Lifestyle+ — 27

Before leaving sleep, I would be remiss not to highlight sleep apnea, a common disruption of sleep that affects 34 percent of men and 17 percent of women in the United States. The most common symptom is excessive daytime sleepiness, but even that is not reported in more than half of people affected. Other symptoms include loud snoring, episodes during sleep when you stop breathing as reported by another person, gasping for air during sleep, and difficulty staying asleep. When suspected, the diagnosis can be made with a home sleep apnea testing with about 80 percent sensitivity and specificity, preempting a formal sleep lab study. In my experience, avoidance of such formal studies is desirable. They are nonphysiologic and expensive, and it is rare to see people get anything but abnormal results. For individuals who are symptomatic, multiple interventions ranging from weight loss and exercise to oral appliances that hold the jaw forward, to positive airway pressure devices, to surgery, have been shown to be effective. Since sleep apnea is associated with a twofold or greater risk of cardiovascular and metabolic diseases, its diagnosis and management in symptomatic individuals is of obvious importance.

ENVIRONMENTAL TOXINS

The health dangers of air pollution and other environmental toxins have recently become far more obvious, too. The Institute for Health Metrics concluded that “particulate matter air pollution was the leading contributor to the global disease burden.” Even short-term exposure to inhalable particulate matter (PM) of 10 μm or less (PM10) and fine (less than 2.5 μm) particulate matter (PM2.5) is associated with increased all-cause, cardiovascular, and respiratory mortality, with each PM type exhibiting independent association with these outcomes.. About one million deaths globally per year are attributable to short-term fine particulate matter exposure. The supralinear relationship between fine particulate air pollution and mortality means there is a steep slope of increased risk even at low exposures. No safe threshold has been identified for chronic effect of PM2.5 on cardiovascular health. An estimated 20 percent of type 2 diabetes is related to chronic exposure of fine particulate matter (fig. 3.11). The risks for PM2.5, nitrogen dioxide, and ozone have been documented to exist at levels that are below current national air quality standards. Cognitive decline, a reduced immune response to COVID-19 vaccination, and increased blood pressure from rush-hour traffic have also been associated with air pollution. The mechanisms for these multiorgan system harms include body-wide inflammation, compromised immune function, increased oxidative stress, autonomic nervous system dysfunction, and pro-clotting effects (fig. 3.11). Rather than air pollution’s PM2.5 induction of genomic mutations being the primary driver of lung cancer air pollution, activating immune cells and the inflammation they trigger appears to play a pivotal role for increasing the risk of lung cancer. Outdoor pollution, with PMs and ozone, was estimated to account for about 6 percent of global mortality, now over 8 million annual premature deaths, more than 80 percent of which could be addressed by phasing out fossil fuels. About 130 million Americans live in places with failing grades for unhealthy levels of ozone or particulate matter pollution, and that number has been increasing rapidly. The climate crisis, with new peaks in land and ocean surface temperatures and widespread wildfires, with synergistic hazard of extreme heat and wildfire smoke, is unquestionably making matters worse.