cardiovascular disease

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Health 24 reports that sleep apnoea raises the risk of sudden cardiac death, according to a long-term study that strengthens a link doctors have suspected. The new research is published online June 11 in the Journal of the American College of Cardiology.

“The presence and severity of sleep apnoea are associated with a significantly increased risk of sudden cardiac death,” said study leader Dr. Apoor Gami, a cardiac electrophysiologist at Midwest Heart Specialists-Advocate Medical Group in Elmhurst, Ill.

Sudden cardiac death kills 450,000 people a year in the United States, according to study background information. It occurs when the heart unexpectedly and suddenly stops beating due to problems with the heart’s electrical system. Those problems cause irregular heartbeats. The condition must be treated within minutes if the person is to survive.

In earlier research, Gami and his team had found that patients with sleep apnoea who suffered sudden cardiac death often did so at night, a completely opposite pattern than found in others without sleep apnea who had sudden cardiac death. In the new study, the researchers tracked more than 10,000 men and women, average age 53, who were referred for sleep studies at the Mayo Clinic Sleep Disorders Center, mostly due to suspected sleep apnoea, from 1987 through 2003. After sleep tests, 78 percent were found to have sleep apnoea. During the follow-up of up to 15 years, they found that 142 had sudden cardiac arrest, either fatal or resuscitated.

Three measures strongly predicted the risk of sudden cardiac death, Gami said. These include being 60 or older, having 20 apnoea episodes an hour or having low blood levels of oxygen. This “oxygen saturation” drops when air doesn’t flow into the lungs. “If the lowest oxygen saturation was 78 percent, or less, their risk of [sudden cardiac death] increased by 80 percent,” Gami said. In a healthy person, 95 percent to 100 percent is normal. Having 20 events an hour would be termed moderate sleep apnea, Gami said.

Gami found a link, not a cause-and-effect relationship, between sleep apnea and sudden cardiac death. He can’t explain the connection with certainty, but said there are several possible explanations. For example, sleep apnea is related to the type of heart rhythm problem that causes sudden cardiac death, he said. The study findings should be taken seriously by those who have sleep apnea or suspect they do, said Dr. Neil Sanghvi, an electrophysiologist at Lenox Hill Hospital, in New York City, who reviewed the findings.

People with sleep apnea are often but not always obese, and many have other heart risk factors such as heart failure or heart disease. Having these other risk factors already puts a person at risk of sudden cardiac death, Sanghvi said. “The sleep apnea may be the tipping point. Each of these factors adds a level of risk. When you add sleep apnea, you could have a worse outcome.”

Anyone who suspects they have sleep apnea should ask their doctor about a sleep test, Sanghvi said. Daytime sleepiness and fatigue are frequent symptoms. Another tipoff is a bed partner who complains of snoring. The study didn’t address whether those who used sleep apnea treatments — such as the CPAP machine (continuous positive airway pressure) prescribed during sleep to help breathing — would reduce risk. “It would be fair to say we suspect it would,” Gami said.

 

 

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In a study presented on today at the Society for Maternal-Fetal Medicine’s annual meeting, The Pregnancy Meeting, in San Francisco, researchers reported findings that women with obstructive sleep apnea (OSA) and cardiac symptoms have a 31 percent incidence of cardiac dysfunction. The use of echocardiograms should be considered in the clinical management of these women.

OSA is characterized by abnormal pauses in breathing or instances of abnormally low breathing, during sleep. These pauses can last from at least ten seconds to minutes, and may occur five to 30 times or more an hour; this can lead to cardiovascular disease. The objective of the trial was to measure the incidence of OSA among pregnant and reproductive women.

The cohort was made up of 1,265 women between the ages of 15-45 who met the Apnea-Hypopnea Index (AHI) criteria for OSA based on nocturnal Polysomnogram testing. Data was gathered from 2005-2012 at a tertiary care center. Sleep lab data and individual transthoracic echocardiogram reports were reviewed.

“As obesity rates increase among reproductive age women, the frequency of obstructive sleep apnea and cardiovascular disease in pregnancy is anticipated to rise. The increased hemodynamic demands of pregnancy can cause women with underlying cardiac disease to decompensate,” said Laura K.P. Vricella, MD, fellow, Maternal-Fetal Medicine at MetroHealth Medical Center.

“We found a 31 percent incidence of abnormal echocardiograms among symptomatic women with obstructive sleep apnea. Further investigation is needed to understand the relationship between obstructive sleep apnea and cardiovascular disease and their impact on pregnant women.”

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Life longevity specialist Dr Dick Richards blogs on Breathing Relief about the dangers of lack of sleep to health, and side effects of sleep apnoea:

“The bad news is that this [sleep deprivation] causes a rapid fall in the ability of the metabolism to conduct its requisite routines of anti-oxidation and other tissue repairing processes. If repeated several times , as is usually the case, there can be significant falls in oxygenation levels in the blood leading to a recognisable state of what is called oxygen desaturation. The serious consequences over this were such that over thirty years ago there was a careful medical study [*] into the relationship between sleep loss and these unwelcome side effects. It was clearly shown that symptoms of the obstructive sleep apneoa [OSA] syndrome include excessive daytime sleepiness, nocturnal awakenings, reduced sexual inclination and performance, and morning headaches. A number of other mortality studies have suggested decreased survival statistics in persons with the OSA syndrome, possibly due to this causing vascular-related disease.”

We know sleep apnoea leads to greater incidence of hypertension and atherosclerosis related diseases such as stroke, angina, and acute myocardial infarct. In addition to shortened longevity in patients with untreated or inadequately treated OSA there are also other factors which could account for this early mortality, for example sudden death during sleep (arrhythmia) or even fatalities from sleep related automobile or other accidents.

 

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Severe obstructive sleep apnea was associated with a risk of cardiovascular death in women, but continuous positive airway pressure (CPAP) seemed to reduce the risk, according to a small Spanish study.

In a 116-patient, observational study, those with severe obstructive sleep apnea had a cardiovascular mortality rate of 3.71 per 100 person-years compared with the control group’s rate of 0.28 per 100 person years, Francisco Campos-Rodriguez, MD, from Valme University Hospital in Seville, Spain, and colleagues found.

Women with mild to moderate apnea had a mortality rate of 0.94 per 100 person-years (P=0.034 compared with the control group), they reported in the Annals of Internal Medicine.

Despite prevalence data suggesting that 2% to 3% of middle-age women have obstructive sleep apnea, most of the studies on both apnea and cardiovascular effects have been done exclusively in men. The researchers were interested in investigating this issue in a large group of women.

Source: Medpage Today

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Philips Respironics has released the first issue of Philips Respironics Clinical Newsletter, Philips Respironics – The Clinical Advantage.

The Clinical Advantage is designed to bring you up to date clinical information on a current topic of interest. Each issue will cover a specific theme and include an editorial by Dr David White, and externally written feature articles, case studies and reviews of ongoing research by leading physicians. Dr White writes:

“Welcome to the first edition of Philips Respironics’ newsletter The Clinical Advanage. This is a newsletter dedicated to keeping you up to date with clinical information and new clinical literature regarding sleep apnea. Obstructive sleep apnea (OSA) has been the engine that has driven the remarkable growth of the sleep field over the last 25 years. Although the medical community and the general public have been interested in the performance and quality-of-life problems that result from sleep apnea, the real concern has been the potential relationship between OSA and the cardiovascular system.

“The theme of the first issue is SDB and Cardiovascular disease and includes a feature article by Dr Michael Arzt (Germany). Michael Arzt summarizes the current state of the literature regarding the association between OSA and cardiovascular disease and points out many of the areas where controversy still remains. Case studies are also presented which develop several of these themes further. However, this controversy will not end until adequately powered, randomized, controlled, clinical trials are conducted addressing this issue. At last, several such studies are underway.”

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Two studies that link the quality of sleep to the occurrence of erectile dysfunction and other urologic conditions were presented to reporters during the 2011 Annual Meeting of the American Urological Association (AUA).

The studies suggest that men with erectile dysfunction (ED) should be screened for obstructive sleep apnoea (OSA). After adjusting for age and other health conditions, patients with ED were more than twice as likely to have sleep apnoea than their normal counterparts.

This was the largest study to date to demonstrate a relationship between obstructive sleep apnoea and erectile dysfunction. Researchers at Mount Sinai Medical Center in New York evaluated 870 consecutively enrolled men through a cardiac screening program. Patients were screened for obstructive sleep apnea and erectile dysfunction through clinical questionnaires and were asked about their history of cardiovascular disease, blood pressure, diabetes and smoking. The mean age in the study population was 47.3 years, with a mean BMI of 30.2.

Sixty-three percent of patients in the study screened positive for obstructive sleep apnea, 5.6 percent had a history of diabetes, and 29 percent had a smoking history. The likelihood for having OSA increased as the severity of ED increased.

The good news for patients with both OSA and ED is that treatment for sleep apnea through continuous positive airway pressure therapy (CPAP), together with drug therapy, has been shown to improve symptoms of ED.

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