Sleep Apnea and Heart Disease

A very common cause of a poor night's sleep is obstructive sleep apnea (OSA). OSA is characterized by a disordered breathing pattern during sleep that results in a temporary cessation of respiration and repeated cycles of partial awakening. Patients often have symptoms of poor concentration, fatigue and somnolence during the day. A sign of OSA is severe snoring and significant restlessness during sleep. Not only can this make you feel lousy, but it has been shown to be dangerous for your heart.
It has been long understood that obese patients have a higher risk for OSA. Factors are body weight and a large neck size. The upper airway has excess tissue that reduces the effective airway size when lying flat on the back, causing obstruction of airflow. The brain senses low oxygen levels and actually decreases the drive to breathe.
Data is emerging that show patients with OSA are prone to a variety of heart disorders. Most recently an association was shown between nighttime heart attacks and OSA. In a recent study, 91 percent of patients who had heart attacks between 12 a.m. and 6 a.m. had OSA (1). Obesity and OSA were found to be independent predictors of developing the serious condition of arrhythmia atrial fibrillation (2). Another study of patients with a diagnosis of heart failure (CHF) who had OSA found twice the mortality when the sleep disorder was not treated (3). The stress on the heart from the low oxygen levels may explain some of these findings. Most patients with OSA have risk factors for cardiovascular disease, including hypertension, diabetes and high cholesterol, all associated with or made worse by obesity. Mortality has been confirmed to be three times greater in patients with OSA.
Conservative treatments for OSA include weight loss and the avoidance of drugs and alcohol. More selective therapy includes continuous positive airway pressure breathing, or C-pap. Severe cases may even require surgery to reduce the excess soft tissue in the airway. Patients with confirmed cardiac disease often require the most aggressive treatment or combination therapy to improve symptoms and reduce serious complications. If you find that you are experiencing these symptoms, or your mate confirms that you have significant snoring at night, discuss it with your doctor before it can affect your heart.

References
1. Kuniyoshi, Journal of the American College of Cardiology 2008; 52: 343-346.
2. Gami, A.S., Journal of the American College of Cardiology 2007; 49: 565-571.
3. Wang, Journal of the American College of Cardiology 2007; 49(15): 1632-3.