Public health officials pin sleep apnea as serious a public health hazard as smoking!

Sleep Disorders Affect Cardiovascular Health

Public health advocates believe obstructive sleep apnea (OSA) is as severe a public health hazard as smoking. The National Commission on Sleep Disorders Research estimated that sleep apnea is responsible for 38,000 cardiovascular deaths yearly, with an associated 42 million dollars spent on related hospitalizations.

Additionally, according to the Journal of Clinical Sleep Medicine, obstructive sleep apnea (OSA) may be more prevalent than asthma and adult diabetes, affecting more than 18 million Americans. Although this is an older study, it gives clinicians valuable information to treat their patients effectively, thus increasing their quality of life.

How sleep apnea affects the heart:

Obstructive sleep apnea increases the risk of heart failure by 140%, the risk of stroke by 60%, and the risk of coronary heart disease by 30%. Sleep apnea is a vital target for public health interventions aiming at reducing cardiovascular disease, which remains the leading cause of death among adults in developed countries.

Sleep apnea can have significant effects on the heart and cardiovascular system. Sleep apnea is a sleep disorder characterized by pauses in breathing or shallow breaths during sleep. There are two main types of sleep apnea:

   1. Obstructive sleep apnea (OSA).

   2. Central sleep apnea (CSA)

OSA is the most common form caused by a physical blockage or upper airway obstruction during sleep. This obstruction usually occurs when the muscles at the back of the throat relax excessively, leading to airway collapse.

During an episode of OSA, breathing stops or becomes significantly reduced due to the blocked airway. The brain detects the lack of airflow and briefly arouses the individual from sleep to reopen the airway. This cycle repeats multiple times throughout the night.

Symptoms of OSA include:

1. Loud snoring
2. Choking or gasping during sleep
3. Restless sleep
4. Daytime sleepiness
5. Difficulty concentrating.

  6. Morning headaches.

  7. Problems with concentration and memory.

  8. Mood or behavior changes, including irritability.

  9. Anxiety and depression

The less common CSA (Central Sleep Apnea) occurs when the brain fails to send the appropriate signals to the muscles responsible for controlling breathing. Unlike OSA, there is no physical obstruction of the airway.

In CSA, the lack of breathing effort leads to pauses in breathing. The central nervous system fails to provide the necessary signals to the respiratory muscles, resulting in a temporary cessation of breathing.

Symptoms: CSA may be associated with frequent awakenings during the night, difficulty staying asleep, and more noticeable breathing pauses than OSA. Individuals with CSA may not exhibit the same loud snoring commonly seen in OSA.

Regardless of which type of sleep apnea you have, you could be damaging your heart.

During apnea episodes (breathing pauses), the oxygen levels in the blood drop. Apnea leads to hypoxia, where the body and organs, including the heart, do not receive enough oxygen. The heart has to work harder to pump blood and maintain oxygen delivery to the rest of the body.

In addition to low oxygen levels, sleep apnea can cause an increase in carbon dioxide levels in the blood (hypercapnia). Elevated carbon dioxide levels can also place additional stress on the heart.

Sympathetic Nervous System Activation: Sleep apnea is associated with an over-activation of the sympathetic nervous system, which is responsible for the “fight or flight” response. This activation leads to increased heart rate, elevated blood pressure, and heightened levels of stress hormones such as adrenaline. Over time, this may contribute to hypertension (high blood pressure).

People with sleep apnea often experience intermittent episodes of high blood pressure during apnea events. Sleep apnea contributes to the development or exacerbation of hypertension, a significant risk factor for cardiovascular diseases.

Sleep apnea is associated with inflammation and dysfunction of the endothelium (the inner lining of blood vessels). These changes contribute to the development of atherosclerosis, a condition characterized by plaque buildup in the arteries, increasing the risk of heart disease.

Sleep apnea is linked to an increased risk of arrhythmias, including atrial fibrillation. The intermittent lack of oxygen and the stress on the cardiovascular system can disrupt the heart’s normal electrical conduction and rhythm.

The chronic strain on the heart and the increased workload contribute to the development or worsening of heart failure, a condition where the heart is unable to pump blood effectively.

It’s worth noting that effective sleep apnea treatment, such as continuous positive airway pressure (CPAP) therapy or lifestyle changes, can help mitigate cardiovascular risks. If you suspect you have sleep apnea or are experiencing symptoms, it is crucial to seek medical evaluation and appropriate management.

Treatment

• A Continuous Positive Airway Pressure (CPAP) machine delivers a continuous air stream to keep the airway open.

• Bi-level Positive Airway Pressure (BiPAP): Similar to CPAP, but with variable pressure levels for inhalation and exhalation.

• Adaptive Servo-Ventilation (ASV): A specialized device that adjusts airway pressure based on detected breathing patterns.

• Lifestyle Changes such as weight loss, positional therapy, and avoiding alcohol and sedatives before bedtime are recommended to manage both types of sleep apnea.

• A surgical procedure to open the airway where excess tissue in the throat is removed to widen the airway and allow air to move through the throat more easily.

If you suspect that you or someone else may have sleep apnea, it’s important to seek evaluation by a healthcare professional for a proper diagnosis and appropriate treatment. You may think you have sleep apnea if a sleep partner tells you they hear loud snoring or gasping at night.

When hypoxia(reduced oxygen) and hypercapnia (increased carbon dioxide) trigger an inflammatory response, a cascading effect leads to downstream consequences, including hypertension, diabetes, and dyslipidemia, all of which represent significant risk factors for cardiovascular morbidity.

Nobody wants to be tethered to a machine with a mask over their face all night. However, the use of CPAP or bilevel PAP therapy has mitigating positive benefits in that it is very effective in improving the heart’s pumping ability, lowers blood pressure, reduces sympathetic activity, has significant effects on lowering lipid levels, improves quality of life, and thus reduces your overall risk of dying from heart disease. When weighing the risks to disadvantages, it’s a no-brainer unless you like to gamble.

The Journal of Clinical Sleep Medicine. Obstructive Sleep Apnea and Cardiovascular Disease. Published June 15, 2008. Accessed, January 4, 2024.