Snoring could be a silent killer: Doctors warn of a hidden sleep disorder spreading across the globe

Snoring, often dismissed as a harmless sign of deep sleep, can sometimes be a warning from the body that something is wrong. Across the world, doctors are increasingly diagnosing people with Obstructive Sleep Apnea (OSA) — a serious sleep-related breathing disorder that interrupts normal breathing patterns and can lead to long-term health complications if left untreated.  

According to global estimates, nearly 936 million adults aged between 30 and 69 years suffer from OSA. What makes OSA especially dangerous is that it quietly damages the heart, brain, and metabolism over time, often without the person realising it. Understanding what OSA is, why it develops, how it is different from snoring, and how it can be managed has therefore become a crucial part of addressing this growing health challenge. 

What is obstructive sleep apnea? 

Obstructive sleep apnea is the most common form of sleep-related breathing disorder. It occurs when a person’s throat muscles relax excessively during sleep, causing the airway to narrow or become temporarily blocked. These pauses in breathing, called apneas, can last for a few seconds to even a minute, drastically lowering oxygen levels in the blood.  

Each time this happens, the brain sends a signal to wake the person briefly to resume breathing, often with a gasp or snort. Although the person may not remember waking up, this cycle can repeat dozens of times every hour, disrupting the natural rhythm of deep, restorative sleep. 

As a result, people with OSA often wake up feeling unrefreshed despite spending the entire night in bed. Loud, chronic snoring is one of the most common signs, but other symptoms, such as morning headaches, daytime fatigue, difficulty concentrating, or irritability, can also indicate the presence of the condition. In some cases, a partner may be the first to notice the irregular breathing or choking sounds at night, prompting a medical evaluation. While not everyone who snores has OSA, almost everyone with OSA snores, and this distinction is crucial. 

Why it happens and how it affects the body

The underlying mechanism of OSA lies in the relaxation of muscles that support the soft palate, tongue, and airway walls. When these muscles loosen excessively during sleep, the airway narrows or collapses. This leads to a temporary halt in breathing and a drop in blood oxygen levels.

The body’s immediate response is to jolt the sleeper into partial wakefulness so that breathing can resume. Over time, these repeated interruptions prevent the body from entering the deeper stages of sleep that are essential for physical recovery and mental alertness. 

The consequences of OSA extend far beyond disturbed sleep. Repeated episodes of oxygen deprivation, known as intermittent hypoxia, can put immense strain on the cardiovascular system. Studies have shown that OSA contributes directly to hypertension, heart attacks, strokes, and irregular heart rhythms. It is also linked to metabolic conditions such as diabetes and obesity, creating a cycle where weight gain worsens apnea and apnea further complicates weight management. The fatigue caused by poor sleep quality can lead to decreased productivity, impaired judgment, and a higher risk of road and workplace accidents. 

Even mood and cognitive function are affected — people with OSA often report memory lapses, reduced concentration, and increased irritability. In the long run, untreated OSA can lead to depression. In children and young adults, it may even affect learning and growth. 

How is it different from snoring?

Dr Saumya Shishir Agrawal, Pulmonologist at Medanta, Noida, explains that while snoring and obstructive sleep apnea (OSA) may seem similar, they are not the same. “Normal snoring is physiological — some people snore, some don’t,” he says, adding that not everyone who snores suffers from OSA. According to him, “OSA is a disease process in which there is an actual blockage of the airways, disrupting normal breathing during sleep. Snoring, on the other hand, can simply occur due to temporary nasal blockages, seasonal conditions like rhinitis or sinusitis, or even increased pollution levels that irritate the respiratory tract.”  

Why is obstructive sleep apnea increasing in India?  

India is now among the countries witnessing a steep rise in OSA cases, and experts are calling it an emerging public health crisis. A 2023 review found that “approximately 104 million Indians of working age suffer from OSA, of whom 47 million have moderate-to-severe OSA. This represents a major public health problem in India with important implications for the global burden of the disease.” 

Several factors are fueling this increase. Urban lifestyles, irregular sleep schedules, sedentary habits, and obesity have all created fertile ground for the condition to spread. A 2017 study at King George’s Medical University in Lucknow identified “obesity, large neck size, alcoholism and use of sedatives/tranquillisers” as major risk factors for Obstructive Sleep Apnea Syndrome (OSAS).  

Another 2023 study stated that “the public health impact of obstructive sleep apnea is escalating, particularly in developing countries like India, because of increasing urbanisation leading to sedentary lifestyles, and its potential contribution to the worsening rates of cardiovascular disease, diabetes and other co-morbidities.” 

It also added that “identifying and addressing lifestyle and behavioural factors as well as comorbidities that may be exacerbating OSA, by budding clinicians, is a must for a comprehensive management of obstructive sleep apnea.” 

Commenting on the scale of obstructive sleep apnea in India, Dr Agrawal points out that the rising prevalence of obesity is a major contributing factor. “There is an increase in obesity due to improper diet and lifestyle changes. A lot of sedentary work has become common in our society, which has contributed to this rise,” he explains. He notes that while OSA has existed for a long time, it has been significantly underdiagnosed. “As awareness grows, we are beginning to identify cases that were previously missed,” he says. 

He also highlights key risk factors for OSA, including obesity, a short neck, shorter height, and certain genetic or anatomical variations in the neck. Individuals with pre-existing conditions such as asthma, COPD, diabetes, or hypertension are also more vulnerable. 

Lack of awareness and limited acceptance of the condition remain major challenges. “Even when we use scoring systems like STOP-Bang to predict OSA, patient acceptance is very low. Many are unwilling to undergo diagnostic tests, and even when diagnosed, they may not pursue treatment,” he says. Financial constraints further complicate diagnosis and management, as sleep studies can cost between Rs 4,000 and Rs 15,000, and most health insurance policies do not cover sleep disorders. 

Dr Agrawal also emphasises the absence of government-led initiatives or widespread public awareness campaigns. “There are no specific government programs for OSA, and the facilities to diagnose it are limited. Very few hospitals provide comprehensive sleep disorder diagnostics, and the number of specialists — pulmonologists or neurologists focusing on sleep disorders,  is very small in the country,” he explains. 

What is the solution? 

The Indian Initiative on Obstructive Sleep Apnea Guidelines (INOSA) was launched in 2014 under the Department of Health Research, Ministry of Health and Family Welfare. It became India’s first national framework for the diagnosis and management of OSA. The guideline recommended that individuals suspected of OSA undergo supervised overnight polysomnography as the “gold standard” for evaluation. 

It further emphasised that Positive Airway Pressure (PAP) therapy should remain the mainstay of treatment, with oral appliances prescribed for those with mild to moderate symptoms or for patients unable to tolerate PAP. Surgical interventions, the guideline advised, should be reserved for cases where all other treatments fail or are not tolerated. 

Beyond clinical management, the INOSA initiative called for nationwide awareness campaigns, training programs for healthcare professionals, and the establishment of dedicated sleep laboratories across medical institutions.  

Dr Agrawal emphasises that managing obstructive sleep apnea begins with lifestyle modifications. He advises, “We start with lifestyle changes, the first being a nutritious diet. Weight loss is crucial, and maintaining proper sleep hygiene, going to bed early and waking up early also play a key role.” 

For patients with more severe OSA, he explains the role of therapy. “Next comes BiPAP or CPAP therapy, where the patient sleeps with a mask connected to a machine that delivers positive airway pressure. This keeps the airways open and reduces the severity of OSA,” he says. He adds that surgical intervention is reserved for cases where anatomical distortions in the palate or pharynx obstruct breathing, correcting the airway structure to improve symptoms.

Highlighting the early signs of OSA, he notes, “The earliest symptoms patients notice are fatigue and not feeling refreshed even after six to eight hours of sleep. Snoring is often pointed out by a bed partner or family member. Daytime tiredness, napping while reading or even driving, are danger signs that should not be ignored.” 

Dr Agrawal also describes the diagnostic process. “We look at factors like BMI over 30, short neck, and hypertension. If these are present, we recommend a sleep study to confirm the diagnosis,” he says. He stresses the importance of consulting a specialist. “If you experience symptoms like snoring, tiredness, or fatigue, the first step is to see a pulmonologist to get screened for OSA. A sleep study will determine if you actually have the condition.” 

He further underscores the preventive power of routine and lifestyle. “Following a good daily routine, sleeping early, doing 30 minutes of aerobic exercise, and avoiding fatty or high-salt foods can make a significant difference. Controlling chronic conditions like hypertension, diabetes, or hypothyroidism is also essential, as these can contribute to the development of OSA.” 

 

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