Apnea and Heart Disease, Stroke

Researchers Find Strong Links Between Apnea and Stroke

by William Park, MD

From Sleep Center News, Winter 2006

For years researchers have known of the correlations between severe apnea and coronary heart disease, heart failure, irregular heartbeat, and high blood pressure. Add to those conditions that individuals suffering prolonged severe obstructive sleep apnea (OSA) may be up to three to four times more likely to suffer stroke than those without OSA, according to researchers at the Yale Center for Sleep Medicine.

In OSA, a person’s airways narrow, or totally collapse, during sleep. While the individual stops taking in air, they continue to try to breathe.

The Yale researchers concluded that “after adjusting for age, sex, race, smoking status, alcohol-consumption status, body-mass index, and the presence or absence of diabetes mellitus, hyperlipidemia, atrial fibrillation, and hypertension, the OSA syndrome retained a statistically significant association with stroke.”

Some physicians describe the apnea-stroke correlation as a “two-way street”—OSA may cause stroke or stroke may cause OSA. The Yale study, reported in the November issue of the New England Journal of Medicine, does not negate the possibility that patients may also develop apnea post-stroke, rather it focuses on whether OSA leads to stroke—crucial information for physicians treating OSA patients to prevent more serious problems.

According to another recent study by the American Thoracic Society, one main reason OSA is believed to increase stroke risk is its link to high blood pressure, the most common stroke risk factor. Faced with oxygen deprivation—as happens during the several seconds apnea causes the sufferer to stop taking in air—the body becomes traumatized and prepares for physical duress, causing blood to clot more quickly. Since clots, which block the brain’s oxygen supply, are a cause of stroke, the American Thoracic Society is further studying whether anti-clotting treatments such as aspirin therapy may be useful for OSA sufferers at risk for stroke.

There are many treatments for OSA. Because apnea is linked with some lifestyle choices, quitting smoking, losing weight, and avoiding alcohol, sedatives, and muscle relaxants can help. Other options include special pillows that keep patients from sleeping on their backs and oral appliances that keep airways open. In more severe cases, a mask is worn connected to a machine that creates continuous positive airway pressure (or CPAP), forcing the soft tissue to remain open during sleep.

It is important to begin OSA treatment as soon as possible, because the longer a patient suffers from OSA, the higher the risk of developing long-term health problems, including stroke.

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Research Underscores Increased Sudden Death Risk With Obstructive Sleep Apnea

From Sleep Center News Fall, 2005

The summer issue of Sleep Center News highlighted the unfortunate death of NFL player Reggie White at age 43 from potential complications of obstructive sleep apnea. Research showed the risk of dying in your sleep from sleep apnea is low unless you have other severe heart or lung ailments.

“Day-Night Pattern of Sudden Death in Obstructive Sleep Apnea,” an article in the March 2005 New England Journal of Medicine, supports the link between sudden death and obstructive sleep apnea.

According to the study “persons with obstructive sleep apnea have a significantly increased risk of sudden death from cardiac causes during the sleeping hours.” The study’s authors reported that from midnight to 6 AM sudden death from cardiac causes occurred in 46 percent of people with obstructive sleep apnea, compared with 21 percent of people without obstructive sleep apnea.

“The risk of sudden death while sleeping probably doesn’t apply to all patients with sleep apnea, but rather those patients who already have cardiac risk factors, and as shown in the study, mainly those with the most severe sleep apnea” said William Park, MD, co-medical director of the Sleep Center at Valley.

“Obstructive sleep apnea syndrome is a highly treatable condition,” Dr. Park said. “Successful control of the syndrome has been shown to improve hypertension control, heart failure, diabetes control, and reduce cardiovascular risk. This study implies that control of sleep apnea may significantly reduce mortality from nocturnal sudden cardiac death as well.”

The American Academy of Sleep Medicine recommends patients with systolic or diastolic heart failure should have a polysomnogram, and those with coronary artery disease should be evaluated for sleep apnea.

For more information, call the Sleep Center at 425.656.5340.

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Risk of Death With Untreated Obstructive Sleep Apnea

by William Park, MD, Co-Medical Director, Sleep Center at Valley

From Sleep Center News, Spring 2005

The unfortunate death of NFL player Reggie White at age 43 earlier this year highlighted obstructive sleep apnea syndrome as a potentially fatal disease. The publicity surrounding the cause of White’s death served notice to those with sleep apnea who have delayed evaluation and treatment. At the Sleep Center, there has been an increase in the number of questions and concerns from patients and physicians about the risks of dying from untreated sleep apnea.

The risk of dying in your sleep from sleep apnea, a highly curable disease, is low unless you have other severe heart or lung ailments. Although sleep apnea apparently contributed to Reggie White’s death, he was also diagnosed with sarcoidosis. This disease can affect the lungs and heart, increasing the chance of serious problems with sleep apnea.

The greatest health consequences for those with untreated sleep apnea are increased risks of secondary health effects associated with the disease, such as high blood pressure, heart attack, arrhythmia, stroke, lung disease, and diabetes. These risks generally increase steadily over years of living with untreated sleep apnea.

Although the risk of death due to sleep apnea is low, it increases in patients who are also living with heart disease. It is estimated that heart disease patients who also have sleep apnea have 20 times the risk of heart attacks than those without it. Sleep apnea is thought to have played a role in the death of Jerry Garcia, who died in his sleep and reportedly suffered from both sleep apnea and heart disease.

Research shows treatment of sleep apnea leads to improved heart function in patients with congestive heart failure. Successfully treating sleep apnea reduces the risk of developing other medical conditions like diabetes and improves sleep quality, daytime mood, energy levels, alertness, and productivity.

For more information about diagnosing and treating obstructive sleep apnea or to refer your patients to the Sleep Center at Valley, call 425.656.5340.

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