Sleep Apnea and Heart Disease
Along with obesity, the incidence of sleep apnea
has risen at an alarming rate in the United States. Sleep
apnea is the general term for a group of
medical problems that impact breathing during
sleep. The most common form, known as obstructive
sleep apnea (OSA), is caused by extra tissue
in the upper airway that collapses and literally
blocks the airflow to the lungs.
The risk factors for OSA include:
- Gender – Men
and post-menopausal women are at a greater
risk
- Having a neck size greater than
17 inches
- Having a diagnosis of
hypertension requiring the use of antihypertensive
medications
- Obesity – Individuals
with a body
mass index (BMI) of greater
than 30 kg/m2
You may already recognize symptoms in yourself
or a loved one. Oftentimes, they can be mistaken
for common ailments.
Symptoms of OSA include:
- Fatigue
- Early morning headaches
- Snoring
- Falling asleep during the
daytime (even while driving)
- Depression
- Witnessed episodes of
irregular breathing while sleeping
Typically, OSA can be treated with special devices
worn in the mouth, surgery to the upper airway
or through weight loss. Treatment may also include
wearing a special mask at night. This mask is
connected to a machine that provides pressure
to the inside of the airway keeping it open and
allowing air to freely pass into the lungs.
Researchers at the University of Pennsylvania
School of Medicine are studying the connection
between sleep apnea and heart disease. As a person
with sleep apnea experiences breathing interruptions
throughout their sleep, their body releases very
high levels of the stress hormone epinephrine.
This “fight
or flight” hormone not only disrupts sleep,
but it puts a tremendous strain on the heart,
blood vessels and other organs.
The strongest associations connect sleep apnea
with high blood pressure. Studies demonstrate
that treating sleep apnea decreases blood pressure
without the aid of additional medications. The
National Guidelines used by physicians
to treat high blood pressure list OSA as a major
cause of hard-to-control high blood pressure.
Recently, OSA has been linked to an increased
risk of stroke, heart attack, heart failure,
atrial fibrillation and sudden cardiac death.
Penn Cardiac Care's Heart Failure program,
together with the Sleep Medicine program of the
University of Pennsylvania Health System is addressing
issues concerning OSA. As research partners,
these groups study the consequences and treatment
of sleep apnea in people with heart disease.
Most recently, the two programs have completed
a multi-center clinical trial evaluating the
treatment of a specific type of sleep apnea on
heart failure symptoms.
Over the past year, the Heart Failure and Sleep
Medicine programs have developed a procedure
to rapidly evaluate and treat any person suspected
of having sleep apnea that may be complicating
their heart disease. Rapid diagnosis and treatment
combined with other therapies should improve
the quality of life for those impacted by both
sleep apnea and heart disease.
To learn more about heart
disease and sleep
disorders such as obstructive sleep apnea,
call 1-800-789-PENN (7366) or request
an appointment online.
Reviewed by: Lee Goldberg,
MD and Ilene Rosen,
MD
December 2005
Lee
Goldberg, MD, MPH, is Medical Director
of the Heart and Lung Transplantation Program
at the Hospital of the University of Pennsylvania
and is an Assistant Professor at
the University of Pennsylvania School of Medicine.
Dr. Goldberg earned his medical degree at Boston
University School of Medicine and completed
his internship and residency at the Hospital
of the University of Pennsylvania. He is a
fellow of the American College of Cardiology
and a member of both the American Heart Association
Council of Clinical Cardiology and the International
Society of Heart and Lung Transplantation.
Dr. Goldberg specializes in cardiovascular
medicine and cardiac transplantation.
Ilene
Rosen, MD, a physician with the Division
of Sleep Medicine, is an Assistant Professor
of Clinical Medicine. Dr. Rosen earned her
medical degree at the University of Pennsylvania
School of Medicine and completed her internship
and residency at the Hospital of the University
of Pennsylvania. She is a member of the American
Thoracic Society, the American College of Chest
Physicians and the American Academy of Sleep
Medicine. Dr. Rosen specializes in pulmonary,
critical care and sleep medicine.
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