While you were sleeping

Those of you who have been reading these e-Alerts almost as long as I’ve been writing them may remember the story about the night I awoke thinking a helicopter was hovering over my house. It was, in fact, my husband snoring in the bathtub. As a health problem, snoring doesn’t seem like much to get excited about. Husbands, and mostly wives, get annoyed, we complain, and eventually we find ways to cope. And of course snoring gets laughs on TV and in movies. But chronic snoring is often due to sleep apnea, a disorder that should not be taken lightly, as my friend, Jim, recently discovered.

Nightly oxygen needs

The word apnea literally means “without breath,” and that’s a pretty fair representation of how almost 25 percent of all middle-aged men and 9 percent of women in America spend their nights. People with sleep apnea actually stop breathing during their sleep, sometimes as many as a hundred times per night, with each episode lasting a minute or longer. Part of the reason a person with sleep apnea feels fatigued during the day is because their body hasn’t been getting enough oxygen during sleeping hours.

But as serious as daytime fatigue can be (resulting in ineffectiveness at work and accidents on the road), a new study released at the end of July reveals that sleep apnea can have far more serious consequences than just fatigue.

The most common kind of sleep apnea is obstructive sleep apnea (OSA) in which the soft tissue in the back of the throat collapses during sleep, closing off the airway. This was the type of sleep apnea examined by the Sleep Laboratory at Sahkgrenska University Hospital in Gothenburg, Sweden, in a study that concluded with alarming information about the health risks of OSA and the effectiveness of treatment.

Connection to the heart

Over a 7-year period, the Gothenburg researchers observed 182 men, 60 of whom were diagnosed with OSA. At the beginning of the trial, none of the subjects had any other severe health problems or alcohol dependency, and the average age of the group was 47.

At the end of the study period, 22 of the men with OSA had developed some type of cardiovascular disease (CVD) – either stroke, heart disease or hypertension. Yet only eight men in the much larger group without sleep apnea developed CVD during the same period.

The daunting conclusion of the test is that men who suffer from OSA are five times more likely to develop cardiovascular disease, regardless of their age, body mass index, blood pressure or smoking habits.

But the study also drew some important conclusions about treatment for OSA. The researchers found that 15 of the subjects with sleep apnea were effectively treated, and only one man in that group developed CVD.

There are three ways to treat OSA. Some patients use oral devices designed to open the airway passage during sleep. Another method, called nasal continuous positive airway pressure (CPAP), uses a device to supply a stream of air through a small plastic mask secured over the nose. Surgery is a less frequent treatment. Admittedly, the treatment choices are not terribly appealing, but their effectiveness in reducing the risk of CVD makes them well worthwhile.

My friend, Jim, uses the CPAP treatment. He tells me it was uncomfortable at first and took some getting used to. But within a week he was feeling less fatigued and more alert throughout the day, which helped him develop a positive attitude about wearing the device.

Again: homocysteine

Because people with sleep apnea have such a high risk of cardiovascular disease, it’s no surprise that they often have elevated levels of homocysteine – possibly the most critical marker for CVD. In the e-Alert I mentioned above (“Could Snoring Mean Increased Risk for Heart Failure?” 11/3/02), I told you about a study that showed how sleep apnea inhibits the production of nitric oxide (NO), a compound that binds homocysteine. Over time, as NO is reduced and high homocysteine concentrations are released, the cells that line the heart and blood vessels become damaged, signaling the onset of cardiovascular disease.

Not everyone with sleep apnea has high levels of homocysteine, and not everyone with high homocysteine levels has sleep apnea. But there’s definitely enough of an association here to create a serious concern. If you consistently snore, consider it to be a health risk – possibly a quite serious risk – and make an appointment with your doctor for a sleep apnea evaluation.

Then, while you’re at the doctor’s office, ask to have your homocysteine levels analyzed. This can be easily done with a routine blood test, and the results could lead to a profound effect on your cardiovascular system.

To Your Good Health,

Jenny Thompson
Health Sciences Institute

Sources:
“Increased Incidence of Cardiovascular Disease in Middle-aged Men with Obstructive Sleep Apnea” American Journal of Respiratory and Critical Care Medicine, 166.159-165
“Take Warnings About Sleep Apnea to Heart” Health Scout News, 7/30/02
“New Study: Sleep Apnea Linked to Decreased Libido” American Society for Technion – Israel Institute of Technology, 7/30/02