Obstructive sleep apnea (OSA), often referred to as simply sleep apnea, is a condition that has become more frequent in the past decade and is expected to increase by 130% by 2030. According to the American Heart Association (AHA), “Between 40% and 80% of people in the U.S. with cardiovascular disease also have obstructive sleep apnea (OSA)…” Sleep apnea can cause certain cardiovascular symptoms to become worse; interestingly, heart disease also has a negative impact on OSA. Let’s examine the relationship between these two health conditions and explore what can be done to better treat them and mitigate complications.
What is obstructive sleep apnea?
Obstructive sleep apnea is a condition that deprives the body of sufficient oxygen due to periods of when the patient stops breathing while asleep. This is caused by pressure from the soft tissues in the throat area blocking the patient’s airway. OSA is more common in men and patients who are overweight. Symptoms include snoring and irregular breathing while sleeping, daytime tiredness, high blood pressure, morning headaches, problems with memory/concentration and mood changes. Some people may not experience severe symptoms and therefore the condition can go undetected in certain individuals.
How and why are OSA and heart disease connected?
Unfortunately, obstructive sleep apnea and heart disease have negative impacts on each other. Periods without breathing (called apneas) can cause an inflammatory and stress response in the body, leading to an increase in heart rate and blood pressure, as well as a stiffening and narrowing of the blood vessels in the body. OSA can also cause pressure changes in the chest cavity which puts strain on the heart and can lead to changes in the heart’s structure called “remodeling”. On the other hand, heart disease can often cause weakness, fatigue and shortness of breath making it difficult to perform the necessary lifestyle changes needed to treat OSA. Also, the increased workload on the heart that occurs with heart disease may result in episodes of apnea that are more frequent and more severe.
What are the potential negative outcomes?
According to the AHA, “OSA is associated with several cardiovascular complications”:
- High Blood pressure – OSA is present in 30-50% of patients with high blood pressure and up to 80% of patients with high blood pressure that is hard to treat.
- Irregular heart rhythms such as atrial fibrillation
- Stroke
- Heart attack
- Pulmonary hypertension – as many as 80% of patients with pulmonary hypertension have OSA
- Worsened heart failure
- Diabetes and metabolic syndrome – a known risk factor for heart disease and cardiovascular related complications.
Prevention and Treatment
Despite the prevalence of OSA, it is underdiagnosed and undertreated. Therefore, efforts to mitigate the potential health risks and complications should focus on:
Prevention – Some cases of OSA can be prevented by maintaining a healthy weight and following your healthcare provider’s recommendations for management of other heath conditions such as diabetes and high blood pressure.
Prompt Diagnosis – Patients with common risk factors (overweight, increased neck circumference, snoring/irregular breathing while sleeping) should talk with their healthcare provider about getting screened for OSA. Advancements in technology including home sleep studies, smart watches and smart pajamas are making early detection and diagnosis easier.
Treatment – Individuals diagnosed with OSA are most commonly treated with a machine such as a CPAP (continuous positive air pressure) or similar device. Other potential treatment measures include lifestyle changes, medication (for patients with OSA and obesity) oral repositioning devices, and surgical interventions.
As previously mentioned, patients should also follow their healthcare provider’s recommendations for their related conditions including diabetes, pulmonary hypertension, high blood pressure, atrial fibrillation and heart failure to improve the management of their sleep apnea.
Sleep apnea affects around 20% of US adults and is even higher in patients with heart disease; unfortunately, around 90% of OSA cases are undiagnosed. Discuss with your healthcare provider if you have concerns about possible undiagnosed or undertreated sleep apnea.
Check out our related articles, “An Ounce of Prevention” and “The Diabetes and Heart Disease Connection”