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Sleep Apnea & Cardiovascular Disease

Tuesday, June 5, 2007


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Sleep Apnea & Cardiovascular Disease - Tuesday, June 5, 2007Sleep apnea is a common and potentially serious disorder. It is a condition in which there is interruption of normal breathing patterns while asleep. The pauses in breathing typically last 10-20 seconds or even longer. They can occur many times per hour (20-30 times or even more frequently). "Apnea" is a Greek word meaning "without breath."

There are two common forms of sleep apnea: obstructive and central. Obstructive sleep apnea is more frequent. In this condition, there is a blockage of airflow through the throat or nose while asleep. This form of sleep apnea is often the result of throat muscles that relax. Central sleep apnea is less common and occurs when the brain does not send appropriate signals to the muscles that control breathing.

Obstructive sleep apnea is twice as common in men as in women. It is 2 to 3 times more frequent in older than younger adults. Obstructive sleep apnea is more prevalent in overweight individuals. Over 60% of patients with this disease are obese. Most women that develop obstructive sleep apnea are postmenopausal.

With obstructive sleep apnea, the repeated episodes of upper airway obstruction during sleep result in reduced oxygen levels in the blood. Individuals with this condition are unable to enjoy the benefits of a good night's sleep, with its restorative properties. Obstructive sleep apnea is associated with excessive daytime sleepiness (hypersomnolence). This excessive daytime sleepiness is a result of disruption of the normal sleep patterns and repeated arousal from sleep. Patients can experience episodes of falling asleep while seated quietly or during activities that require little attention. It can lead to falling asleep while driving or waiting at a traffic light. Automobile accidents have been reported to occur 2 to 2.6 times more frequently among persons with obstructive sleep apnea than in the general population.

Snoring is a frequent symptom of obstructive sleep apnea. It is often noticed by the affected person's spouse or partner. Morning headaches are another sign of sleep apnea. The disordered sleep associated with this condition can lead to impaired ability to concentrate and memory loss. Sleep apnea is also associated with irritability, moodiness, and wetting the bed (nocturnal enuresis).

Sleep apnea also has the potential to cause severe cardiovascular complications. Obstructive sleep apnea is more common in those with hypertension, and hypertension is more common in those who have sleep apnea. Appropriate treatment of obstructive sleep apnea correlates with improvement in blood pressure in many patients. The interrupted sleep associated with sleep apnea gives rise to elevation of stress hormones in the body. This can cause blood vessels to constrict and lead to elevation of blood pressure. The effects can occur not only while asleep but during the waking hours of the day. Arrhythmias, or abnormal pattern of heart beating, are more prevalent in those with obstructive sleep apnea. Sleep apnea can be associated with delay in electrical conduction through the heart. Sudden death from arrhythmia is more common in those with obstructive sleep apnea than in the general population, and this condition is also a risk factor for stroke. Sleep apnea can lead to constriction of the blood vessels that supply the lungs and force the right side of the heart to work overtime.

There are surgeries that are available for selected patients with obstructive sleep apnea, but most patients will derive benefit from a treatment known as continuous positive airway pressure (CPAP), or a variation of this treatment called bi-level positive airway pressure (BiPAP). CPAP and BiPAP allow for a positive flow of air delivered from a blower unit through a tightly fitting nasal mask that is held in place by head straps. Both of these treatments protect against collapse of the upper airway while asleep. They are used for the entire sleep period every night. They can eliminate apnea episodes (pauses in breathing) in most cases, and they can help to lower blood pressure and reduce the chance of abnormal heart rhythms in those who have obstructive sleep apnea.

Sleep apnea can be diagnosed in a sleep center, where individuals are assessed with overnight observation - including evaluation of breathing patterns, electrical activity of the heart, brain activity, and eye movements while asleep.

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