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The majority of what we know about sleep apnea comes from research done in the past decade. One fact that has become evident is that there is now a clear link between sleep apnea and cardiovascular problems. It’s possible that the constant fluctuation in blood oxygen levels caused by sleep apnea may contribute to arterial inflammation, blood flow obstruction, insulin resistance, and, increased hypertension and cardiovascular-related events. |
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A person with severe sleep apnea can momentarily stop breathing hundreds of times a night. These pauses in breathing can cause drastic changes in oxygen levels, putting an enormous strain on the heart that can lead to an increase in heart rate and risk for vascular disease. When left untreated, sleep apnea can have life-threatening cardiovascular consequences by causing high blood pressure, abnormal heart rhythms (arrhythmias), and increased risk of heart attack and stroke. Sleep experts consider sleep apnea to be as great a risk factor for cardiovascular disease as cholesterol, smoking, hypertension, and diabetes. Sleep apnea can also contribute to memory problems and problems at work and automobile/truck-related accidents due to fatigue. Researchers have also linked sleep apnea to erectile dysfunction and obesity, triggered in great part by the disturbed sleep states caused by sleep apnea. |
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A study in the medical journal, The Lancet, reported that the risk of a cardiovascular event was three times higher in men with severe apnea. A study in the New England Journal of Medicine noted that sudden cardiac death in people with sleep apnea peaks between midnight and 6 A.M., unlike the general population, where the risk of death sinks to its lowest point during sleeping hours. Sleep apnea is quite common, affecting an estimated 45 million Americans. About 4% of middle-aged men and 2% of middle-aged women have the condition, according to the National Heart, Lung, and Blood Institute. |
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Even with such a high prevalence, and even though sleep apnea has such negative effects on health, this ailment is grossly underdiagnosed. However, it is easily detected with an at-home testing device like WatchPAT or in a sleep laboratory, and there are effective treatments for it. How long sleep apnea lasts depends on it’s cause, as well as the effectiveness of the therapy used to treat it. For some people, losing weight, avoiding alcohol and sedatives is enough to lessen or eliminate sleep apnea. Typically, however, sleep apnea is a chronic condition that needs daily therapy. The following are questions most frequently asked by patients about sleep apnea:![]() ![]() Q. What is sleep apnea?
A. Derived from the Greek word for “lack of breath,” sleep apnea is a serious, potentially life-threatening sleep-related breathing disorder that is often linked with loud, heavy snorers. Sleep apnea can be the result of an abnormality in the respiratory pacemaker in the brain (central sleep apnea) or, more commonly, it may be triggered by an obstruction in the upper airway (obstructive sleep apnea), which decreases the amount of inhaled air, collapsing the tissue in the back of the throat, and disrupting sleep. An episode of partial airway closing is called a sleep hypopnea. Patients with OSA experience repetitive episodes of obstruction of the upper airway during sleep, lasting anywhere from 30 seconds up to two minutes. With no air flowing into the lungs, oxygen levels drop and carbon dioxide levels rise in the blood. The reduction in oxygen and increased carbon dioxide alert the brain to resume breathing and cause an arousal. Finally, the patient awakens with a jolt and resumes breathing, andquickly falls back to sleep—and resumes the loud snoring. Blood pressure spikes up during the arousal, sometimes by as much as 30 mm Hg systolic, the top number in your hypertension reading. As the person goes back to sleep, typically unaware of having awakened, the throat muscles relax once again, the airway closes, and the sleep apnea pattern is repeated again. And again. And again. These subsequent and frequent arousals, although necessary for breathing to restart, prevent the patient from getting enough restorative, deep sleep.![]() ![]() Q. How many people develop sleep apnea?
A. As many as 4% of American men, 2% of all women, 3% of children, and as many as 20% to 30% of adults older than 60 develop sleep apnea, making it as common as diabetes and asthma. The Greek philosopher Homer, who once described sleep as “the brother of death” might have said the same about apnea had he known that it quadruples the risk of heart attack and triples the risk of stroke.![]() ![]() Q. What are the symptoms of sleep apnea?
A. Sleep apnea has one major tip-off: Loud and harsh snoring interspersed with long pauses when breathing stops for extended periods. This is followed by a violent snort, gasp, or moan when the brain signals a need for more oxygen. It’s these constant disruptions throughout the night, with its reduced levels of oxygen in the blood and increased levels of adrenaline from the autonomic nervous system, that are thought to cause unnatural surges in blood pressure experienced by people with sleep apnea. |
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Not everyone who snores has sleep apnea, but almost everyone who has sleep apnea snores. Common symptoms of sleep apnea include: • Awakening due to gasping or choking • Restless sleep • Memory impairment • Morning headaches • Morning sore throat or dry mouth • Frequent awakening to urinate • Erectile dysfunction |
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Anything that makes you stop breathing—like sleep apnea—has to be considered dangerous. This ailment will not go away by itself and must be diagnosed and treated. If you think that you have sleep apnea, speak to your doctor about an at-home sleep apnea test with WatchPAT.![]() To Learn More About WatchPAT Click Here |
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![]() Q. What causes sleep apnea?
A. Sleep apnea is caused by abnormal closure of the airway during sleep. The cause of this may be multi-factorial. Sleep researchers used to think that sleep apnea occurred in obese patients due to their upper airway closing during sleep because of the fat that surrounded the airway, narrowing it and making it more collapsible. However, it’s much more complicated than that. While it is true that obesity is a major risk factor for sleep apnea, there are many obese people who don’t have sleep apnea, and there are also non-obese people who do have it. Clearly, sleep apnea is more than just upper airway closure related to obesity. Sleep experts are now looking into neuromuscular control issues as a possible cause.![]() ![]() Q. How does sleep apnea affect hypertension?
A. Sleep apnea results in periods of higher blood pressure, or hypertension, as the heart tries to counter the build-up of carbon dioxide by pumping harder. Increases in arterial pressures of 30 mm Hg or more are not uncommon. By contrast, adults who do not have sleep apnea will typically experience nighttime blood pressure drops of about 10%. A recent study reported that sleep apnea treatment with CPAP (continuous positive air pressure) resulted in an average reduction of 10 mm Hg systolic and 4.5 mm Hg diastolic blood pressure. In contrast, CPAP had no measurable effect on nocturnal blood pressure in study participants with hypertension who did not have sleep apnea. Recently, researchers at the University of Wisconsin Medical School established that sleep apnea is likely to be an important cause of hypertension. Results of their eight-year study involving more than 700 people were published in the New England Journal of Medicine. The researchers reported that even mild to moderate levels of sleep apnea produced a substantial risk of hypertension. They observed that the more severe the sleep apnea, the greater the likelihood of developing hypertension. In the study, 709 participants, all randomly selected, were monitored in an overnight stay in a special sleep laboratory at University of Wisconsin Hospital. Researchers measured the number of episodes of breathing pauses each participant had during sleep to determine the presence and severity of sleep apnea. Five to fifteen pauses per hour represented mild to moderate sleep apnea; 15 or more pauses indicated moderate to severe sleep apnea. Participant health was reassessed four years later and in some cases eight years later as well. The Wisconsin team statistically accounted for other factors related to hypertension—age, gender, weight, menopause, smoking, and alcohol use—but still found that sleep apnea played a significant and independent role in hypertension risk. • People with mild to moderate sleep apnea were twice as likely to become hypertensive. • People with moderate to severe sleep apnea were almost three times as likely to become hypertensive. These findings tell us that doctors should take seriously any symptoms or signs of sleep apnea in their patients.![]() |
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Q. What is the link between apnea and heart arrhythmias? A. Atrial fibrillation (AF), the most common arrhythmia (abnormal rhythm), is a rapid-fire beating of the heart’s upper chambers, called the atria, which then leads to an irregular and often rapid beating of the lower chambers, called the ventricles. While AF may cause bothersome symptoms for some, other people diagnosed with AF experience no symptoms whatsoever. Unlike ventricular arrhythmias—the rapid and controlled/uncontrolled beating that originates in the heart’s lower chambers (ventricles) that can cause sudden death—AF usually poses no immediate danger. However, for some older patients, and those with underlying heart disease, AF does present a risk for stroke if left untreated. While it’s not always possible—or even necessary—to restore the heart to normal rhythm, some physicians believe it’s logical to restore the normal tempo of a healthy heart. |
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Researchers taking part in the Sleep Heart Health Study reported that patients with severe sleep apnea are two to four times more likely to experience complex, abnormal heart rhythms while sleeping than individuals without the problem. The researchers reported that individuals with sleep-disordered breathing had four times the odds of atrial fibrillation and three times the odds of nonsustained ventricular tachycardia. Atrial fibrillation consists of very rapid contractions of the atria (the upper chambers of the heart), leading the ventricles (the lower chambers of the heart) to beat irregularly. This results in decreased heart output and potential for clot formation. Tachycardia is defined by abnormally rapid heartbeats—over 100 beats per minute in an adult. Similar findings were reported by researchers from St. Louis University who studied 134 patients with coronary heart disease who hadn’t been diagnosed with a sleep disorder. In the patients who had a type of an irregular heartbeat called ventricular premature contraction, more than 40% also had severe sleep apnea—and didn’t realize it. The real worry is that benign arrhythmia can be a harbinger of a much more serious—and lethal—heart rhythm disorder. While most people with the mild version of arrhythmia will be just fine, in some people it’s possible it can worsen during the night and lead to sudden death. The researchers reported that sleep apnea seemed to exacerbate ventricular premature contraction, especially during the dream stage, or REM, of sleep. That’s because there’s less oxygen being pumped through the body in REM than in other stages of sleep, and this can bring on arrhythmia. The brain is less alert, which is why people don’t simply wake up to solve the problem. Q. What effect does sleep apnea have on memory?A. Many people develop memory deficits due tosleep apnea and they will often complain of daily forgetfulness, losing their keys, forgetting phone numbers, or forgetting to complete daily tasks. The good news is that some patients with obstructive sleep apnea may improve their memory by using Continuous Positive Air Pressure, also known as CPAP. Special Report: CPAP and Memory Back to Top | Contact Us |
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Q. Is sleep apnea linked to depression? A. Depression is a very common ailment in this country and there’s a very strong link between the two ailments. People with sleep apnea often complain of fatigue, lack of energy and poor sleep, all of which are hallmarks of depression. However, sleep researchers don’t know if the depression is due to sleep deprivation, or if it’s a specific manifestation of the sleep apnea itself. What we do know is that when sleep apnea is effectively treated, the depression often gets better. |
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Q. How often does sleep apnea adversely affect marriages? A. Sleep researchers know that sleep apnea can cause problems in marriages. Loud snoring will certainly make it difficult for anyone to sleep, and this includes even the most loving and understanding of partners. Moreover, for many bed partners forced to sleep with someone who snores, it’s often a long and troubled sleep as they lay in bed listening to their partner’s long periods of not breathing, followed by the violent gasping and struggle for air. Using a CPAP device on a nightly basis is often an area of contention for some partners too, due to the fact that it’s often noisy and can disrupt a bed partner’s sleep. Case Study: OSA and Marriage |
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Q. If you haven’t had sleep apnea as a young adult, why does it suddenly show up when you’re 30, 40, or 50? A. That’s a complicated question with a complicated answer. With most people, it gets back to being overweight or obese. Leading sleep experts believe that if a person gains weight, that’s what leads to their sleep apnea. Seasonal allergies or sinus problems that people may not have had before can suddenly cause sleep apnea. For women, menopause seems to play a significant role in sleep apnea. It’s quite common for older menopausal women to develop some fat in their necks and that obstructs breathing. During the post-menopausal years, sleep apnea is almost as common for women as it is for men, perhaps due to both the increase in testosterone and the decrease in progesterone and estrogen that occur in menopause. |
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Q. What role does sleep apnea play in automobile and truck accidents? A. A large one, unfortunately. According to recent figures from the National Sleep Foundation, 36% of Americans admitted to falling asleep at the wheel. Daytime sleepiness could indicate that many of these drivers are suffering from sleep apnea. With so many people suffering from sleep apnea and the hundreds of breathing pauses during the night that disrupt their sleep and leave them exhausted the next day, it’s not surprising that so many people are susceptible to car and truck accidents while behind the wheel. |
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Sleep apnea is one of the major causes of driver fatigue and sleepiness and is thought to increase the risk of a car or truck accident by two-to seven-fold. And while a four-wheel vehicle can wreak a high level of damage when a driver falls asleep behind the wheel of a car or small truck, the havoc and fatalities jump exponentially when one of the 2.4 to 3.9 million licensed commercial truck drivers thought to have sleep apnea dozes off while driving an 18-wheeler.
OSA and Trucking Q. Does being overweight increase the chance of developing sleep apnea? A. Being overweight does increase the likelihood of obesity, which is a risk factor for sleep apnea. Do your best to keep your weight in a healthy range—a BMI of between 18.5 and 24.9. A BMI of 25 to 29.9 is considered overweight; obesity is aBMI of 30 or more. |
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If you would like to have your BMI automatically calculated, go to the government website www.nhlbisupport.com If your weight is creeping up, cut calories and develop good exercise habits. Q. How is sleep apnea diagnosed? A. If you snore, have daytime fatigue, and have hypertension, it’s worth querying your family physician about the possibility of sleep apnea. Obesity is a risk factor, even though sleep apnea can occur in people of ideal weight. In addition, a large neck size is associated with increased risk of apnea. Men with a neck size greater than 17 inches (women with neck sizes greater than 16 inches) are at risk. If, following questioning and a physical examination, your doctor suspects that you have sleep apnea, you will be offered WatchPAT, an at-home sleep apnea test, or you will be sentto a sleep specialist or an accredited sleep laboratory for a night of extensive specialized monitoring. The primary objective test for obstructive sleep apnea is a sleep study, known as polysomnography (PSG). |
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WatchPAT is an FDA-approved portable diagnostic device that uses the most innovative technology to ensure the accurate screening, detection, and follow-up of sleep apnea. Its ease of use is unparalleled in the marketplace and it is greatly complemented by the fact that WatchPAT testing is done in the comfort of your own bedroom, an environment that best reflects the pattern of your sleep habits. Thanks to WatchPAT’s automated data analysis, you don’t have to wait to get your diagnosis. Once you return the WatchPAT to your physician, you will receive an immediate detailed sleep report. This instantaneous report generation—compared to a lengthy wait in most hospital-based settings—allows you to initiate sleep apnea treatment the same day and without delay.
For more information about WatchPAT click here |
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Q. Do I have sleep apnea? A. You may, if you are overweight or obese or if you snore loudly. High blood pressure, decreased airway size, and a family history of apnea are also risk factors. Sleep apnea is a serious condition that requires prompt attention to avoid potentially life-threatening complications. The good news is that a host of effective therapies for sleep apnea—including lifestyle and medical—can control sleep apnea and help you avoid such potentially devastating complications as heart attack or stroke. Take the Sleep Disorder Questionnaire The following questionnaire is a self-administered screening tool consisting of five simple yes or no questions that was created by sleep expert, David P. White, M.D., Professor of Sleep Medicine at Harvard Medical School. This brief quiz helps you determine your chances of having a sleep-related medical issue and whether you need to seek medical advice. |
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Sleep Questionnaire Q. What is entailed with a hospital-based sleep study for sleep apnea? A. Based on your medical history and an office examination, your doctor may recommend overnight observation in a sleep laboratory to confirm their suspicion of sleep apnea. Typically, during an overnight sleep study (called a polysomnogram or PSG), electrodes are placed to record brain activity, eye movements, and muscle activity as you sleep. The sleep technician may place other sensors on your chest or near the nose to record your breathing patterns. Testing is usually performed in a private room beginning at your normal bedtime and you will be allowed to leave early the next morning. After your sleep data is analyzed, a detailedsleep report is sent to your family physician.![]() Q. What is the Apnea-Hypopnea Index? A. In severe sleep apnea cases, people are briefly awakened hundreds of times every night due to oxygen deprivation (imagine someone sitting at your bedside, tapping you on the shoulder every minute or so to awaken you), leading to poor sleep and extreme fatigue during the day. The number of these episodes per hour of sleep—as measured with an at-home WatchPAT sleep study or a sleep-laboratory study—is called the Apnea-Hypopnea index, or the AHI. This index specifically calculates sleep apnea severity based on the total number of complete cessations (apnea) and partial obstructions (hypopneas) of breathing per hour of sleep. Some patients have 50 or more episodes per hour; most sleep experts use a cutoff of 10 events or more per hour beforeconsidering treatment with a continuous positive airway pressure (CPAP) device or some other sleep apnea therapy. |
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