Sleep Apnea Increases Heart Disease Risk

Snoring is a common and probably most annoying symptom for many people suffering from sleep apnea and for anyone trying to sleep within 20 feet of them.     It may however be a warning signal for serious health problems festering in the heart.

In the most recent study made available by the American Heart Association (AHA) in Circulation: Journal of the AHA, July 2010, researchers concluded that “obstructive sleep apnea (OSA) is associated with an increased risk of incident heart failure in community-dwelling middle-aged and older men; its association with incident coronary heart disease in this sample is equivocal.”

Men and women, 1,927 and 2,495 respectively, at least 40 years old and heart healthy (no coronary heart disease or heart failure), at the time of the baseline polysomnography, were followed for 8 ½ years.  

Polysomnography, commonly referred to as a sleep study, is a multiple-component test that electronically transmits and records specific physical activities while you sleep. The recordings are analyzed by a qualified sleep specialist to determine whether or not you have sleep apnea or another type of sleep disorder.

Adjusting for multiple risk factors, OSA was discovered to be a significant predictor, 58% increased risk of heart failure and 68% increased risk of heart attack, surgical heart procedures such as coronary artery bypass grafting or coronary artery stent placement due to coronary heart disease death for men aged 40-70.  

OSA is measured by apnea-hypopnea index (AHI), the number of breathing interruptions causing oxygen depletion for at least 10 seconds per hour.  OSA causes patients to struggle to breath due to the collapse of their airway during sleep.   Thirty or more interruptions per hour are considered to be severe sleep apnea.

"The Sleep Heart Health Study is the first to demonstrate prospectively that sleep apnea is associated with an increased incidence of heart failure," said Daniel J. Gottlieb, M.D., M.P.H., lead study author and associate professor at Boston University's School of Medicine. "It's also the first large community-based study specifically designed to examine the association of sleep apnea with either coronary heart disease or heart failure. Previous work has focused more narrowly on patients receiving care at sleep clinics."

OSA is common, affecting 24 percent of adult men and 9 percent of adult women, said Gottlieb, Finding no link between OSA and heart problems in women, may be due to the fact that women are about half as likely as men to have sleep apnea which causing difficulty in detection of an apnea-heart disease link. “This is an area for further study”, Gotlieb who is also director of the Sleep Disorders Center at VA Boston Healthcare System, said, adding “OSA is common, affecting 24 percent of adult men and 9 percent of adult women.”

Common sleep apnea symptoms listed at WebMD include:

*Waking up with a very sore and/or dry throat
*Loud snoring
*Occasionally waking up with a choking or gasping sensation
*Sleepiness or lack of energy during the day
*Sleepiness while driving
*Morning headaches
*Restless sleep
*Forgetfulness, mood changes, and a decreased interest in sex
*Recurrent awakenings or insomnia

Behavioral modifications for mild sleep apnea include:

*Losing weight
*Avoiding alcohol and sleeping pills
*Changing sleep positions to promote regular breathing
*Stop smoking. Smoking can increase the swelling in the upper airway which may worsen both snoring and apnea.
*Avoid sleeping on your back

Minimally invasive office procedures which have been effective in treating snoring, such as the pillar palatal implant, somnoplasty, and injection snoreplasty are designed to reduce and stiffen the soft tissue of the soft palate.  It has not been determined however if these procedures are successful in treating sleep apnea.

More invasive options for treatment of severe OSA which should be discussed with your health care professional are Continuous Positive Airway Pressure (CPAP), Dental Devices and Nasal surgery, Uvulopalatopharyngoplasty (UPPP) or Mandibular maxillar advancement surgery.

Laura Lamp King