Harvard Heart Letter

Ask the doctor: Sleep apnea and heart risk?

Q. I have always had a snoring problem and recently underwent a sleep test at the insistence of my wife. I was diagnosed as having sleep apnea We have read about the connection between sleep apnea and heart disease, and now we are both concerned. Will treating my sleep apnea reduce my heart risk?

A. Sleep apnea is a nighttime breathing pattern of held breaths and explosive snores. There's little question that it's associated with both high blood pressure (hypertension) and coronary disease. But does sleep apnea cause cardiovascular disease? Or is the association due to common risk factors, such as obesity, which contribute to the development of both sleep apnea and cardiovascular conditions? In other words, we don't know whether sleep apnea is a cause of heart disease, or an innocent bystander. Maybe it is both. Obstructive sleep apnea, the most common form of this condition in which the tongue or throat tissue blocks the airway, causes surges of adrenaline during the periods when breathing is obstructed. It is highly likely that those surges contribute to hypertension and strain the cardiovascular system. People with obstructive sleep apnea also have an elevated risk for stroke and heart failure.

But the key question is whether treating sleep apnea will reduce your cardiovascular risk. To date, there is no evidence of a cardiovascular benefit from treatments like chronic positive airway pressure (CPAP). Studies are under way, but until they are concluded, I'd recommend treating obstructive sleep apnea solely to reduce sleep-related symptoms, such as excessive daytime sleepiness.

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