When weekends worsen sleep apnea

The diagnosis of obstructive sleep apnea (OSA) is often based on a single night of polysomnographic recording, which is usually performed during the week. However, the severity of this disorder varies considerably from one night to the next, which could lead to underestimation in nearly 20% of cases. Researchers at Flinders University in Adelaide, Australia, wondered whether changes in rhythm specific to weekends—catch-up sleep, social jet lag, alcohol consumption, etc.—could aggravate OSA. They describe this phenomenon as “social apnea.”To answer this question, the team analyzed records from 70,052 adults from a global database collected between January 2020 and September 2023. Participants used a Food and Drug Administration (FDA)-approved under-mattress sleep sensor that can measure sleep duration and timing as well as the apnea-hypopnea index (AHI). The study included only individuals with an average AHI of at least five events per hour, with a minimum of four weekly recordings and 28 valid measurements per year.OSA intensifies on weekendsAccording to the authors, this approach made it possible to “assess, for the first time on a large scale, the impact of the day of the week on the severity of sleep apnea.” As lead author Lucía Pinilla (PhD) explained, “We were able to follow thousands of patients over several years, which gave us a unique perspective on the variability of OSA according to lifestyle habits.”The results, recently published in the American Journal of Respiratory and Critical Care Medicine, show a clear worsening on Saturdays: The odds of having moderate to severe OSA (AHI ≥ 15) were 18% higher than on Wednesdays (OR [odds ratio] = 1.18; 95% CI 1.18–1.19). The effect was more pronounced in men (OR = 1.21; 95% CI 1.20–1.21) than in women (OR = 1.09; 95% CI 1.08–1.10), and greater among those under 60 (OR = 1.24; 95% CI 1.24–1.25) than among older individuals (OR = 1.07; 95% CI 1.06–1.08).Irregular sleep patterns further reinforced this trend. Catching up on sleep for at least 45 minutes increased the odds by 47%, while “social jetlag” of one hour or more increased them by 38%. On average, the AHI rose by 6% on weekends, or about 0.8 additional events per hour.“Our findings indicate that seemingly harmless behaviours, such as going to bed later or sleeping more on weekends, can have a significant impact on the severity of OSA,” said Danny Eckert (PhD), director of the Adelaide Institute for Sleep Health and lead author of the study.These findings raise several issues for clinical practice. First, they remind us that polysomnography tests performed on a single night during the week may fail to detect clinically significant worsening. “This unaccounted-for variability may lead to misdiagnosis or misclassification of OSA severity,” the researchers warned.They also highlight the importance of consistent adherence to treatment. Eckert notes that, “Less regular use of CPAP [Continuous Positive Airway Pressure] on weekends may partly explain our results.” The researchers therefore recommend emphasizing to patients the need for daily use, including on Fridays, Saturdays and Sundays.Finally, the study suggests ways to prevent this. Maintaining regular sleep schedules, limiting alcohol consumption, and avoiding repeated shifts between weekdays and weekends could reduce the worsening of symptoms. "Our weekend behaviours, whether related to sleep or social habits, directly influence the severity of sleep apnea. This is a modifiable factor that patients and clinicians can act on," said Dr. Pinilla. Public health issueThe Quebec Lung Association estimates that one in 10 people suffer from OSA, making it as common as asthma, diabetes, and high blood pressure. However, 80% of people who suffer from it have not yet been diagnosed, even though this sleep disorder has significant cardiovascular, metabolic and neurocognitive impacts. Left untreated, it increases the risk of high blood pressure, diabetes, coronary heart disease, stroke and even car accidents.In this context, the identification of “social apnea” highlights a public health issue. “Even small variations in prevalence can have a major impact in terms of costs and quality of life,” concluded the Australian researchers. For clinicians, this means incorporating weekly sleep variability into patient assessment and followup in order to better prevent complications from an already widespread disease.

When weekends worsen sleep apnea

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