In this Issue:
- Message from the President
- What is Sleep Apnea?
- Sleep Apnea and Heart Disease
- Sleep Apnea Could Raise Obstetric Risks
Message from the President
A growing number of individuals today have sleep apnea, a serious sleep disorder. This newsletter discusses sleep apnea, its symptoms, and its associated health risks. Sleep apnea is considered a major risk factor in the metabolic syndrome, also known as insulin resistance syndrome. Other risk factors of the metabolic syndrome include: high blood pressure, elevated cholesterol, being overweight and Type 2 diabetes. Sleep apnea and its related risk factors increase one’s chances for heart disease, stroke and cardiovascular disease, so its early detection and treatment is extremely important in order to improve one’s health.
Sincerely,
Mary O’Sullivan
President
What is Sleep Apnea?
Sleep apnea is a serious condition described as brief interruptions in breathing during sleep. (Apnea means the absence of breath.) It is caused by relaxed throat muscles that sag and block the upper airway. This airway obstruction causes one to snort, jerk awake, gasp for air, then resume sleep until the whole process starts once again. The sleeper may not even be aware this is happening, because they are “sleeping” but their bed partner knows they have a sleep problem.
Breathing pauses almost always are accompanied by loud snoring although not everyone who snores has sleep apnea. The number of stop-breathing incidents normally ranges from 20 to 90 times per hour, and each one may last up to a minute or more. These stop-breathing incidents reduce oxygen levels in the body placing a strain on the heart and lungs. Because sleep is being constantly interrupted by gasps for breath, these poor sleepers don’t get the benefit of quality sleep, and as a result they are unusually sleepy most of the time. Other common symptoms are being overweight, poor concentration and memory and morning headaches.
Nearly 40% of our population has a mild form of sleep apnea and at least 24% of us have a dangerous level of this serious sleep disorder. In fact, people of all ages and both sexes can have sleep apnea, although men have it more often than women. Overweight people, especially men with a neck size greater than 17 inches, and women whose neck size is greater than 15 inches, are more likely to have sleep apnea, as well as those who have an irregularity in the nose, throat and other parts of the upper airway that impacts their breathing.
Individuals with sleep apnea incur twice the health care costs as those without it. An estimated 38,000 fatal heart attacks and strokes in the U.S. each year are due to sleep apnea.
Adapted from: “What You Need to Know About Sleep” Booklet, Quanta Dynamics, Inc., 2005.
Sleep Apnea and Heart Disease
What is the Connection Between Sleep Apnea and Heart Disease?
We know that people with cardiovascular problems such as high blood pressure, heart failure and stroke, have a high prevalence of sleep apnea. Whether sleep apnea actually causes heart disease is still unclear, but we do know that if you have sleep apnea today, the chance that you will develop hypertension in the future increases significantly. One of the problems in defining the relationship between sleep apnea and heart disease is that people with sleep apnea often have other co-existing diseases as well.
If we treat people with high blood pressure and sleep apnea, or heart failure and sleep apnea, the measures of blood pressure or heart failure are significantly improved. There is good evidence there is a cause-and-effect relationship between hypertension and sleep apnea.
Why Does Blood Pressure go up When Sleep is Disrupted by Sleep Apnea?
Blood pressure will go up because when you’re not breathing, the oxygen level in your body falls and excites receptors that alert the brain. In response, the brain sends signals through the nervous system and essentially tells the blood vessels to “tighten up” in order to increase the flow of oxygen to the heart and brain, because they have priority.
The problem is that things that go on at night tend to carry over in the daytime, even when the sleep apnea patient is awake. The low oxygen levels at night seem to trigger multiple mechanisms that persist during the daytime, even when the patient is breathing normally.
How Can CPAP Reduce the Cardiovascular Consequences of Sleep Apnea?
The available evidence tells us that when you treat people with sleep apnea using CPAP, (continuous airway pressure) their blood pressure is not only lower at night it’s also lower during the day. That’s a very good thing. Moreover, people with atrial fibrillation (a common type of irregular heart beat) with sleep apnea that is appropriately treated, have only a 40% chance of coming back for further treatment of their fibrillation. If their sleep apnea is untreated, the chance of a recurrence of atrial fibrillation goes up to 80%. The message to heart patients with sleep apnea is: With treatment of your sleep apnea, your chances of improvement are considerably better.
Adapted from article by Dr. Virend K Sommers, Professor of Internal Medicine at the Mayo Clinic, Rochester, MN,
for National Sleep Foundation, “Sleepmatters,” Summer, 2004.
Sleep Apnea Could Raise Obstetric Risks
Sleep apnea greatly increases the risk of diabetes and high blood pressure
during pregnancy, according to a U.S. study that looked at nationwide data
on millions of pregnancies in 2003. The findings were presented in May, 2007
at the American Thoracic Society’s International Meeting in San Francisco.
According to the research, 452 women out of a total of 4 million deliveries, had sleep apnea. Sixty-seven of almost 168,000 women with gestational diabetes had sleep apnea. Of the almost 201,000 women with pregnancy-induced high blood pressure, 166 had sleep apnea.
The researchers concluded that sleep apnea was associated with a twofold increase in the risk of gestational diabetes and a fourfold increase in the risk of pregnancy-induced high blood pressure.
“The repetitive decrease of oxygen that occurs during the night in someone with sleep apnea heightens the body’s ‘fight or flight’ state, which can raise blood pressure,” said Hatim Youssef of the Robert Wood Johnson Medical School at the University of Medicine and Dentistry of New Jersey. “The body also secretes more hormones such as cortisol and epinephrine, and the body responds by producing more glucose coupled with decreased sensitivity to insulin, which can lead to diabetes,” Youssef explained.
He noted that pregnancy can worsen sleep apnea, particularly during the third
trimester when weight gain is the greatest. “When a mother’s oxygen
drops at night, it may also affect the oxygen level of the fetus and we don’t
know what the long-term effects are,” Youssef stated. “That’s
why it’s particularly important for a pregnant woman with sleep apnea
to be treated with CPAP (continuous positive airway pressure) during her pregnancy.”
Adapted from: ScoutNews, LLC, The Canadian Press, 2007.
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