How Sleep Apnea and Heart Problems Are Connected

Sleep apnea and heart problems are known to be connected.  The obstructive type (OSA) is a risk factor for cardiovascular disease according to a recent study conducted by researchers at Drexel University in Pennsylvania. 

The researchers pointed out that doctors should be suspicious that OSA is present and order testing when symptoms or risk factors are noticed.  The symptoms of OSA include snoring, daytime fatigue and difficulty concentrating.  The risk factors include obesity and being middle aged.  Males and postmenopausal females are most likely to suffer from OSA.

OSA has a negative effect on the cardiovascular system because as breathing stops, the oxygen levels in the bloodstream become lower.  In response to low blood oxygen levels, pulse rate and blood pressure increase. 

High blood pressure or hypertension is known to put a strain on the heart and increase a person’s risk of stroke.  People with OSA often have hypertension.

While most doctors suggest lifestyle changes to address the issue of obesity, the researchers pointed out that beginning OSA treatment immediately could reduce the risk of damage to the patient’s cardiovascular system.  It is possible to diagnose and begin treatment nearly simultaneously with a “split night” study. 

When the technician observes the patient having multiple periods of breathing cessation, he or she can wake the patient and begin using a CPAP (continuous positive air pressure) machine.  Fitting the mask and testing for the appropriate pressure can be done right away.

Since the connection between sleep apnea and heart problems has mainly to do with the low blood oxygen levels and resulting increase in blood pressure, restoring normal breathing could result in lower blood pressure, which should decrease the risk of damage to the circulatory system.

If use of a CPAP machine is undesirable or not well-tolerated by the patient, surgical options may be recommended for OSA.  Patients undergoing any kind of surgical treatment should be screened for OSA, as there is an increased risk of death during surgery and during the post-operative period. There may also be other surgical complications, having to do with the administration of anesthesia during surgery.  French researchers suggest the use of the “STOP-BANG” questionnaire by anesthesiologists at the preoperative visit to screen for OSA.

In a study conducted in Estonia, researchers reported that smoking and the use of alcohol combined with nasal obstruction, frequent upper respiratory infections and enlarged tonsils are accompanied by an increased risk of sleep apnea and heart problems. 

It is well known that smoking increases blood pressure and the risk of cardiovascular disease.  It is not so well known that smoking increases the risk of OSA due to the changes it causes in the muscles of the throat. 

The same is use of excessive alcohol consumption.  It is accompanied by an increased risk of cardiovascular diseases and causes changes in the muscles of the throat.  Excessive alcohol consumption is defined as more than two drinks per day for a man and more than one drink per day for a woman.

Alcohol use is dangerous for anyone with OSA, because it further relaxes the throat muscles and the tongue.  Because of that, even moderate drinking is usually discouraged in people who suffer from OSA.

Enlarged tonsils and or adenoids are commonly associated with snoring and OSA in children.  Since there is a connection between untreated sleep apnea and heart problems, it is important for children to be evaluated by an ear, nose and throat doctor. 

Removal of the tonsils and adenoids improves breathing in 60% of cases according to researchers in London.  The surgery also significantly reduces the damaging dips in blood oxygen levels.
In another study concerning the connection between sleep apnea and heart problems, researchers found that 51% of males with coronary heart failure also suffered from either OSA or CSA, central sleep apnea.  Most studies have focused primarily on OSA.  It is easier to make the connection between OSA and cardiovascular disease, because of the obesity link.

In CSA, there is no obstruction.  There is no link to obesity.  Only the brain or central nervous system is involved.  The brain does not respond appropriately to changes in blood gas levels.  It does not signal the body to breathe in.

Patients with CSA do not struggle to catch their breath.  They rarely snore.  But they are frequently awakened by the changes in pulse rate and the feeling of breathlessness.  The rise in blood pressure and increased stress on the cardiovascular system will still occur.  There should be no doubt that central sleep apnea and heart problems are connected.

There are fewer cases of CSA for researchers to study.  There has been some question about whether or not CPAP machines are effective for treating CSA.  At Cedars-Sinai Medical Center, BPAP therapy has been used to successfully treat CSA.

The BPAP devices do not constantly send out the same airflow.  The pressure changes in order to make exhalation easier.  There are even some new devices that sense the patients’ normal breathing patterns before falling asleep and respond to changes in those patterns. 

In addition to the connection between sleep apnea and heart problems, researchers have also noticed a connection between OSA and delirium.  Delirium is not usually listed as a complication caused by SAs.  Cedars-Sinai also reported successfully treating a patient with CSA and delirium through the use of BPAP,

Complications of SAs that are commonly listed include memory problems, mood swings, depression and impotence.  Not only is there are connection between sleep apnea and heart problems connected.  SAs are connected to many other conditions.

Children with an undiagnosed SA may be diagnosed with Attention deficit/hyperactivity disorder.  People with apneas are more likely to have acid reflux disease, which is more bothersome at night.  They are more likely to need to urinate during the night. 

In general, it is more difficult for these people to get the rest that they need.  Without adequate rest, the body simply cannot function optimally or even normally.  That is the thread that connects sleep apnea and heart problems, a simple lack of rest.