Sleep apnea means that
your breathing often is blocked or partly
blocked during sleep. The problem can be mild to severe, based on
how often your lungs don't get enough air. This may happen from 5 to
more than 50 times an hour.
This topic focuses on obstructive sleep apnea, which is the most common
type.
A less common type of apnea, called central sleep apnea,
can occur in people who have had a stroke, have heart failure, or have a brain
tumor or infection. Even though this topic isn't about central sleep apnea,
some of the treatments discussed here may also help treat it. Talk with your
doctor to find out more about central sleep apnea.
What causes obstructive sleep apnea?
Blocked or
narrowed airways in your nose, mouth, or throat can cause sleep apnea. Your
airway can become blocked when your throat muscles and tongue relax during
sleep.
Sleep apnea can also occur if you have large
tonsils or adenoids or a large
uvula. During the day, when you are awake and standing
up, these may not cause problems. But when you lie down at night, they can
press down on your airway, narrowing it and causing sleep apnea. Sleep apnea
can also occur if you have a problem with your jawbone.
In
children, the main cause of sleep apnea is large
tonsils or adenoids.
Sleep apnea is more likely to occur if you are
overweight, use certain medicines or alcohol before bed, or sleep on your
back.
What are the symptoms?
The main symptoms of sleep apnea that you may
notice are:
Not feeling rested after a night's
sleep.
Feeling sleepy during the day.
Waking up with a
headache.
Your bed partner may notice that while you sleep:
You stop breathing.
You often snore
loudly.
You gasp or choke.
You toss and turn.
Children who have sleep apnea:
Nearly always snore.
May
be hyperactive or have problems paying attention during the
day.
May be
restless during sleep and wake up often. They also may have problems
with bed-wetting.
But children may not seem very sleepy during the day (a key
symptom in adults). The only symptom of sleep apnea in some children may be
that they do not grow as quickly as most children their age.
Can sleep apnea cause other problems?
If you have
sleep apnea, you may not be sleeping as well as you could. And you may be more
likely to end up with serious problems such as:
Your doctor will probably examine you and ask about your past health. He
or she may also ask you or your sleep partner about your snoring and sleep
behavior and how tired you feel during the day.
Your doctor may
suggest a
sleep study. A sleep study usually takes place at a
sleep center, where you will spend the night. Sleep studies find out how often
you stop breathing or have too little air flowing into your lungs during sleep.
They also find out how much oxygen you have in your blood during sleep. You may
have blood tests and X-rays.
How is it treated?
You may be able to treat mild sleep apnea by
making changes in how you live and the way you sleep. For example:
Lose weight if you are
overweight.
Sleep on your side and not your back.
Avoid alcohol and medicines such as
sedatives before bed.
If lifestyle changes don't help sleep apnea, you
may be able to use an oral breathing device or other types of devices. These devices help keep your
airway open while you sleep.
Sleep apnea is often treated with a machine that helps you breathe
while you sleep. This treatment is called
continuous positive airway pressure, or CPAP (say
"SEE-pap"). Sometimes medicine that helps you stay awake during the day may be
used along with CPAP. If your tonsils, adenoids, uvula, or
other tissues are blocking your airway, your doctor may suggest surgery to open
your airway.
Obstructive sleep apnea usually occurs when the throat
muscles and tongue relax during sleep and partially or completely block the
airway. When you stop breathing or have reduced flow of air into your lungs
during sleep, the amount of oxygen in your blood decreases briefly.
Bone deformities, enlarged tissues
Obstructive sleep apnea can also occur if you have bone deformities or
enlarged tissues in your nose, mouth, or throat. For
example, you may have enlarged
tonsils. During the day when you are awake and
standing up, this may not cause problems. But when you lie down at night, the
tonsils can press down on your airway, narrowing it and causing sleep
apnea.
Other things that may
contribute to sleep apnea include:
Drinking alcohol, which affects the part of the
brain that controls breathing. This may relax the breathing muscles and cause a
narrowing of the airway and sleep apnea.
Obesity. Fat in
the neck area can press down on the tissues around the airways. This narrows
the airways and can cause sleep apnea. About 7 out of 10 people who have sleep apnea
are obese.1
Some medicines that are taken for conditions such as
allergies,
long-term pain,
insomnia, or
anxiety. These medicines,
such as narcotics, can also relax the muscles and tissues in
the throat, causing it to narrow.
Symptoms
With sleep apnea, there are symptoms that you may notice and symptoms that others may notice when you're asleep.
Waking with an unrefreshed feeling after sleep, having
problems with memory and concentration, feeling tired, and experiencing
personality changes.
Morning or night headaches. About half of all
people with sleep apnea report headaches.2
Heartburn or a sour taste in the mouth at
night.
Swelling of the legs.
Getting up during the night to urinate.
Sweating and chest pain while you are sleeping.
Symptoms others may notice include:
Episodes of not breathing (apnea), which may
occur as few as 5 times an hour (mild apnea) to more than 50 times an hour
(severe apnea). How many episodes you have determines
how severe your sleep apnea is.
Loud
snoring. Almost all people who have sleep apnea snore. But not all people who snore have sleep apnea.
Restless tossing and
turning during sleep.
Nighttime choking or gasping spells.
Symptoms in children
Children who have sleep apnea nearly always snore. But
they may not appear to be excessively sleepy during the day (a key symptom in
adults).
In children younger than 5, other symptoms include:
Mouth breathing.
Sweating.
Restlessness.
Waking up a
lot.
In children 5 years and older, other symptoms include:
Bed
wetting.
Doing poorly in school.
Not growing as quickly as they should for
their age. This may be the only symptom in some children. These children may also have behavior problems and a short attention
span.
In rare cases,
sleep apnea in children can cause
developmental delays and can cause failure
of the right side of the heart (cor pulmonale).
Obstructive
sleep apnea causes your airway to
narrow or close off, reducing or stopping breathing for short
periods during sleep.
If your breathing stops,
you may make grunting, gasping, or snorting sounds and restless body movements.
As breathing resumes, loud
snoring starts. This may happen many times during a
night.
The more often it happens, the more severe your sleep apnea is. Sleep apnea is called either mild, moderate, or severe.
When you stop breathing, the oxygen levels in your blood go
down and
carbon dioxide levels go up. This makes your heart and
blood vessels work harder and can affect your heart rate and
nervous system. That in turn may:
Lead to
other problems,
such as high blood pressure and
heart disease.
Make these other problems worse and harder to treat.
Family history. If other members of your family
have sleep apnea, you are more likely to have it than someone who doesn't have a family history of it.
Ethnicity. Blacks, Hispanics, and Pacific
Islanders have a greater risk of sleep apnea than whites. Blacks get
sleep apnea at a younger age than whites.1
Deformities of the spine. Deformities of the
spine, such as
scoliosis, may interfere with breathing and contribute
to sleep apnea.
Conditions that may cause head and face abnormalities. Conditions such as
Marfan's syndrome and
Down syndrome may result in abnormalities and increase the risk for sleep apnea.
Menopause. Recent studies show that sleep
apnea occurs more often in women who have been through
menopause than in women who have not.1 After menopause, women get sleep apnea at a rate similar to
men.2 Experts don't know why or how menopause
increases the risk of sleep apnea.
Things you may be able to change
Obesity. About 7 out of 10 people who have sleep apnea
are
obese.1 Obesity is the factor
most likely to lead to sleep apnea.
Neck circumference. People who are overweight may
have extra tissue around their neck, adding to their risk for sleep apnea. The
risk increases for a man whose neck measures more than 17 inches around and for
a woman whose neck measures more than 16 inches around.
Enlarged tissues of the nose, mouth, or throat.Enlarged tissues in the nose, mouth, or throat can
block your airway while you sleep, making sleep apnea
more likely. Surgery can sometimes correct the blockage and improve sleep
apnea.
Bone deformities. Bone deformities of the nose,
mouth, or throat can interfere with breathing, causing sleep apnea. Some people
who have sleep apnea have a small, receding jaw. Surgery can sometimes correct
these deformities and improve sleep apnea.
Use of alcohol or medicine. Drinking alcohol or
taking certain medicines before going to sleep can increase the risk for sleep
apnea. Medicines include sleeping pills and
sedatives.
Sleeping on your back and using pillows. Sleeping
on your back and using one or more pillows may make sleep apnea
worse.
Smoking. Smoking can increase your risk for sleep
apnea, because the nicotine in tobacco relaxes the muscles that keep the
airways open.
Poor sleep habits. For example, going to bed in different places may increase your risk for sleep apnea.
Disorders of the hormone (endocrine) system. Disorders that may increase your risk include hypothyroidism and
acromegaly.
When To Call a Doctor
Call your doctor if:
You or your bed partner snores loudly and
heavily and feels sleepy during the day.
You notice that your bed
partner stops breathing, gasps, or chokes during sleep.
You
sometimes fall asleep at inappropriate times, such as while you are talking or
eating.
Your child snores, has trouble breathing while sleeping,
sleeps restlessly, wakes up often, and is very sleepy during the day.
Watchful waiting
Watchful waiting is a wait-and-see approach. If
you get better on your own, you will not need treatment. If you get worse, you
and your doctor will decide what to do next. Watchful waiting may be right for
you if you snore but are not
excessively sleepy during the day.
Watchful waiting may not be right if you notice that your sleep
partner snores loudly and heavily, is restless during sleep, and is sleepy
during the day. If you think your sleep partner may have periods when
breathing stops, suggest that he or she talk with a doctor.
Who to see
Health professionals who can check people who have
symptoms of obstructive
sleep apnea include:
Your doctor will
examine you and ask you and possibly your sleep
partner some questions about your lifestyle, snoring, sleep behavior, and how tired
you feel during the day (this is called a
medical history).
Your doctor may ask you to complete
a questionnaire, such as the Epworth Sleepiness Scale. The answers to questions
in this questionnaire can help the doctor find out if you have sleep apnea. If
your doctor thinks that you may have sleep apnea, he or she may suggest sleep studies
or other tests.
Sleep studies
are a series of tests that record what happens to your body during sleep. The
most important test for sleep apnea is polysomnography. This test records
electrical activity of your brain, eye movement, muscle activity, heart rate,
breathing, airflow through your nose and mouth, and blood oxygen levels (saturation). Polysomnography is the only sure way to
find out whether you have sleep apnea.
To see how well your treatment is working, you may need sleep tests after treatment begins.
If your sleep apnea has not improved after initial
treatment, and if
enlarged tissues in your mouth and throat are causing
it, your doctor may do one or more tests before suggesting surgery to remove
the excess tissue. These tests may include:
CT scan of the head to look for an overly large tongue
and excessive soft tissue in the neck, as well as to locate the narrowest part
of your airway.
X-rays. A cephalometric X-ray is a type
of head X-ray that allows your doctor to see bone deformities of the skull.
This type of X-ray test may not be available in every hospital.
Treatment Overview
Treatment for obstructive sleep apnea may include:
Lifestyle changes, such as losing weight. For more information, see Home Treatment.
Your doctor will probably have you try lifestyle changes and CPAP first. Surgery might
be a first choice only if the sleep apnea is caused by a blockage that is
easily fixed.
Children have the same treatment options as adults. But
surgery (removing tonsils or adenoids) typically is the
first choice, because enlarged tonsils or adenoids cause most cases of sleep
apnea in children. If surgery isn't possible
or doesn't work, children are treated using CPAP.
Prevention
You can help prevent obstructive
sleep apnea if you:
Don't use alcohol and medicines, such as
sleeping pills and
sedatives, before bed. These can relax your throat
muscles and slow your breathing.
Eat sensibly, exercise, and stay at a healthy weight.
Quit smoking. The nicotine in tobacco relaxes the
muscles that keep the airways open. If you don't smoke, those muscles are less
likely to collapse at night and narrow the airways.
Home Treatment
Home treatment for obstructive
sleep apnea includes lifestyle changes and changing some sleeping habits.
Lifestyle changes
Lose weight. Some studies have shown that losing weight reduces the number
of times an hour that you stop breathing (apnea) or that the airflow to your
lungs is reduced (hypopnea).5, 6 Experts agree that
weight loss should be part of managing sleep apnea.6 If you are overweight and have sleep apnea, nutritional counseling may help.
Limit the use of alcohol and medicine. Drinking
excessive amounts of alcohol or taking certain medicines, especially sleeping
pills or
sedatives, before sleep may make symptoms worse.
Get plenty of sleep. Apnea episodes may be more
frequent when you have not had enough sleep.
Quit smoking. The
nicotine in tobacco relaxes the muscles that keep the airways open. If you
don't smoke, those muscles are less likely to collapse at night and narrow the
airways.
Promptly treat breathing problems, such as a
stuffy nose caused by a cold or allergies.
Sleeping habit changes
Sleep on your side. Try this: Sew a pocket in
the middle of the back of your pajama top, put a tennis ball into the pocket,
and stitch it shut. This will help keep you from sleeping on your back.
Sleeping on your side may eliminate mild sleep apnea.7
Raise the head of your bed4 in. (10 cm) to
6 in. (15 cm) by putting bricks
under the legs of the bed. You can also use a special pillow (called a cervical
pillow) when you sleep. A cervical pillow can help your head stay in a position
that reduces sleep apnea. Using regular pillows to raise your head and upper
body won't work.
Use your CPAP machine every night. If you are using a
continuous positive airway pressure (CPAP) machine to
help you breathe, use it every night. If you don't use it all night, every
night, your symptoms will return right away. For more information about CPAP, see Other Treatment.
Some people use nasal
strips, which widen the nostrils and improve airflow. Although these strips may
decrease snoring, they cannot treat sleep apnea.
Medications
Doctors typically don't suggest using medicines to treat obstructive
sleep apnea.
But medicine can help reduce
daytime sleepiness when
continuous positive airway pressure (CPAP) is reducing
the number of times you stop breathing at night but you still feel sleepy during the day.8, 9
Tonsillectomy and/or adenoidectomy. This is often the first treatment option for children, because
enlarged tonsils and adenoids are usually the cause of their sleep
apnea.
Tracheostomy. Although this is effective at treating sleep apnea, it is done only when other treatments have failed or when treatment is needed right away.
Maxillo-mandibular advancement (MMA). This moves the upper and lower jaw forward to increase the size of the airway.
Radiofrequency ablation (RFA). This reduces the size of the tongue and other tissues that may be blocking airflow to the lungs.
Palatal implants. These are small plastic rods that are implanted in the soft palate. They make the soft palate stiffer to keep the tissue from blocking the airway.
Laser-assisted uvulopalatoplasty uses a laser to
perform surgery. It is sometimes used to treat mild to moderate sleep apnea,
although not all people benefit. This surgery is not recommended by the American
Academy of Sleep Medicine to treat sleep apnea.11, 12
Other Treatment
Continuous positive airway pressure (CPAP)
CPAP is nearly always the first medical treatment for sleep
apnea. With CPAP, you use a breathing device that
prevents your airways from closing during sleep.
Research shows that:
CPAP decreases daytime sleepiness, especially in
people who have moderate to severe sleep apnea.13, 6 If you still feel sleepy during the day
while using CPAP at night, tell your doctor.
CPAP can lower daytime and nighttime blood pressure.14
It may
take time for you to be comfortable using CPAP. You may find that you want
to take off the mask, or you may find it hard to sleep. If
you can't get used to CPAP, talk to your doctor. You might be able to try another
type of mask or make other adjustments.
Some
CPAP devices automatically adjust air pressure or use different air pressures
when you breathe in or out. They are easier and more comfortable for some
people to use.
If you use CPAP to treat sleep apnea, you need to use it every night. If you don't use it, your symptoms will return right away.
If CPAP isn't working, you may need
another
sleep study to find out whether your CPAP machine
needs to be adjusted. You may also need to think about surgery.
Oral breathing devices
Oral breathing devices reposition your tongue
and jaw during sleep, which opens up your airways. They may be used for people who have mild to moderate sleep apnea. They may also be used for people with severe sleep apnea who try CPAP but find out that it does not work for them.
Other devices
The U.S. Food and Drug Administration has approved nasal disks for treating sleep apnea and snoring. The disks attach to the outside of your nose. One disk is attached over each nostril. A valve positioned over the nostril makes it harder to breathe out, which causes a little back-pressure in the airways. This back-pressure may help keep the airways open during sleep.
Other Places To Get Help
Organizations
National Institute of Neurological Disorders and
Stroke
NIH Neurological Institute
P.O. Box 5801
Bethesda, MD 20824
Phone:
1-800-352-9424
Phone:
(301) 496-5751
TDD:
(301) 468-5981
Web Address:
www.ninds.nih.gov
The National Institute of Neurological Disorders and
Stroke (NINDS), a part of the National Institutes of Health, is the leading
U.S. federal government agency supporting research on brain and nervous system
disorders. It provides the public with educational materials and information
about these disorders.
American College of Physicians
190 North Independence Mall West
Philadelphia, PA 19106-1572
Phone:
1-800-523-1546 (215) 351-2600
Web Address:
www.acponline.org/patients_families
The American College of Physicians (ACP) is
a national organization of internists. Doctors of internal medicine focus on
adult medicine and have had special study and training focusing on the
prevention and treatment of adult diseases. The ACP provides information for
patients and families on the organization's website, including information on
diseases and conditions, end-of-life care, women's issues, and immunizations.
The site also offers video news stories, health tips, special reports, and a
link to the ACP diabetes webpage.
American Sleep Apnea Association
(ASAA)
1424 K Street NW
Suite 302
Washington, DC 20005
Phone:
(202) 293-3650
Fax:
(202) 293-3656
Email:
asaa@sleepapnea.org
Web Address:
www.sleepapnea.org
The American Sleep Apnea Association provides education and support
for people who have sleep apnea.
National Heart, Lung, and Blood Institute
(NHLBI)
P.O. Box 30105
Bethesda, MD 20824-0105
Phone:
(301) 592-8573
Fax:
(240) 629-3246
TDD:
(240) 629-3255
Email:
nhlbiinfo@nhlbi.nih.gov
Web Address:
www.nhlbi.nih.gov
The U.S. National Heart, Lung, and Blood Institute
(NHLBI) information center offers information and publications about preventing
and treating:
Diseases affecting the heart and circulation, such as heart
attacks, high cholesterol, high blood pressure, peripheral artery disease, and
heart problems present at birth (congenital heart diseases).
Diseases that affect the lungs, such as asthma, chronic
obstructive pulmonary disease (COPD), emphysema, sleep apnea, and
pneumonia.
Diseases that affect the blood, such as anemia,
hemochromatosis, hemophilia, thalassemia, and von Willebrand disease.
National Sleep Foundation
1010 North Glebe Road
Suite 310
Arlington, VA 22201
Phone:
(703) 243-1697
Email:
nsf@sleepfoundation.org
Web Address:
www.sleepfoundation.org
The National Sleep Foundation, an independent nonprofit
organization, can provide you with brochures on sleep disorders and a list of
accredited sleep disorder clinics.
Malhotra A, White DP (2002). Obstructive sleep apnea.
Lancet, 360(9328): 237–245.
Guilleminault C, Abad VC (2004). Obstructive sleep
apnea syndromes. Medical Clinics of North America,
88(3): 611–630.
Arzt M, et al. (2005). Association of sleep-disordered
breathing and the occurrence of stroke. American Journal of Respiratory and Clinical Care Medicine, 172(11): 1447–1451.
American Academy of Pediatrics (2002). Clinical
practice guideline: Diagnosis and management of childhood obstructive sleep
apnea. Pediatrics, 109(4): 704–712.
Johansson K, et al. (2009). Effect of a very low energy diet on moderate and severe obstructive sleep apnoea in obese men: A randomised controlled trial. BMJ. Published online December 3, 2009 (doi:10.1136/bmj.b4609).
Hensley M, Ray C (2008). Sleep apnoea, search date May
2008. Online version of BMJ Clinical Evidence: http://www.clinicalevidence.com.
Silverberg DS, et al. (2002). Treating obstructive
sleep apnea improves essential hypertension and quality of life.
American Family Physician, 65(2): 229–236.
Schwartz JRL, et al. (2003). Modafinil as adjunct
therapy for daytime sleepiness in obstructive sleep apnea: A 12-week,
open-label study. Chest, 124(6): 2192–2199.
Hirshkowitz M, et al. (2007). Adjunct armodafinil
improves wakefulness and memory in obstructive sleep apnea/hypopnea syndrome.
Respiratory Medicine, 101(3): 616–627.
Buchwald H, et al. (2004). Bariatric surgery: A
systematic review and meta-analysis. JAMA, 292(14):
1724–1737.
Aurora RN, et al. (2010). Practice parameters for the surgical modifications of the upper airway for obstructive sleep apnea in adults. Sleep, 33(10): 1408–1413.
Littner M, et al. (2001). Practice parameters for the
use of laser-assisted uvulopalatoplasty: An update for 2000. Sleep, 24(5): 603–619.
Giles TL, et al. (2006). Continuous positive
airways pressure for obstructive sleep apnoea in adults. Cochrane Database of Systematic Reviews
(3).
Norman D, et al. (2006). Effects of continuous
positive airway pressure versus supplemental oxygen on 24-hour ambulatory blood
pressure. Hypertension, 47(5): 840–845.
Other Works Consulted
Collop NA, et al. (2007). Clinical
guidelines for the use of unattended portable monitors in the diagnosis of
obstructive sleep apnea in adult patients. Journal of Clinical Sleep Medicine, 3(7): 737–747.
Kushida CA, et al. (2006). Practice parameters for the
indications for polysomnography and related procedures: An update for 2005.
Sleep, 28(4): 499–521.
Kushida CA, et al. (2006). Practice parameters for the
treatment of snoring and obstructive sleep apnea with oral appliances: An
update for 2005. Sleep, 29(2): 240–243.
Kushida CA, et al. (2006). Practice parameters for the
use of continuous and bilevel positive airway pressure devices to treat adult
patients with sleep-related breathing disorders. Sleep,
29(3): 375–380.
Kushida CA, et al. (2008). Clinical guidelines for the manual titration of positive airway
pressure in patients with obstructive sleep apnea. Journal of Clinical Sleep Medicine, 4(2): 151–171.
Marcus CL, et al. (2012). Diagnosis and Management of Childhood Obstructive Sleep Apnea Syndrome, Pediatrics, 130(3): e714–e755.
Morgenthaler TI, et al. (2006). Practice parameters
for the medical therapy of obstructive sleep apnea. Sleep, 29(8): 1031–1035.
Credits
By
Healthwise Staff
Primary Medical Reviewer
Anne C. Poinier, MD - Internal Medicine
Specialist Medical Reviewer
Mark A. Rasmus, MD - Pulmonology, Critical Care Medicine, Sleep Medicine
Malhotra A, White DP (2002). Obstructive sleep apnea.
Lancet, 360(9328): 237–245.
Guilleminault C, Abad VC (2004). Obstructive sleep
apnea syndromes. Medical Clinics of North America,
88(3): 611–630.
Arzt M, et al. (2005). Association of sleep-disordered
breathing and the occurrence of stroke. American Journal of Respiratory and Clinical Care Medicine, 172(11): 1447–1451.
American Academy of Pediatrics (2002). Clinical
practice guideline: Diagnosis and management of childhood obstructive sleep
apnea. Pediatrics, 109(4): 704–712.
Johansson K, et al. (2009). Effect of a very low energy diet on moderate and severe obstructive sleep apnoea in obese men: A randomised controlled trial. BMJ. Published online December 3, 2009 (doi:10.1136/bmj.b4609).
Hensley M, Ray C (2008). Sleep apnoea, search date May
2008. Online version of BMJ Clinical Evidence: http://www.clinicalevidence.com.
Silverberg DS, et al. (2002). Treating obstructive
sleep apnea improves essential hypertension and quality of life.
American Family Physician, 65(2): 229–236.
Schwartz JRL, et al. (2003). Modafinil as adjunct
therapy for daytime sleepiness in obstructive sleep apnea: A 12-week,
open-label study. Chest, 124(6): 2192–2199.
Hirshkowitz M, et al. (2007). Adjunct armodafinil
improves wakefulness and memory in obstructive sleep apnea/hypopnea syndrome.
Respiratory Medicine, 101(3): 616–627.
Buchwald H, et al. (2004). Bariatric surgery: A
systematic review and meta-analysis. JAMA, 292(14):
1724–1737.
Aurora RN, et al. (2010). Practice parameters for the surgical modifications of the upper airway for obstructive sleep apnea in adults. Sleep, 33(10): 1408–1413.
Littner M, et al. (2001). Practice parameters for the
use of laser-assisted uvulopalatoplasty: An update for 2000. Sleep, 24(5): 603–619.
Giles TL, et al. (2006). Continuous positive
airways pressure for obstructive sleep apnoea in adults. Cochrane Database of Systematic Reviews
(3).
Norman D, et al. (2006). Effects of continuous
positive airway pressure versus supplemental oxygen on 24-hour ambulatory blood
pressure. Hypertension, 47(5): 840–845.
This information does not replace the advice of a doctor. Healthwise, Incorporated disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use.
How this information was developed to help you make better health decisions.
Print This Page
