This sleep problem worsens heart disease, yet often untreated

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In a new paper from the University of California, San Francisco, researchers urge increased awareness of obstructive sleep apnea among people with cardiovascular disease or risk factors such as high blood pressure.

Obstructive sleep apnea (OSA) occurs in 40% to 80% of people with cardiovascular disease, yet it is under-recognized and under-treated, according to the statement.

OSA occurs when an upper airway obstruction causes repeated episodes of disrupted breathing during sleep.

Symptoms include snoring, lapses in breathing, fragmented sleep and daytime sleepiness. In general, about 34% of middle-aged men and 17% of middle-aged women meet the criteria for OSA.

OSA can negatively impact patients’ health and increase the risk of cardiovascular events and death. This statement is to encourage increased awareness, screening and treatment as appropriate for sleep apnea.

Risk factors for OSA include obesity, large neck circumference, craniofacial abnormalities, smoking, family history and nighttime nasal congestion.

OSA is linked to several cardiovascular complications:

high blood pressure – OSA is present in 30-50% of people with high blood pressure, and up to 80% of those who have resistant, or hard-to-treat high blood pressure;

heart rhythm disorders such as atrial fibrillation and sudden cardiac death;


worsening heart failure;

worsening coronary artery disease and risk of heart attack;

Pulmonary hypertension (PH) – as many as 80% of people with PH have OSA; and

Metabolic syndrome and Type 2 diabetes.

While there’s no consensus that screening for OSA alters clinical outcomes, the high prevalence of OSA among people with cardiovascular disease, along with evidence that OSA treatment improves patient quality of life, are reasons to screen and provide treatment.

The team says patients report better mood, less snoring, less daytime sleepiness, improved quality of life and work productivity with OSA treatment.

They suggest:

Screening for OSA in patients with resistant or difficult to control hypertension, pulmonary hypertension and atrial fibrillation that recurs despite treatment.

Screening for OSA via a sleep study for some patients with heart failure, especially if sleep-disordered breathing or excessive daytime sleepiness are suspected.

Treating patients diagnosed with OSA with available therapies, potentially including lifestyle and behavior modifications and weight loss.

When possible, treating patients with severe OSA with a CPAP machine.

Treating mild to moderate OSA cases with oral appliances that adjust the jaw and tongue placement during sleep to prevent obstructed breathing.

Routine follow-up including overnight sleep testing to confirm if treatment is effective.

If you care about heart health, please read studies about this sleep treatment could protect heart health in people with prediabetes and findings of chronic itch could mean high risks of sleep loss and heart disease.

For more information about health disease, please see recent studies about common cholesterol-lowering drugs may do double duty on cancer and heart disease and results showing that this treatment may cut heart attack, stroke risk by half in people with high blood pressure.

The study is published in Circulation. One author of the study is Yerem Yeghiazarians, M.D., FAHA.

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