Apnoea Hypopnea Index that is used to indicate the severity of OSA] value of 10, which is categorised as mild,” said Sasidharan.
She said the man was told to reduce his weight through diet control and exercise. “Also, a surgery was done to correct his deviated nasal septum. He was advised to use the device CPAP [Continuous Positive Airway Pressure, which provides a steady pressure of air in the airway] during sleep, and had to adhere to the diet regime, which he did. On follow-up, after a few months, we found that he could sleep without disturbance, and was feeling far better.”
Suhasini Vasu, 48, an IT professional in Bengaluru, hopes to feel better the same way. Vasu felt anxious after hearing about Lahiri’s death. She has been of late having bouts of breathlessness while sleeping. “I wake up at least twice in the night, all of a sudden, finding it difficult to breathe. During the pandemic, my diet regime went for a toss. I have put on some weight. Anxiety and work-related pressures, I guess, are taking a toll. My husband said I have started snoring loudly at night. I think I need to consult a doctor at the earliest. I am not sure whether it is OSA, but Lahiri’s death is a wake-up call for people like me. I can’t believe that someone who roared with his music had to die of OSA,” said Vasu.
While diagnosing patients with sleep disorders, doctors also measure the patient’s daytime sleep with the Epworth Sleepiness Scale (ESS). ESS is used to screen for the symptoms associated with OSA. It describes eight situations where a person might fall asleep---like reading, watching television, sitting inactive at a public place, lying down to rest in the afternoon, as a passenger in a car, while talking to someone, sitting quietly after a lunch without alcohol, and while in a car when it is stopped in the traffic. The patient then rates it using the following scale:
0 = would never doze
1 = slight chance of dozing
2 = moderate chance of dozing
3 = high chance of dozing
The score ranges from 0 to 24, with scores above 16 indicating severe sleepiness.
Sleep apnoea is mostly either obstructive [OSA] or central sleep apnoea, says Dr Ahamed Subir, a neurologist at the MES Medical College in Perinthalmanna, Kerala. “As per my sources, about 80 per cent of the middle-aged population [in the country] are snorers, of whom about a quarter are heavy snorers suffering from OSA. There could be respiratory failure [in OSA patients] if the condition is severe. It will result in complications like hypertension and sudden death depending on the duration of the illness and on whether any treatment was instituted.”
Subir said central sleep apnoea, which accounts for less than 10 per cent of apnoeas, occurs when the nervous system controls breathing. “We [neurologists] come across a few cases of a mixture of these two apnoeas, which we call mixed apnoeas. The diagnosis is made with a polysomnogram machine, which helps in timely diagnosing and instituting treatment in patients so that they don’t have any complications,” said Subir. “But it is a medical quandary when an obese patient has apnoea, while also having lifestyle diseases with lung, heart or neurological conditions.”