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Cardiac Death Risk Rises with Sleep Apnea

Breaking News - April 2005 - Week 1

(Apr 6, 2005)

Healthcare in  the News

-- Obstructive sleep apnea, characterized by short but frequent interruptions in breathing, may raise cardiac death risk in the small hours of the night, according to a study reported in theNew England Journal of Medicine (NEJM).

Picture of a man and a woman sleeping

According to theNational Institute of Neurological Disorders and Stroke (NINDS), sleep apnea is a common disorder in which breathing stops during sleep for 10 seconds or more, sometimes more than 300 times a night.

The hallmark of the disorder is excessive daytime sleepiness and compromised quality of life, including significant social and emotional problems.

There are two main types of sleep apnea, statesNINDS. "Obstructive sleep apnea" may represent cessation of breathing due to mechanical blockage of the airway. "Central sleep apnea" appears to be related to a malfunction of the brain's normal signal to breathe.

Results from Study Convincing

The study of 112 Minnesota residents who died suddenly from cardiac causes found people with obstructive sleep apnea were twice as likely to die between midnight and 6:00 a.m. than those without the condition.

That isa striking departure from the pattern of sudden death in the general population, which most often strikes in the hours right after awakening, says lead researcher Dr. Virend K. Somers, a professor of medicine and cardiology at the Mayo Clinic, in Rochester, Minn.

"We have always been curious about why cardiovascular deaths can occur in the early hours of the morning, when people are peacefully sleeping," Dr. Somers says. The study, published in the March 24 issue of theNEJM suggests that for people with sleep apnea, sleep can be far from a time of quiet rest.

Sleep apnea consists of frequent stoppages of breathing lasting about 10 seconds - not enough to shake someone awake permanently, but enough to deprive a person of rest and cause drowsiness and lethargy throughout the following day.

More than 17 percent of Americans are affected by sleep apnea, according to the researchers. Some cases are caused by problems with the brain center that controls sleep, but most are due to collapse and obstruction of the air passages.

Sleep apnea disturbs heart function in several ways, Somers said.

"If you hold your breath as long as you can, your blood oxygen levels drops to 90 percent of normal," he says. "In sleep apnea, it drops to 60 percent of normal."

"And it is not just the fact that the body is subjected to low levels of oxygen during the night," Dr Somers adds. "Sleep apnea tightens blood vessels and significantly raises blood pressure. With low levels of oxygen and high levels of carbon dioxide, several kinds of abnormal heart rhythms can develop during sleep apnea."

Unfortunately, the study does not provide any new way to manage the problem, Dr. Somers says.

"There is no clear message that is patient-oriented," he says. "It is one more brick in the wall about why we should be more aggressive in finding sleep apnea and treating it."

One simple treatment is to tell people to sleep on their side, not on their back. Another effective method is to attack the obesity that is a major cause of sleep apnea, Dr. Somers says, since weight reduction can often provide significant relief.

If ordinary dieting and exercise fail, some patients may want to consider bariatric surgery, which shrinks the stomach and reduces the body's ability to take in calories, he says.

Surgery to reduce obstruction of the respiratory tract usually is not effective, Dr. Somers notes: "Surgical treatment often results in a recurrence of apnea six months to a year later."

Some people are helped by CPAP - continuous positive airway pressure, in which air is forced into the body through a mask, he said, and "in really severe cases we can go to temporary measures such as tracheotomy," in which surgeons implant a breathing tube.

Experts Confirm Concern

The study "is part of a growing body of evidence that this disease called sleep apnea is deadly," says Dr. Steven H. Feinsilver, a member of the board of directors of theAmerican Sleep Apnea Association.

While the snorts and snoring caused by sleep apnea are unmistakable to anyone in the same room, people who sleep alone often don't realize they have the condition, Dr. Feinsilver adds.

"Most people with sleep apnea know only that they are sleepy during the day," he says. Treatment is necessary "not only because it improves sleep, but also because treatment helps people live longer," he said. "It is a major risk factor for heart disease and stroke, and we are just beginning to learn how dangerous it is."

Always consult your physician for more information.


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What Is Sleep Apnea?

Symptoms of sleep apnea may include restless sleep, loud, heavy snoring (often interrupted by silence and then gasps), falling asleep while driving and/or during the day (at work, watching TV, etc.), morning headaches, loss of energy, trouble concentrating, irritability, forgetfulness, mood or behavior changes, anxiety or depression, obesity, and decreased interest in sex.

Not all people with sleep apnea experience all of these symptoms and not everyone who has these symptoms has sleep apnea.

However, it is recommended that people who are experiencing even a few of these symptoms visit their physician for evaluation.

Prompt and proper diagnosis of sleep apnea is an important first step to treating the disorder.

Problems associated with untreated sleep apnea include hypertension, coronary artery disease, myocardial infarction, stroke, psychiatric problems, impotence, cognitive dysfunction, memory loss, and death.

For mild cases of obstructive sleep apnea, treatment often consists of using methods to avoid sleeping on one's back.

For people with significant nasal congestion, a decongestant therapy may be prescribed.

Patients with obstructive and central apnea should avoid central nervous system depressants such as alcoholic beverages, sedatives and narcotics. Weight loss and diet control are encouraged for overweight patients.

Many serious cases of obstructive sleep apnea can be relieved by a treatment called nasal continuous positive airway pressure (nasal CPAP).

Nasal CPAP uses a mask-like device and pump that work together to keep the airway open with air pressure during each inspiration. Surgery may benefit some patients by eliminating or reducing the narrowing of the airway due to anatomical defects.

Eliminating the obstruction usually reverses the commonly associated pulmonary and systemic hypertension and cardiac problems of obstructive apnea.

Untreated, sleep apnea can greatly affect daytime functioning. Sleep apnea sufferers have a tendency to fall asleep during the day, a potentially deadly consequence of the disorder.

Diagnosis of sleep apnea is not simple because there can be many different causes.

Primary care physicians, pulmonologists, neurologists, or other physicians with specialty training in sleep disorders may be involved in making a definitive diagnosis and initiating treatment.

Tests are available for evaluating a person for sleep apnea, including:

  • polysomnography- a test that records a variety of body functions during sleep, such as the electrical activity of the brain, eye movement, muscle activity, heart rate, respiratory effort, air flow, and blood oxygen levels.
  • Multiple Sleep Latency Test (MSLT)- a test that measures the speed of falling asleep. People without sleep problems usually take an average of 10 to 20 minutes to fall asleep.

Individuals who fall asleep in less than 5 minutes are likely to require some type of treatment for sleep disorders.

Diagnostic tests usually are performed in a sleep center, but new technology may allow some sleep studies to be conducted in the patient's home.

Always consult your physician for more information.

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