When people have heart attacks, they most often have them during the day, usually between 6 a.m. and noon. Doctors believe that is because for most people the morning is a high-stress time of day. When someone has a nighttime heart attack it signifies that something unusual has happened because it is a time when the heart should be at rest. Now in a recent report, obstructive sleep apnea is being linked to nighttime heart attacks.
For years, Dr. Virend Somers, a cardiologist from the Mayo Clinic, has suspected that sleep apnea is to blame for nighttime heart attacks and strokes. In fact, more than a decade ago Somers and his colleagues showed that obstructive sleep apnea has a powerful effect on the sympathetic nervous system, and causes a high increase in the flow of adrenaline, high blood pressure and a lack of oxygen.
His report last year in the Journal of the American College of Cardiology is based on years of study in which Somers and his colleagues studied 92 people hospitalized after heart attacks. The vast majority of those who suffered heart attacks at night had undiagnosed sleep apnea. “So, perhaps sleep apnea is acting as a trigger for night-time heart attacks.” Somers said.
Although not considered conclusive since it was not a controlled study, this is just another of example of several studies that have shown that sleep apnea and cardiac problems are linked. A number of years ago the largest study in this area showed thousands of people with sleep apnea who refused treatment had 2 to 4 times an increased risk of cardiac events. Somers’ study is different in that it makes the timing connection, allowing physicians to suspect sleep apnea when a nighttime heart attack occurs.
Sleep apnea is characterized by repeated pauses in breathing during sleep, and unless a spouse makes the individual aware that they gasp for breath when waking from an episode, often the sleep apnea sufferer isn’t aware of the problem. Daytime sleepiness and fatigue, which are common symptoms, are sometimes not connected in the sleep apnea sufferer’s mind so the disorder can go undiagnosed for years. Once it is diagnosed however, sometimes lifestyle modifications such as losing weight and quitting smoking can be beneficial and there are also devices available that successfully treat apnea by keeping the airways while the patient sleeps.
>> back to top
In a recent study conducted on golfers who were diagnosed with moderate to severe obstructive sleep apnea, those who received treatment through nasal positive airway pressure (NPAP) therapy not only improved their health, but their golf games, too. It’s long been known that sleep apnea can cause daytime sleepiness and cognitive impairment, but never has it been so clearly demonstrated than by watching the golfer’s scores improve through treatment.
The research findings were presented last fall at CHEST 2009, the scientific assembly of the American College of Chest Physicians, and the study was conducted by Marc L. Benton, MD, FCCP a of the Atlantic Sleep and Pulmonary Associates in Madison, NJ and Neil S. Friedman, RN, RPSGT of Morristown Memorial Hospital. With obstructive sleep apnea, breathing becomes periodically blocked during sleep. The NPAP treatment uses special nasal masks that push pressurized air into the windpipe to keep it open.
The research showed the impact of the NPAP treatment on the golf handicap index of a dozen players with obstructive sleep apnea. The treatment spanned three to five months, and after 20 rounds of golf, golfers in treatment demonstrated a significant drop in their average handicap, from 12.4 to 11. The study found the best golfers, often older in the group, had the best improvements in their scores, dropping from 9.2 to 6.3 in their average handicaps. Twelve golfers without obstructive sleep apnea and who did not receive NPAP treatment were used as comparison, and showed no changed in their scores. In addition to reduced handicaps, the NPAP-treated golfers had significant improvements in their levels of sleepiness.
“Any golfer knows, when your ability to think clearly or make good decisions is compromised, the likelihood of playing your best is greatly diminished. Through treatment with NPAP, we can improve many cognitive metrics, such as attention span, memory, decision-making abilities and frustration management, which may in turn, positively affect a person’s golf games,” said Benton.
The NPAP is only effective when used properly and regularly, and it is reported that of men that use the NPAP device, only 40% are compliant, blaming discomfort, inconvenience, cost, noise or embarrassment as reasons for skipping the therapy. “Providers typically attempt to maximize compliance with the therapy by promoting its medical benefits or warning patients of the risks involved in not being treated.” Untreated obstructive sleep apnea can lead to heart disorders, lung dysfunction, high blood pressure and stroke. However, in this study, patients had a compliance rate above 90%. “The possibility of improving one’s ability to play golf appears to have been a significant motivation to improve treatment compliance,” said Benton.
If the hope of improving golfer’s scores is a way to encourage them to seek help with their sleep apnea, we’re all for it.
>> back to top
In a new study out of Great Britain, researchers have uncovered a link between obstructive sleep apnea (OSA) and floppy eyelid syndrome (FES). The study finds the factors that are shared by the two syndromes, and it is believed will help doctors better diagnose and treat patients as it gives doctors the suggestion that they should look for OSA in a patient when they find FES, and vice-versa.
The study was led by Daniel G. Ezra, MD, MRCOphth, of Moorfields Eye Hospital, London, England and published in the April issue of Ophthalmology, the journal of the American Academy of Ophthalmology.
FES is characterized by rubbery-textured upper eyelids that may flip while a person is asleep to expose the whites of their eyes. The patient’s eyes then become dry and irritated and may develop a discharge. It is believed that since Obstructive Sleep Apnea may impair the central nervous system, during sleep a patient may not wake up normally when breathing slows down or stops, or when their eyelid is subjected to extreme stress. This, combined with the belief that OSA patients may often sleep on their side, is believed to cause repeated pressure on the eyelid, which could be contributing factors to Floppy Eye Syndrome.
Dr. Ezra stated that “About one-third of the FES patients in our study also had OSA. The significant association of the two disorders was evident even when we considered and controlled for patients’ body-mass index (BMI, an indicator of whether obesity was a factor). FES is often considered a disease of overweight, middle-aged men, but our study did not find a patient cluster based on age, gender or BMI,” he added.
If you would like to read more from the study, visit The American Academy of Opthomology.
To find out more about Obstructive Sleep Apnea, visit Eos Sleep’s section.
In yet what seems to be another reason for parents to get their children’s eating habits in check, a new study conducted by Italian researchers found that obese children were twice as likely to suffer from sleep apnea than their more fit counterparts. The researchers studied a range of children of different weights, from those that did not snore to those with occasional snoring and habitual snoring.
The study compared 627 children who did not snore with 44 children with habitual snoring, and 138 children who snored occasionally. Of those children, 64 were obese, 121 were overweight, and 624 were normal weight.
It was found that 12.5 percent of obese children snored, which was more than two times higher than commonly overweight children, and three times higher than normal-weight children. Those obese children were more than twice as likely to suffer from the more serious condition of sleep apnea.
Sleep apnea is characterized by loud snoring and periods of holding the breath. People who suffer from sleep apnea stop breathing dozens of times during sleep and may not breathe for as much as three fourths of the time that they’re sleeping. This can lead to severe health issues such as high blood pressure, heart arrhythmia, enlargement of the heart, stroke and long dysfunction.
Statistically, sleep apnea is as prevalent as adult-onset diabetes. During a sleep apnea event, the airway becomes obstructed during sleep. Unchecked, it can be dangerous because the heart is sensitive to oxygen levels in the blood.
The study was published in the May issue of the journal CHEST.
For more information about the symptoms of sleep apnea, visit Eos Sleep’s link to: Sleep Apnea section.
>> back to top
There is a simple (and free) technique that researchers from Brazil have studied, suggesting that exercising the throat muscles may improve severe obstructive sleep apnea symptoms. These throat exercises, derived from speech therapy, seem to work because they have a marked ability to strengthen and tone the muscles of the throat, even reducing the circumference of a patient’s neck.
Sleep apnea is a potentially life threatening sleep disorder that is caused when the muscles of the throat collapse during sleep. Obstructive sleep apnea (OSA) is the most common type of apnea and also the most serious because it causes the soft tissue in the palate, throat, or tongue to “obstruct” the flow of air as a person struggles to breathe while they are asleep. Apnea is particularly severe when there are more than twenty or thirty events per hour because it severely limits the amount of oxygen the person receives throughout the night. Carrying extra weight, especially around the throat area has been found to be a related cause of OSA.
According to an article last month in The New York Times, a study on the effects of specific throat exercises on obstructive sleep apnea patients was conducted by the Heart Institute’s Pulmonary Sleep Laboratory at the University of São Paulo Medical School in Brazil. Researchers split the OSA patients into two groups. One group was instructed to do simple breathing exercises every day, the other group was instructed to do 30 minutes of throat exercises a day, comparable to those that speech therapists employ. The motions included swallowing and chewing, sliding the tongue back and forth to front of the palate, and repeating particular vowel sounds quickly. This exercise technique may be an alternative for some patients to the most widely known treatment of sleep apnea today, the CPAP (Continuous Positive Airway Pressure) machine, which is attached to a mask the patient wears while asleep.
The researchers found that after three months, the group that only did the breathing exercises had almost no improvement, while those that performed the throat exercises reduced the severity of their sleep apnea by 39 percent. Although the patients’ body mass index remained consistent, also noted was that the exercises reduced the circumference of the subjects’ necks significantly. The study also stated they snored less and slept better, concluding that throat exercises “significantly reduce Obstructive Sleep Apnea severity and symptoms, and represent a promising treatment for moderate OSA.”
The report analysis can be found at PubMed.org. For more information about the available treatments of obstructive sleep apnea, including a throat exercise program, contact Eos Sleep. If you suspect you have sleep apnea, it is important to get the treatment you need.
>> back to top
Although home sleep apnea testing equipment has be utilized for a few years, it wasn’t until recent findings presented at the American Thoracic Society 2010 International Conference confirmed that used the home sleep test showed similar improvements in their obstructive sleep apnea (OSA) treatment as did patients who had their sleep testing performed in an overnight lab, making the idea of finding a diagnosis much more appealing to many patients.
Prior to the findings of this study, it was commonly thought that patients would have the most successful treatment if they stayed overnight in a lab, because they would be spending more time with a technician who provides education of OSA and the importance of its treatment, which would improve the patient’s compliance using the standard CPAP (continuous positive airway pressure) device of their treatment once at home. Since many patients complain about the discomfort of the CPAP, compliance is difficult for many.
However, as this study found, of 300 patients who randomly either underwent their sleep testing in the lab or at home, 185 of them completed three months of follow-up treatment. The results of their OSA improvements using CPAP treatment where similar regardless of whether they had their sleep testing done in the lab or in the home.
Eos Sleep now offers home sleep testing equipment to qualified patients, and has found similar results as this study with its own patients who either under go sleep testing at the center’s overnight lab or at home.
A home sleep test is used only to diagnose sleep apnea, and obstructive sleep apnea is the most common type, as well as the most serious. It is caused by an obstructed upper airway in which soft tissue of the palate, throat or tongue blocks the flow of air as a person struggles to breathe. Since OSA symptoms can lead to severe health conditions, it is very serious and important that patients receive expert medical care and guidance. There are other physical causes of snoring and apnea, and since home sleep tests only diagnose apnea, a patient should have a thorough physical exam first to see if the test is right for them or if a different line of treatment is necessary. Even if sleep apnea is suspected, there are other factors that may make a test in an overnight sleep lab necessary.
Visit Eos Sleep website for more information about the home sleep test. If you suspect that you have sleep apnea or if snoring is keeping you from getting a good night’s sleep, contact us today to schedule an appointment.
>> back to top
An on-going study taking place in Sweden has released preliminary findings that suggest that obstructive sleep apnea (OSA) may be an even stronger risk factor for coronary artery disease than diabetes, obesity, hypertension and even smoking.
At the European Respiratory Society 2010 Annual Congress last week, Swedish pulmonologist Yuksel Peker from the Skaraborg Hospital in Sweden presented his latest finding from the ongoing Randomized Intervention with CPAP in Coronary Artery Disease and Sleep Apnea (RICCADSA) trial.
Although the study is on-going, he acknowledged, he also stated “analyses of baseline demographics and comorbidity profiles continue to strongly support OSA as a risk factor for CAD.” The study was started in 2005 to analyze the impact of continuous positive airway pressure (CPAP) on patients who had undergone revascularization for CAD and who also had OSA. ”Not only is the prevalence of OSA ‘surprisingly high,’” Dr. Peker said, but “these patients do not always show typical symptoms such as sleepiness.“
OSA was found in 64% of those with CAD. Comparatively, 58% had hypertension, and 28% were obese, making OSA much more common that was before thought of as more “conventional” risk factors. In addition, CAD patients with OSA were older than those without, were more obese, we mostly male, and had higher incidents of hypertension, diabetes, and atrial fibrillation.
Dr. Peker looked at both OSA syndrome (or “sleepy OSA,” because of daytime sleepiness symptoms) and “non-sleepy OSA.” He found that the CAD risk increase was present with both types of OSA.
The good news seems to be that those CAD patients that were studied with OSA had better compliance to the CPAP treatment. Dr. Peker indicated, “if we ask the CAD patients to use CPAP so far, they appear motivated enough to follow treatment.” At this point there is no proof that CPAP treatment actually reduces the risk for cardiovascular disease, however Dr. Peker suggested that it should be thought of as a “secondary cardiovascular prevention method.” The final results of the study are due out in 2012.
European Respiratory Society (ERS) 2010 Annual Congress: Abstract 5374. Presented September 22, 2010.
>> back to top
The Veterans Administration announced that from 2008 to 2010, the number of veterans who receive benefits for sleep apnea increased by 60%, and that more than 20% of military veterans suffer from the sleeping disorder, compared to the estimate of 5% for those not in the military.
Although one of the main causes can be excess weight, the VA doctors suspect that repeat deployments to Iraq and Afghanistan are exposing the military service members to dust and smoke which are contributing to the increase in cases.
More than 63,000 veterans receive benefits for sleep apnea, which can cause daytime drowsiness, heart disease, and even strokes. The most common treatment is the continuous positive airway pressure (CPAP) mask. Although the Social Security Administration recognizes sleep apnea as a disability and pays benefits to those who can’t work, the VA says veterans can receive benefits and hold jobs.
The Department of Veterans Affairs is expected to spend approximately $500 million a year to treat veterans with sleep apnea, and it is expected to rise in the upcoming years. Considering that sleep apnea is linked to serious conditions such as heart disease, diabetes, hypertension, obesity, and daytime sleepiness, which can cause memory loss and decrease work productivity, it is critical that these veterans receive appropriate care.
>> back to top
According to a study in the October issue of the Archives of Otolaryngology — Head & Neck Surgery, there is a questionnaire available to help identify patients undergoing surgery to identify whether they have obstructive sleep apnea (OSA), and whether they are at a higher risk for post-operative complications of the heart and lungs.
The questionnaire was administered by a team led by Tajender S. Vasu, M.D., of the Thomas Jefferson University Hospital in Philadelphia to 135 patients who were about to undergo elective surgery. The study compared the number of patients with high and low OSA with those that had post-op complications using the questionnaire called the “STOP-BANG,” which is an acronym for identifiable signs of OSA: Snoring, Tiredness during the day, Observed apnea, high blood Pressure, Body mass index, Age, Neck circumference and Gender.
Of the 41.5% of patients that had high risk scores for OSA from the questionnaire, 19.6% had post-op complications, compared to 1.3% who had low OSA scores. The study was able to demonstrate that a high risk score for OSA on the STOP-BANG test is associated with post surgical complications, providing physicians with a means to identify those patients prior to their surgery.
>> back to top