I need to wear a mask to prevent the spread of COVID-19, but I want to take it off because it is difficult to breathe. Naturally, I don’t wear a mask when I sleep, so I don’t think there will be such a feeling of frustration. However, like wearing a mask while sleeping, there are times when you may be more choked and stuffy than this. That’s sleep apnea.
Sleep apnea is a condition in which you stop breathing for a few seconds while sleeping. If snoring is simply a problem with loud noises, sleep apnea literally means repeated inability to breathe properly for a long period of time, so the health problems caused by it are much bigger and more serious. The association with hypertension, cardiovascular disease, stroke, diabetes, erectile dysfunction, and dementia has been confirmed one following another, and recently, it has also been found to accelerate aging. Among them, the relationship between dementia and aging, which dominates the quality of life in old age, will be examined.
Many people consider dementia as the most feared disease of old age. The most common type of dementia is Alzheimer’s disease, accounting for 50-70% of cases. One of the causative agents of Alzheimer’s dementia is ‘beta-amyloid’. Beta-amyloid is a type of protein, a by-product of normal brain activity. If it is not removed and accumulates in the brain, Alzheimer’s disease occurs.
Beta-amyloid produced as a result of active brain activity during the day is removed by macrophages, a type of immune cell, during sleep. In other words, macrophages play the role of scavengers, and these activities occur actively during ‘deep sleep’ (slow wave sleep).
To understand this process, let’s take a quick look at the sleep cycle. In sleep, non-REM sleep and REM sleep form and repeat one cycle, and non-REM sleep is divided into three stages according to the depth of sleep, with the last stage being the deepest sleep state. This sleep cycle repeats 4-5 times a night, and deep sleep accounts for 5-15% of the total sleep time.
However, if you have sleep apnea, you may not be able to breathe properly, so there is not enough oxygen to get to your brain. At this point, the brain wakes the body up to breathe once more. In other words, if you have severe sleep apnea, you often wake up during sleep and cannot fall asleep, and beta-amyloid accumulates in the brain without being cleaned.
As a result, the likelihood of developing dementia increases, and beta-amyloid is known to accumulate at least 10 to 15 years before the diagnosis of dementia. The more you delay sleep apnea treatment, the more beta-amyloid accumulates.
Aging is one of the long-term problems caused by sleep apnea. In other words, if you don’t get enough sleep and get a good night’s sleep, you’ll get old quickly and you’re more likely to develop various diseases. This relationship can be confirmed through the association between sleep apnea and telomeres.
Human chromosomes are formed in an X-shape, and telomeres surround the ends of chromosomes like hats. Telomeres act as a protective barrier when cells divide, and they naturally shorten with age. That is why telomeres are also called the aging clock.
When chromosomes were extracted from the blood of sleep apnea patients and analyzed for telomere length, the more severe the sleep apnea, the shorter the telomere length. Patients with moderate sleep apnea had 2-2.5 times shorter telomeres than the general population.
Much has been revealed recently regarding what happens to the body when telomeres shorten. Shortening of telomeres means that cells are aging, which leads to decreased sensory function and weakened wound healing and immunity. In addition, infections, chronic diseases, tumors, etc. easily occur, eventually shortening the lifespan.
Sleep apnea doesn’t mean something will happen tomorrow. However, in the brain, beta-amyloid, which causes dementia, builds up one following another, and the telomeres get shorter and shorter, speeding up the aging clock. This is why it is important to treat sleep apnea as soon as possible.
[이상덕 하나이비인후과병원장]
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