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Sleep apnea wakes up heart disease

The snorts, whistles, gasps, and groans you make while sleeping may do more than rob you and your bed partner of a good night’s sleep. They may steal years of your life, too. That’s the message from two large studies that looked at the influence of sleep apnea, a special cause of snoring, on life span.

What is sleep apnea?

When you breathe, air usually flows soundlessly through the nasal passages and the pharynx (the back of the throat), and then on into the lungs. During sleep, the small muscles that hold open the pharynx relax, allowing the tissue to flop into the airway. Air rushing through this loose tissue can make it vibrate. We hear the vibrations as snoring.

In people with simple snoring, the airway remains open. Sleep apnea is a different story. People afflicted with this common condition temporarily stop breathing many times a night. In those with the most common kind, obstructive sleep apnea, the soft tissue of the palate or pharynx completely closes off the airway. The brain, sensing a drop in oxygen, sends an emergency “Breathe now!” signal that briefly wakens the sleeper and makes him or her gasp for air.

The pauses and gasps of sleep apnea are hard on the snorer. An immediate effect of sleep apnea is daytime drowsiness due to disrupted sleep. There are plenty of long-term consequences, too.

The “Breathe now!” signals fire up the same stress hormones and nerve pathways that go into hyperdrive when you are angry or frightened. They make the heart beat faster and boost blood pressure. They stoke inflammation, a key player in heart disease. They can damage the delicate inner lining of blood vessels and increase the blood’s tendency to clot, a root cause of heart attack and stroke.

Sleep apnea and survival

Two major studies suggest that the changes wrought by sleep apnea can shorten life (Sleep, August 2008). In a long-term study of the residents of the West Australian town of Busselton, those with moderate to severe sleep apnea were six times more likely to have died over 14 years of follow-up than those without sleep apnea. In the Wisconsin Sleep Cohort Study, participants with severe sleep apnea were three times more likely to have died of cardiovascular disease during 18 years of follow-up than those without apnea. When the researchers excluded people who used a breathing machine at night, the risk jumped to more than five times higher.

Silencing the snorchestra

You don’t have to take sleep apnea lying down. Everything from lifestyle changes to surgery can make a difference.

Lifestyle changes. Excess weight is a big contributor to sleep apnea. If you are carrying too many pounds, losing weight can make a big difference. Sleeping on your side instead of your back may help with mild sleep apnea (a tennis ball sewn into a pocket on the back of a pajama top can help keep you from rolling onto your back during the night.) It can also help to forgo alcoholic drinks before sleeping and to minimize the use of sedatives or muscle relaxants.

Breathing machines. For moderate or severe sleep apnea, most doctors recommend using a radio-sized machine that keeps the airway open by blowing pressurized air into the nose. The most common machines provide continuous positive airway pressure (CPAP). Breathing machines aren’t cheap, ranging from several hundred dollars to $1,000 or more. Medicare and most insurance plans cover much of the cost.

Dental devices. A mouth guard may be an alternative to a breathing machine. These devices work by thrusting the jaw forward, a position that may keep the tissues in the throat from collapsing and blocking the airway. They work well for some people, not so well for others.

Surgery. An operation with a name that’s a mouthful (uvulopalatopharyngoplasty) can make the airway wider by removing excess tissue in the throat. Surgery isn’t usually effective, and generally isn’t done unless other treatments don’t work or aren’t appropriate.

Looking ahead

The Wisconsin study suggests, but doesn’t prove, that treating sleep apnea may help prevent heart disease, or at least keep sleep apnea from contributing to heart disease. We’ll have a better idea about this once the international Sleep Apnea Cardiovascular Endpoints (SAVE) study is finished in the mid-2010s. It is comparing treatment with positive airway pressure against standard care.

In the meantime, it makes sense for anyone with high blood pressure, angina, heart failure, peripheral vascular disease, a past heart attack or stroke, or other types of cardiovascular disease to think about being checked for sleep apnea.

December 2008 update

Avoid sleep deprivation, read Improving Sleep: A Guide to a Good Night's Rest
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Improving Sleep: A Guide to a Good Night’s Rest

Ask anyone with insomnia about the importance of a good night’s sleep and you’ll likely get a very animated answer. Improving Sleep: A Guide to Getting a Good Night’s Rest describes the complex nature of sleep, the latest in sleep research, the factors that can lead to sleep deprivation, and, most important, what you can do to get the sleep you need for optimal health, safety, and well being. Read more

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