HYPERTENSION AND SLEEP APNEA:
EXPLORING THE CONNECTION FOR BETTER CARE
Every night, obstructive sleep apnea (OSA) causes more than 18 million Americans to stop breathing periodically during their sleep. Yet despite the presence of clear signs and symptoms - and despite seeing family physicians - some 80% to 90% of those with the disorder remain undiagnosed for an average of seven years. Clearly, there needs to be a greater awareness of both the prevalence of OSA and of the health issues it can present. For example, OSA and hypertension share so many physiologic, biochemical and hematologic characteristics that they often appear to be the same condition. In fact, about one-half of patients who have essential hypertension have OSA. The interrelationship of OSA and hypertension is still being studied, but it is already clear that successful treatment of the sleep disorder has a positive effect on blood pressure. When the standard treatment of continuous positive airway pressure is applied for apnea, for instance, daytime and nighttime blood pressure levels are greatly decreased.
TREATING SLEEP APNEA AND HYPERTENSION
When physicians routinely ask hypertensive patients about snoring, excessive daytime sleepiness and reports of witnessed apneic events, the number of apnea cases diagnosed increases by about eightfold. Of course, as apnea is treated, patients experience numerous benefits. Eliminating snoring and occurrences of apneic-hypopneic episodes dramatically improves quality of sleep and eliminates excessive daytime sleepiness. In addition, increased alertness reduces the likelihood that patients will be involved in motor vehicle accidents or work-related injuries. If you would like to discuss sleep apnea's relation to hypertension in further detail, or would like to come in for a sleep study, please don't hesitate to give us a call.
UNDERSTANDING THE LINK BETWEEN OBESITY AND SLEEP APNEA
Obstructive sleep apnea (OSA) is a disorder afflicting millions of Americans - which means that you have certainly seen a wealth of patients with complaints of fatigue, morning headaches, excessive daytime sleepiness, snoring and memory problems. OSA is a debilitating breathing disorder that has far-reaching effects on health. One of the major risk factors for OSA is obesity, as 70% of people with apnea are obese. Excess body weight has been hypothesized to affect breathing in numerous ways. The accumulation of fat on the sides of the upper airway causes it to narrow and become predisposed to closure - a risk that is particularly high in patients who have a large neck circumference and central obesity. Obesity may also alter upper airway structure or function, disturbing the relationship between respiratory drive and load compensation.
THE IMPACT OF WEIGHT LOSS ON SLEEP APNEA
A small decrease in overall weight - say 10%, according to several studies - is enough to reduce the severity of apnea symptoms. One of the largest studies of weight loss and apnea was the Wisconsin Sleep Cohort Study, which examined the association between weight change and apnea progression in 690 men and women. The study participants were evaluated twice at four-year intervals for sleep-disordered breathing. Relative to stable weight, a 10% weight gain predicted an approximate 32% increase in the apnea-hypopnea index (AHI), while a 10% weight loss predicted a 26% decrease in the AHI. A 10% increase in weight predicted a sixfold increase in the odds of developing moderate to severe sleep-disordered breathing. If you would like to discuss sleep apnea's relation to obesity in further detail, or would like to come in for a sleep study, please don't hesitate to give us a call.
UNDERSTANDING THE DANGERS THAT OBSTRUCTIVE SLEEP APNEA POSES TO THE CARDIOVASCULAR SYSTEM
Obstructive sleep apnea (OSA) has complications that extend beyond being able to get a good night's sleep. Some evidence suggests that it may also be an important contributor in the development of coronary heart disease, stroke, cardiac arrhythmia and congestive heart failure (CHF) because about one-half of all patients with these diseases have apnea. In fact, apnea is present in approximately 60% of patients with CHF. The impact of apnea on the heart can be grave, as sleep-related breathing disorders with repetitive episodes of asphyxia adversely affect heart function. Part of the reason for this is that high blood pressure is common in OSA, and sudden drops in blood oxygen levels that occur during apnea events increase blood pressure even further. They also strain the cardiovascular system, raising the risk of heart failure and stroke. If there is underlying heart disease, these repeated multiple episodes of low blood oxygen can lead to sudden death from a cardiac event.
TREATMENT APPROACHES
In addition to treating heart disease, physicians should treat any underlying sleep apnea in order to increase survival rates. A series of studies have suggested that using continuous positive airway pressure (CPAP) to treat central sleep apnea and Cheyne-Stokes respiration (CSR) in patients with chronic heart failure may also alleviate the heart disease and possibly lengthen survival. In CHF patients with OSA, chronic nightly CPAP treatment abolishes OSA and improves left ventricular (LV) ejection fraction. By alleviating OSA, CPAP reduces LV afterload and heart rate, unloads inspiratory muscles and improves arterial oxygenation during Stage II sleep. If you would like to discuss sleep apnea's relation to cardiovascular problems in further detail, or would like to come in for a sleep study, please don't hesitate to give us a call.
PEDIATRIC SLEEP DISORDERS AND THE NEED TO PUT THEM TO REST
Children can suffer from a whole host of sleep problems, everything from fear of the dark and the inability to fall asleep to parasomnias, narcolepsy, sleep apnea, circadian rhythm disorder and more. Oftentimes, pediatric sleep disorders require specialized care in order to help children achieve quality sleep, but many parents view these troubles as a normal part of growing up and simply downplay them. Sleep disorders must be considered in the context of age, as age influences the presentation and impact on the developing child or adolescent. For example, sleep-disordered breathing resulting in adult sleepiness can contribute to death in infants.
SLEEP DISORDERS AND BEHAVIORAL PROBLEMS
Children who are hyperactive or inattentive may have an underlying medical condition, one of which may be sleep- disordered breathing. One percent to three percent of schoolchildren in the U.S. suffer from obstructive sleep apnea syndrome (OSAS), symptoms of which include habitual snoring, snorting or gasping for air during sleep and daytime neurobehavioral problems. OSAS can occur in children of all ages, from neonates to adolescents. In 2002, researchers from several university-based sleep laboratories collected data from the parents of over 800 children and found "substantial associations" between sleep disorder symptoms and hyperactive and inattentive behavior. If you would like to discuss pediatric sleep disorders in further detail, or would like to come in for a sleep study, please don't hesitate to call us.
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