OSA Health Concerns

Introduction

Published literature shows that untreated sleep-disordered breathing (SDB) can lead to serious health problems, including high blood pressure (hypertension), congestive heart failure, diabetes, and stroke. But how concerned should you be about these other diseases?

If you use your positive airway pressure (PAP) device every night and you know it stops your symptoms, then you shouldn't worry any more than people who don't have obstructive sleep apnea (OSA). Your therapy should treat apneas, hypopneas, flow limitation, and snoring.

If you aren't using your PAP device every night or not getting effective therapy, don't neglect your health! You can start by reading our Improving Therapy section for tips about how to make your therapy more comfortable and effective. If you still aren't having success, speak with your home medical equipment (HME) provider and your physician.

Cardiovascular Disease

In the past several years, medical research has proven that there is a strong relationship between sleep-disordered breathing (SDB) and cardiovascular disease (CVD). Results from the Sleep Heart Health Study (an ongoing, multi-center study funded by the National Institutes of Health) have shown that people with SDB are more likely to develop high blood pressure (hypertension), congestive heart failure (CHF), and stroke.

Bradley TD (ed), Floras JS (ed). "Sleep Apnea: Implications in Cardiovascular and Cerebrovascular Disease." Lung Biology In Health Disease V 146. Marcel Dekker, Inc, New York; 2000.

The apneas and hypopneas associated with SDB decrease your oxygen level and increase your carbon dioxide level in your blood. As these levels become more extreme, you begin to struggle for air—in essence suffocating—which causes you to wake up briefly and start breathing again. During each apnea, the stress on your body leads to increased or irregular heart rate and increased blood pressure. According to recent medical research, the stress caused by SDB increases your risk for developing high blood pressure, irregular heart rhythms, and heart failure.

Additionally, recent studies show that treating SDB can decrease blood pressure and have positive effects on the heart.

High Blood Pressure (Hypertension)

Published literature shows that people with untreated sleep-disordered breathing (SDB) are more likely to develop hypertension. More importantly, there is what doctors call a "dose-response relationship": the worse your SDB, the greater your risk of developing hypertension.

During healthy sleep, your blood pressure decreases. However, when you are not treating your SDB, you probably experience higher blood pressure during sleep. Instead of getting a restful night's sleep, you put your heart through a night of stress. This nightly stress leads to increased blood pressure that affects you both night and day. Positive airway pressure (PAP) therapy—such as continuous positive airway pressure (CPAP), automatic positive airway pressure (APAP), and bilevel PAP—significantly decreases blood pressure in SDB patients, and these decreases can be seen during both sleep and wakefulness.

People who take more than two drugs for their high blood pressure (called "drug-resistant hypertension") are even more likely to have SDB. About 83% of people with drug-resistant hypertension have SDB. For this group of people, PAP therapy may be especially important.

Congestive Heart Failure (CHF)

People with untreated sleep-disordered breathing (SDB) experience nightly stress on the heart, and that's why they are more likely to develop heart disease, especially congestive heart failure (CHF). With CHF, the heart is not able to circulate blood effectively. Symptoms include weakness, shortness of breath, edema (fluid retention), enlarged and tender liver, and swollen neck veins. If you have these symptoms, contact your doctor.

Approximately 50% of people with CHF have SDB. If you have CHF and do not treat your SDB, you can expect to have more health problems and a shorter life. Using positive airway pressure (PAP) therapy to treat SDB in CHF can improve your heart's ability to do its job and improve your overall health and well-being.

Stroke

Up to 70% of people who have had a stroke also have sleep-disordered breathing (SDB). Many researchers believe that untreated sleep-disordered breathing (SDB) may increase your risk of having a stroke. As with hypertension and congestive heart failure (CHF), the type of stress that SDB puts on your body may lead to stroke.

Stroke patients with untreated SDB have a significant disadvantage in the struggle to recover. Their ability to concentrate is made doubly difficult by the effects of stroke and the effects of SDB. The reduced ability to concentrate makes basic activities more difficult. The excessive daytime sleepiness and fatigue caused by untreated SDB can also make it more difficult for a patient to participate in rehabilitation programs, resulting in poor recovery. In fact, stroke patients with untreated SDB tend to recover less of their pre-stroke abilities and have a higher death rate in the year following their stroke.

The National Stroke Association recommends that all acute stroke facilities and stroke rehabilitation programs screen for SDB. Recognizing SDB in stroke survivors is often challenging because SDB and stroke share some of the same symptoms. Obtaining a complete sleep history from family members will help determine whether SDB was present before the stroke or developed after the stroke. Well-educated medical professionals, nursing staff, and other healthcare providers have the best chance of recognizing SDB in stroke patients.

Copyright © ResMed 2005, Used with Permission