Obstructive sleep apnea, a severe sleep disorder, occurs when an upper airway obstruction causes repeated episodes of disrupted breathing during sleep. It causes breathing to stop and start during sleep repeatedly.
40% to 80% of people with cardiovascular disease suffer from OSA. Still, it is under-recognized and undertreated.
According to a new study, sleep apnea worsens heart disease. OSA is associated with several cardiovascular complications.
Those complications are:
- 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.
Chair of the scientific statement writing group Yerem Yeghiazarians, M.D., FAHA, professor of medicine and the Leone-Perkins Family Endowed Chair in Cardiology at the University of California, San Francisco said, “Obstructive sleep apnea 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.”
While no consensus evaluating for OSA alters clinical results, the high commonness of OSA among individuals with cardiovascular disease, alongside proof that OSA treatment improves patient quality of life, are motivations to screen and give treatment.
Yeghiazarians said, “Patients report better mood, less snoring, less daytime sleepiness, improved quality of life and work productivity with OSA treatment. In addition, screening advances have changed how we diagnose and treat obstructive sleep apnea. For example, many patients do not have to go to an overnight sleep study center anymore.”
“Instead, the FDA now approved sleep devices that patients use at home and send back to their doctor for assessment. And, while a continuous positive airway pressure (CPAP) machine is one form of treatment, there are numerous therapeutic options – from positional therapy and weight loss to oral appliances and surgery – depending on the cause and severity of someone’s OSA.”
“Improvements in-home diagnostic tools and more research on ways to identify cardiovascular risk in people with OSA are needed. Still, the overall message is clear: we need to increase awareness about screening for and treating OSA, especially in patients with existing cardiovascular risk factors.”
- Screening for OSA in patients with resistant or difficult to control hypertension, pulmonary hypertension, and atrial fibrillation 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 prevent obstructed breathing.
- Routine follow-up, including overnight sleep testing to confirm if treatment is effective.
The volunteer writing group prepared this scientific statement on behalf of the American Heart Association’s Council on Clinical Cardiology; the Council on Peripheral Vascular Disease; the Council on Arteriosclerosis, Thrombosis and Vascular Biology; the Council on Cardiopulmonary, Critical Care, Perioperative, and Resuscitation; the Stroke Council; and the Council on Cardiovascular Surgery and Anesthesia.
- Yerem Yeghiazarians, Hani Jneid et al. Obstructive Sleep Apnea and Cardiovascular Disease: A Scientific Statement From the American Heart Association. DOI: 10.1161/CIR.0000000000000988