A tale of two ailments: Obstructive sleep apnea and cardiovascular disease

Meet “Jim,” he is overweight, borderline diabetic, always sleepy and snores like a freight train at night. He suffers from obstructive sleep apnea, but that’s not all, his sleep disorder is putting him at risk for cardiovascular disease.  Do his symptoms sound familiar?

Obstructive sleep apnea is a common disorder affecting one out of every seven men and one out of every 20 women. OSA is characterized by repetitive episodes of narrowing and even closure of the throat that result from relaxation of the muscles that are supposed to keep the throat and airway open when the affected individual is sleeping.

Dr. Ihab Rafic Hamzeh, assistant professor of medicine-cardiology

When Jim goes to sleep, his throat muscles relax and his airway closes. This prevents air and oxygen from flowing into his lungs, and he struggles to breathe. This struggle awakens him from deep sleep so he can catch his breath several times during each hour of sleep. Although Jim does not realize this happens, it is disrupting his sleep and depriving him of much needed rest. As a result he is sleepy all day and has even fallen asleep at work and in meetings.  Can you relate?

So how does this affect the heart? OSA has been shown to increase the risk of developing high blood pressure and making elevated blood pressure harder to control in those who already have hypertension. Using ultrasound imaging technology, research has shown that OSA impairs the ability of the heart to relax and makes the heart arteries stiffer.

However, there is a silver lining! Adequate treatment of OSA (such as the use of a CPAP machine) improves the heart relaxation and improves blood pressure control. Unfortunately the list of ill effects OSA is associated with includes stroke, abnormalities in heart rhythm including atrial fibrillation and it may even increase the risk of death from cardiac causes.

Patients with heart blockages and OSA fare worse than those who only have heart blockages alone. Recently, research by Dr. Christie Ballantyne, chief of cardiology at Baylor College of Medicine, in collaboration with investigators from other centers, found a link between sleep apnea and heart damage at the microscopic level by using highly sensitive laboratory tests.

Jim’s wife has encouraged him to talk to his doctor about his sleep issues and in the meantime has asked him to sleep in the guest bedroom. Jim doesn’t mind though because Becky also snores, has difficulties sleeping at night and feels out of energy during the day. What Becky does not know is that she may have OSA, which also increases the risk of cardiovascular death in women. Unlike men, women with OSA will present with insomnia or difficulty falling and staying asleep.

Since there is a strong connection between OSA and heart problems – the two share common risk factors, and when present together puts the patient at a higher risk of cardiovascular death. Physicians at the Baylor Heart Clinic believe that to give the patient the best care both problems need to be addressed using a team approach. A sleep specialist will optimally treat the OSA and a heart doctor (or the primary care physician) should thoroughly treat and control the heart problems and risk factors.

If this story hits close to home for you, talk to your doctor and determine the best line of defense.

By Ihab Rafic Hamzeh, M.D., B.S., assistant professor of medicine-cardiology at Baylor College of Medicine

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