Celebrating World Sleep Day across specialties: OSA ‘touches every organ’

Key takeaways:

• Sleep is important in patients with diseases and in healthy people.
• Obstructive sleep apnea crosses over into a multitude of specialties.
• Educating patients on the value of sleep requires a tailored approach.

Across the globe, health care professionals are celebrating World Sleep Day, an event created by the World Sleep Society, on March 14.

For 2025, “make sleep health a priority” is the theme of the day, according to the World Sleep Day webpage.

“I love this idea of World Sleep Day because it’s not just about sleep apnea; it’s all things sleep,” Seema Khosla, MD, FCCP, FAASM, medical director of the North Dakota Center for Sleep and American Academy of Sleep Medicine (AASM) spokesperson, told Healio.

Healio spoke with clinicians from pulmonology, neurology and cardiology backgrounds to learn more about sleep in each specialty, the impact of obstructive sleep apnea (OSA) on health, how to educate patients on the value of sleep and the importance of collaboration between specialties when treating patients with sleep disorders.

OSA impact on sleep

According to Cleveland Clinic, seven types of sleep disorders commonly appear in patients: chronic insomnia, OSA, restless legs syndrome, narcolepsy, shift work sleep disorder, delayed sleep phase syndrome and REM sleep behavior disorder.

Among these, OSA, a sleep disorder that impacts breathing, is treated by sleep medicine specialists from any background and is of interest to pulmonologists.

Tetyana Kendzerska

“OSA significantly disrupts sleep quality and overall sleep architecture due to repeated breathing interruptions caused by upper airway obstruction,” Tetyana Kendzerska, MD, PhD, sleep physician, associate scientist at Ottawa Hospital Research Institute and associate professor in the division of respirology at the University of Ottawa, told Healio.

By disturbing breathing during sleep, Khosla told Healio the impact of OSA on sleep can present in a few ways, including snoring, gasping, desaturations, arousal, fragmented sleep, lighter sleep, multiple trips to the bathroom at night and insomnia.

“Due to frequent micro-arousals as the body repeatedly wakes up to restore breathing,” Kendzerska told Healio, “OSA leads to poor sleep continuity, preventing deep, restorative sleep.”

Notably, Kendzerska added that a patient’s sleep architecture is also impacted by OSA.

“Due to sleep disruptions, individuals with OSA may spend less time in slow-wave sleep (deep sleep) and REM sleep, which are crucial for memory, cognitive function and physical recovery,” Kendzerska said.

As Healio previously reported, a study by Tony J. Cunningham, PhD, and colleagues found that patients with OSA showed impaired emotional memory after one night of sleep. Additionally, less time spent in REM sleep, as well as fragmented sleep, had links to troubles in general memory and accurate memory of emotional images.

OSA impact on health

Looking beyond sleep, Khosla told Healio OSA “touches every organ,” which, in turn, impacts an individual’s health in many different ways.

“We definitely see an association with hypertension, stroke, cognitive impairment, pulmonary hypertension and heart failure,” Khosla said.

Noting that OSA is linked to various cardiovascular diseases (CVDs) and conditions, the American Heart Association released a scientific statement in 2021.

“OSA prevalence is as high as 40% to 80% in patients with hypertension, heart failure, coronary artery disease, pulmonary hypertension, atrial fibrillation and stroke,” Yerem Yeghiazarians, MD, FAHA, and colleagues wrote in the statement.

In addition to discussing the frequency of OSA in patients with CVD, the authors made several recommendations related to OSA screening, OSA treatment and follow-up visits.

Kendzerska further noted the link between OSA and “a multitude of morbidities and mortality.” In addition to the cardiovascular diseases highlighted by Khosla, Kendzerska told Healio the risk for metabolic syndrome and potentially cancer is elevated with OSA.

Notably, a 2023 study by Jose Daniel Gómez-Olivas, MD, and colleagues found that untreated moderate to severe OSA among patients with melanoma increased the risk for poor long-term prognosis (composite of melanoma recurrence, metastasis or all-cause mortality) of skin cancer.

Sleep apnea can also impact skin health and eye diseases/disorders, Khosla told Healio.

Although not directly focused on sleep apnea, Khosla highlighted a 2013 clinical trial funded by Estée Lauder that investigated sleep quality and skin aging in pre-menopausal women.

According to a press release from Estée Lauder, researchers divided 60 premenopausal women into good quality sleepers and poor quality sleepers using two sleep-related measures: average sleep length and the Pittsburgh Sleep Quality Index.

Between the two groups, the release reported that several signs of intrinsic skin aging — fine lines, uneven pigmentation, skin slackening and decreased elasticity — were increased among those classified as having poor quality sleep.

In terms of eye health and sleep, Khosla told Healio she has received patient sleep lab referrals from ophthalmologists for floppy eyelid syndrome, all of which were found to have sleep apnea. This syndrome, which Cleveland Clinic says impacts elasticity of the eyelids, was a surprising discovery for Khosla when she first started seeing this almost 2 decades ago.

“I was waiting for one to be negative, but not a single one was negative,” she told Healio.

“It’s so important for us to have collaboration, or else I could have gone my whole life not knowing about floppy eyelid syndrome,” Khosla added.

In addition to all these diseases, OSA also negatively impacts health-related quality of life, Kendzerska said.

An example of these impacts was recently showcased in findings from the Sleep Health Inquiries on Needs and Emotions, or SHINE, survey provided by Apnimed.

Based on responses from 1,500 patients with OSA, researchers found that the negative impact of OSA extends beyond sleep into activities such as childcare, chores, exercise and shopping, as the Apnimed press release and fact sheet indicated that 86% of patients reported limits on these activities due to the disorder.

In terms of mental health, the survey’s webpage and fact sheet said that over half of the assessed population had anxiety (54%) or felt depressed/hopeless (67%). ADHD/ADD was slightly less common but still was reported by 23% of patients.

“Beyond individual health, OSA contributes to impaired memory, concentration, coordination, reduced vigilance and a higher risk of motor vehicle and occupational accidents, leading to significant socioeconomic costs,” Kendzerska told Healio.

Treating OSA

Although there are several ways to treat OSA, both Khosla and Kendzerska told Healio the gold standard is positive airway pressure (PAP) therapy, which includes CPAP, bilevel PAP and auto-adjusting PAP.

Key features of this treatment include “maintaining an open airway during sleep, improving oxygenation and reducing sleep fragmentation,” Kendzerska told Healio.

Another potential benefit of PAP was recently found in a study of patients with moderate to severe OSA and uncontrolled hypertension, in which measures of blood pressure fell significantly with 6-month CPAP use.

PAP therapy has been beneficial for many patients, but for others, it can lead to further struggle when trying to sleep, Khosla said.

“Sometimes CPAP can cause its own problems, and some people have trouble tolerating it,” Khosla told Healio. “Maybe it causes them to wake up more and their sleep gets more fragmented.

“CPAP sounds like it would be this lovely treatment for everybody, but I don’t think it’s meant for everybody,” Khosla added. “If you don’t fall into that CPAP category, it doesn’t mean that there’s anything wrong with you. It just means that we need to try another way.”

According to Kendzerska, “because of the complexity and heterogenous nature of OSA in terms of pathophysiology, risk factors, clinical presentation, associated comorbidities and difficulty complying/tolerating PAP, there is a need for tailored treatment with non-PAP therapy.”

For patients reporting issues with PAP, Khosla and Kendzerska both said clinicians can consider oral appliance therapy, surgery/surgical interventions, positional therapy and implantable devices/hypoglossal nerve stimulation.

Khosla further noted that Zepbound (tirzepatide, Eli Lilly) may be used in patients with OSA, and Kendzerska highlighted lifestyle interventions and pharmacological treatment.

In a 2022 review discussing non-CPAP therapies, Jean-Louis Pépin, MD, PhD, and colleagues highlighted mandibular advancement devices, positional therapy, pharmacotherapy for OSA, pharmacotherapy for residual sleepiness, stimulation therapy and combined therapies.

As outlined in the review, each non-CPAP option has its own advantages, disadvantages and personalization potential, and Kendzerska noted the importance of the latter factor when treating patients with OSA.

“When properly tailored, OSA treatments significantly improve sleep quality, daytime function and overall health outcomes,” Kendzerska told Healio.

Looking ahead, two phase 3 trials assessing AD109 (Apnimed), a combination of aroxybutynin and atomoxetine taken orally, in OSA are in progress, according to a manufacturer-issued press release.

“In patients with OSA, the upper airway muscles no longer fire physically at night, leading to muscle collapse and partial (hypopnea) or complete airway obstruction (apnea),” Larry Miller, MD, CEO of Apnimed, previously told Healio. “AD109 works by restoring muscle firing, which in turn limits collapse and maintains airway patency.”

As Healio previously reported, AD109 taken for 4 weeks lessened OSA severity in the multicenter, randomized, placebo-controlled, parallel arms phase 2b MARIPOSA clinical trial.

Sleep in neurology

As highlighted above by Khosla and Kendzerska, OSA is linked to many organs in the body, one of which is the brain.

Christopher M. Carosella

“I think for a long time, neurologists have been involved in sleep, but I think recognition of the way that sleep interplays with certain, especially chronic, neurologic conditions is really starting to be recognized,” Christopher M. Carosella, MD, assistant professor of neurology at Johns Hopkins University, told Healio.

With a special interest in the impact of sleep on epilepsy, Carosella said his research has shown a relationship between sleep apnea and this chronic brain disorder.

According to results published in Sleep, Carosella and colleagues found that nocturnal hypoxemia and sleep apnea raised the risk for late-onset epilepsy even after adjustment for several risk factors and comorbidities.

Carosella also told Healio there is a bidirectional relationship between sleep apnea and epilepsy.

“We’re learning that epilepsy can predispose people more to sleep apnea, but treatment of sleep apnea can really change epilepsy outcomes, not just quality of life, which I think people tend to recognize with sleep, but actual outcomes in terms of seizure frequency and seizure severity, so that’s really big,” Carosella said.

Alzheimer’s disease and dementia are additional areas in neurology in which sleep apnea has emerged as an important player that impacts the risk for these conditions, according to Carosella.

Searching through five databases up till May 1, 2019, Omonigho M. Bubu, MD, MPH, PhD, and colleagues evaluated 68 studies focused on how OSA is linked to cognitive function, subsequent cognitive decline or Alzheimer’s disease and found a link between OSA and mild impairment in attention, memory and executive function in adults aged 30 to 60 years.

On a similar note, a 2024 study published in SLEEP Advances reported that adults aged 50 years and older, particularly women, who experienced OSA appeared to be at higher risk for dementia.

Switching to adults aged older than 60 years, Bubu and colleagues observed a link between OSA and mild cognitive impairment development, as well as between OSA and Alzheimer’s disease development, but noted an important caveat.

“Symptomatic patients who have a higher likelihood of associated disturbed sleep/cognitive-impairment [were] driving these findings,” Bubu and colleagues wrote.

Notably, a study by Nicola Andrea Marchi, MD, and colleagues published in 2023 further adds to evidence of the link between OSA and worsening cognition in older adults, as adults aged 65 years or older without dementia suffering with hypoxemia while sleeping showed decreased measures of cognition over a 5-year period.

Carosella told Healio research demonstrating a relationship between sleep apnea and Alzheimer’s disease has “really driven neurologists to pay close attention to [OSA] symptoms (snoring, sleep interruptions, etc), and that the treatment seems to make a difference in terms of long-term outcomes.

“Patients with pre-Alzheimer’s or other types of early or pre-dementia syndromes, referred to as mild cognitive impairment, are now often screened for sleep apnea because it’s known that treatment of sleep apnea may impact long-term cognitive impairment,” Carosella added.

Notably, CPAP’s impact in patients with Alzheimer’s disease was highlighted in a 2024 narrative review by Eleonora Rollo, MD, and colleagues via assessment of available studies.

“Randomized clinical trials and observational studies show that OSA treatment with CPAP in patients with [Alzheimer’s disease] results in improvement of daytime vigilance, mood and executive functions as well as sleep consolidation,” Rollo and colleagues wrote. “Moreover, it has been shown that CPAP has a mild potential effect on cognitive trajectories over time.”

When asked about the future of sleep in neurology, Carosella noted that sleep is becoming more important.

“Practitioners are waking up to that idea that sleep is really meaningful, and in general, we know sleep impacts quality of life,” Carosella told Healio.

"When we can’t cure the disease, we manage the symptoms,” Carosella added. “So, quality of life is a big deal, and sleep is a big part of that.”

Some symptoms commonly reported by patients with neurologic conditions that are impacted by sleep include daytime fatigue and sleepiness, according to Carosella.

“Neurologists are now feeling empowered to address sleep, and by addressing sleep, they’re making significant improvements in daytime function symptoms that patients are reporting,” Carosella told Healio.

Sleep in cardiology

Another major organ that sleep and OSA have an impact on is the heart.

Virend K. Somers

“If you don’t sleep enough, that’s linked to a whole host of bad things happening to the cardiovascular system, including high blood pressure, increased risk of heart attacks and so on,” Virend K. Somers, MD, PhD, Alice Sheets Marriott Professor of Cardiovascular Medicine at Mayo Clinic in Rochester, Minnesota, told Healio.

According to Somers, a major study cohort that has been used to demonstrate this relationship between fewer hours of sleep and higher health risks is the Nurses’ Health Study. Back in 2003, Najib T. Ayas, MD, and colleagues found an elevated adjusted risk for coronary heart disease among nurses sleeping for 5 hours or less.

“As nurses slept less, their risk of gaining weight, their risk of heart attacks, their risk of developing diabetes, [their risk of] high blood pressure, all those risks went up,” Somers told Healio.

In his own research, Somers, Naima Covassin, PhD, and colleagues have also shown that sleep deprivation can lead to increased calorie consumption and belly fat in healthy individuals without obesity.

“[In instances where] they were sleep deprived, they will eat 350 calories more per day,” Somers told Healio. “Not only that, but they will gain fat, which unfortunately doesn’t go into a safe space like under the skin. It actually gets into the belly area.”

In addition to these findings, greater sleep time has been highlighted as a potential aid in weight loss, Somers said.

As Healio previously reported, Esra Tasali, MD, and colleagues found that adults who were overweight and extended the amount of time they normally slept lowered their daily energy consumption more than those who did not, which researchers said could suggest that adequate sleep durations may help patients lose weight.

Adding to the evidence demonstrating the harmful impact of less sleep, Covassin and colleagues also found that sleep loss in healthy young adults significantly raises 24-hour and sleep-time BP, particularly among women.

“There’s good reason to think that helping people sleep better will give them a better cardiovascular outcome,” Somers told Healio.

In terms of OSA, Somers said several negative cardiovascular outcomes can take place in patients with this condition due to low oxygen.

“Low oxygen stimulates the chemoreflexes in the carotid sinus, which is in the big artery in the neck,” Somers told Healio. “Those chemoreflexes cause increases in sympathetic activity [and] increases in blood pressure.”

“The low oxygen actually causes generations of things like free radicals and systemic inflammation, and all of those come together to damage the blood vessels, to cause or to increase the risk of high blood pressure, and in the longer term, to generate arrhythmias and even heart attacks and death,” Somers continued.

Notably, a study by Chance Strenth, PhD, and colleagues published in 2024 showcased this link between sleep apnea and poor cardiovascular health outcomes, as adults with OSA had elevated odds for developing various heart diseases including myocardial infarction and stroke.

Educating patients on value of sleep

When asked how pulmonologists/providers can educate patients on the value of sleep, Khosla told Healio each patient has a different perspective on sleep, so you should meet them where they are.

“We really want our patients to be invested in [sleep] and to understand on a very personal level why it’s important for them specifically,” Khosla said.

For some patients, sleep has moved up on their priority list due to social media, according to Khosla.

“If you’re on Instagram, people are evangelizing the importance of sleep,” Khosla told Healio.

However, for other patients, sleep is underutilized and an unimportant daily event.

“We have a lot of patients that really have lived their whole lives on 5 hours of sleep and then are completely stunned when you say the recommended duration of sleep is 7 to 9 hours for adults,” Khosla said.

In addition to considering how the patient currently views sleep, Khosla told Healio the clinician’s message on the importance of sleep should take into account the patient’s culture/religion and living situation.

“If you have a practicing Muslim that is waking up to do prayers in the early morning, that is something that is very important to them,” Khosla said. “So, a conversation about, ‘well, gosh, you shouldn’t get up in the early morning to do prayers,’ that’s not going to work.”

Rather than telling the patient they should not get up in the early morning to say their prayers, Khosla said clinicians can suggest an earlier bedtime, sleeping in more and/or dimming lights during the prayer period.

“We really want to serve our patients for what they’ve already valued in their lifestyle and their day-to-day routine,” Khosla told Healio. “If we are not receptive to hearing their thoughts, then they’re not going to trust us.”

On the living situation side, treating a patient with unstable housing will come with its own unique challenges since they may not have electricity for a CPAP machine, Khosla said.

As with culture/religion, Khosla told Healio it’s important that clinicians make accommodations in these situations. This could mean advising the patient to sleep on their side or using pillows to keep them in one position throughout the night.

An additional way pulmonologists/providers can educate patients on the value of sleep is by stressing sleep’s role across all aspects of health, Kendzerska told Healio.

Kendzerska also recommends that clinicians share “resources for sleep hygiene tips [and] lifestyle counseling” with their patients, one of which could center on sleep duration.

“Sleep health (measured by sleep duration) was recently recognized as the new component of ‘Life’s Essential 8’ of cardiovascular health, among diet, physical activity, nicotine exposure, BMI, blood lipids, blood glucose and blood pressure,” Kendzerska told Healio. “Several organizations have adopted sleep duration guidelines, recognizing the population health value of [approximately equal to] 7 to 8 hours of habitual sleep for adults.”

Collaboration between specialties

With sleep playing a role in many medical specialties, collaboration between specialties is needed to advance understanding and provide the best care, according to Kendzerska.

When treating a patient with OSA, Kendzerska highlighted opportunities for teamwork among specialists.

“We can collaborate with cardiologists because OSA is a major risk factor for hypertension, atrial fibrillation, heart failure and stroke, and with appropriate treatment, we could lower those risks,” Kendzerska told Healio.

“Similarly, we could work with endocrinologists (for diabetes and metabolic disorders), neurologists (for stroke, cognitive impairment and neuromuscular disorders), psychiatrists and psychologists (for mental health and sleep disorders), primary care physicians (for early detection and patient education), dentists and orthodontists (for oral appliance therapy and craniofacial abnormalities), bariatric surgeons and nutritionists (for obesity management), sleep psychologists (insomnia management), etc,” Kendzerska continued.

However, making connections outside of your own specialty can be difficult to achieve for various reasons, according to Kendzerska, Khosla and Carosella.

“Interdisciplinary teamwork enhances patient-centered care for OSA, reduces comorbid risks and improves sleep health, but [it’s] not always easy to implement,” Kendzerska said.

Khosla told Healio one reason is the “siloed and fragmented” health care system, and because of this, she believes the best way to begin collaboration is by figuring out the common disease process that connects two specialties.

“I think creating those inroads where we can have that common disease process, but then also developing those relationships so that it’s maybe less siloed and you can refer patients back and forth or even just develop a collegial relationship where you can text each other [is important,]” Khosla said.

As part of a large academic institution, Carosella said he is able to easily connect with pulmonologists, neurologists, psychiatrists and otolaryngologists; however, he recognizes that collaboration between specialties is not easy in private practice.

For those in private practice looking to make connections with other specialties, Carosella recommends attending statewide sleep society meetings, which bring together various academic institutions throughout the state, as well as people in the community.

“Things like that can be a really nice way to meet people and work those connections,” Carosella told Healio.

For Carosella, collaboration between pulmonologists and neurologists is important because it offers a deeper level of care.

“Pulmonologists will often address the sleep apnea, but they might not be highlighting to their patients how important maintaining good treatment is for the outcomes for any chronic neurologic conditions they might have,” Carosella told Healio.

“In my world, epilepsy is that that big space where I try to be an advocate for making sure that patients understand the nature of how sleep apnea might contribute to their epilepsy and helping their physicians understand that too, so they can adequately advocate for their patients,” Carosella said.

For Somers, collaboration between pulmonologists and cardiologists is significant because OSA could be behind cardiovascular problems that may be improved by OSA treatment.

“A cardiologist who sees a patient with heart disease, No. 1, should actually check for sleep apnea, either by asking the patient questions or maybe doing an overnight screening test when relevant,” Somers told Healio. “Then, [they] should have a low threshold for sending that patient to a sleep specialist for further management because the treatment of sleep apnea, although we make it seem relatively straightforward, isn’t straightforward.”

Notably, Somers said the link between pulmonologists and cardiologists has been strengthened by an effort from the American Association of Sleep Medicine.

“The American Association of Sleep Medicine has created a structure whereby a cardiology practice, after getting the requisite training and certification, can have a sleep evaluation component in their practice,” Somers told Healio.

Impact of collaboration on patients

In addition to fostering opportunities for knowledge in areas outside what is known, collaboration positively impacts the patient.

“Having collaboration allows for two sets of eyes from a different perspective to make sure that nothing is missed,” Carosella said.

“Because we have different tools in our toolbox and different comforts in terms of managing different conditions, being able to collaborate can really improve patient outcomes by making sure that the diseases are managed more holistically,” Carosella added.

Somers also noted the importance of care from a team of health care professionals, especially when a patient has comorbidities.

“Patients benefit from a team approach to their disease condition as a general rule, and probably one of the diseases that is most deserving of a team approach is, in fact, sleep apnea if the patient has multiple conditions,” Somers told Healio.

As part of the Canadian Sleep Research Consortium, Kendzerska added that collaboration should extend beyond medical specialties in order to reach all patients.

“By fostering new partnerships between academia, government, industry and community-based organizations, we aim to catalyze the translation of sleep sciences and technology into practice and health promotion initiatives for diverse communities,” the Canadian Sleep Research Consortium writes on its website.

At the end of the day, all clinicians share the goal of helping their patients get better, and connections to other specialists that will advance the care their patients are receiving are a major step toward achieving this goal.

“It’s always a balance because you don’t want to increase the total number of physicians or practitioners that a patient needs to see, but even a one-time consultation or a curbside visit to ask about how might you manage this additional symptom can be really helpful, and having somebody to reach out to is an important part,” Carosella told Healio.

Celebrating World Sleep Day across disciplines

As demonstrated throughout this article, sleep is a universal event that impacts all specialties, and this calls for acknowledgment of World Sleep Day from all health care professionals.

“Sleep is very different than other fields,” Khosla told Healio. “Not everyone needs to see a cardiologist, not everyone needs to see a diabetologist, but all of us need to sleep. Even if you don’t have a sleep disorder, there’s value in knowing how to optimize your own sleep.”

Somers emphasized that sleep apnea is a common comorbid condition in cardiology.

“I think World Sleep Day helps highlight for the cardiologist the fact that these patients they see in their waiting rooms regularly may have a significant condition that needs to be recognized and treated,” Somers said.

According to Carosella, acknowledgements such as World Sleep Day increase physician and practitioner awareness.

“The next time that [a] neurologist goes into clinic, maybe they will think to ask about sleep problems, or if the sleep problem comes up, feel more empowered to address it,” Carosella added.

In addition to World Sleep Day, the Canadian Sleep Research Consortium along with three other organizations has put together the Week for Better Sleep campaign from March 15 to March 22.

“This year, Week for Better Sleep’s theme is Boost Your Sleep IQ, encouraging participants to learn more about their own sleep and explore the six dimensions of sleep health,” Kendzerska told Healio.

For those reading this article prior to or on World Sleep Day, there is still time to sign up here.

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• Apnimed announces groundbreaking survey revealing the alarming hidden impact of obstructive sleep apnea (OSA). https://apnimed.com/article/apnimed-announces-groundbreaking-survey-revealing-the-alarming-hidden-impact-of-obstructive-sleep-apnea-osa/. Published Oct. 9, 2024. Accessed March 5, 2025.
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For more information:

Christopher M. Carosella, MD, can be reached at ccarose1@jh.edu.

Tetyana Kendzerska, MD, PhD, can be reached at tkendzerska@toh.ca.

Seema Khosla, MD, FCCP, FAASM, can be reached at skhosla@medbridgegroup.com.

Virend K. Somers, MD, PhD, can be reached at somers.virend@mayo.edu.