Obstructive sleep apnea affects around 20 million Americans and can lead to hypertension, heart attack, stroke, depression, muscle pain, fibromyalgia, morning headaches, and excessive daytime sleepiness.

Wednesday, February 17, 2010

SWEDISH EPIDEMIOLOGY: OBSTRUCTIVE SLEEP APNEA INCREASE CARDIOVASCULAR MORBIDITY AND MORTALITY

Obstructive sleep apnea increases cardiovascular morbidity and mortality according to Swedish article. This increase suggests that OSA is an increased (additive) risk above and beyond established risk factors of obesity, hypertension, smoking and hyperlipidemia. (see PubMed Abstract below).

A second article (see PubMed abstract below) published in the Journal of Cardiology 2010 Jan;55(1):92-98 concluded that Sleep Apnea Syndrom increased nocturnal blood pressure even in patients without hypertension. Patients with severe apnea demomstrated more sever elevations in nocturnal blood pressure.

A Japanese study (Heart Vessels. 2010 Jan;25(1):63-9) showed effectiveness of CPAP in treating arrythmias. Sleep apnea treatment with oral appliances and dental sleep medicine should show identical results based on other studies comparing treatment outcomes. This study showed " The results of this study demonstrate a significant relationship between OSA and several cardiac disorders, and also demonstrate the efficacy of CPAP in preventing OSA-associated arrhythmias in a large population of Japanese patients." Again I expect that apnea treated with oral appliances would have similar outcomes to CPAP use. This study again relates cardiac disorders to obstructive sleep apnea.

Another review article (Curr Opin Pulm Med. 2009 Aug 2) "Heart failure and sleep-disordered breathing: mechanisms, consequences and treatment." reviews recent articles on Sleep disordered breathing and Heart Failure. The article's summary (see PubMed abstract below) say "The relationship between CHF (congestive heart failure) and SDB (sleep disordered breathing) is likely to be bidirectional, CHF impacting on SDB severity and vice versa. Identification of SDB in the CHF population appears to be important as it is probably associated with greater mortality, but whether SDB intervention significantly influences CHF survival still remains to be determined. The effects of each conition worsens the other. Treatment that eliminates sleep disordered breathing should result in positive effects on cardiac symptoms. The article also discusses patients with central sleep apnea associated with Cheyne-Stokes breathing. Unfortunately CPAP and Oral appliances are not effective for central sleep apnea but adaptive servo-ventilation shows encouraging results. "Small, short-term studies are discussed, however long-term randomized trials with objective cardiac outcomes are still lacking" in regards to aaptive servo-ventilation.

A key point from all of these studies is that sleep apnea is a dangerous condition with multiple associated morbidities and with treatment improvement in morbidities and mortality is seen. While CPAP is extremely effective studies show it is rejected by the majority of patients. Dental Sleep Medicine and oral appliances provide needed alternatives to CPAP. Oral appliances are a first line treatment for mild to moderate sleep apnea. Patients with severe apnea who do not tolerate CPAP will benefit from an oral appliances. Patients with central sleep apnea may want to consider sero-ventilation.


Anadolu Kardiyol Derg. 2010 Feb;10(1):75-80.
Cardiovascular consequences of sleep apnea: I -Epidemiology.
Turgut Celen Y, Peker Y.

Sleep Medicine Unit, Department of Neurology and Rehabilitation Medicine, Skaraborg Hospital, Skövde, Sweden. yuksel.peker@lungall.gu.se.
Obstructive sleep apnea (OSA) is common in general population. There is an accumulating research evidence for an independent relationship between OSA and cardiovascular morbidity and mortality. This relationship is stronger in clinical cohorts compared with the general population, which suggests that concomitant OSA in subjects with traditionally recognized risk factors such as obesity, hypertension, smoking, and hyperlipidemia may provide an additive risk factor for the cardiovascular consequences. In the current article, the clinic-and population-based epidemiologic data will be reviewed in this context.

PMID: 20150011 [PubMed - in process]

J Cardiol. 2010 Jan;55(1):92-98. Epub 2009 Nov 22.
Relationship between sleep apnea syndrome and sleep blood pressure in patients without hypertension.
Sekizuka H, Kida K, Akashi YJ, Yoneyama K, Osada N, Omiya K, Miyake F.

Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao Miyamae-ku, Kawasaki-city, Kanagawa-prefecture 216-8511, Japan.
BACKGROUND AND PURPOSE: Ambulatory blood pressure monitoring (ABPM) provides an accurate assessment of blood pressure (BP) and shows non-dipper BP pattern in many sleep apnea syndrome (SAS) patients with hypertension (HTN); however, little information is available on the relationship between the severity of SAS and circadian BP changes in SAS patients without HTN. This study investigated whether SAS patients without HTN would have different BP courses in the severity of SAS. METHODS AND SUBJECTS: Seventy-four consecutive outpatients without HTN [systolic BP (BPs) at clinic <140mmHg and/or diastolic BP (BPd) at clinic <90mmHg], who received no antihypertensives, underwent overnight polysomnography (PSG) and ABPM. The apnea-hypopnea index (AHI) was calculated from the PSG results; patients were stratified into the following 4 groups based on their AHI: non-SAS, mild-, moderate-, or severe-SAS. RESULTS: The diurnal BPs and BPd showed no differences in the severity of SAS; however, the sleep BPs, lowest BPs, and pre-awake BPs were significantly higher in the severe-SAS group than the non-SAS group (p=0.02, p=0.04, and p=0.006, respectively). The sleep BPd and pre-awake BPd were significantly higher in the severe-SAS than the non-SAS (p=0.01 and p=0.0003, respectively) and mild-SAS (p=0.01 and p=0.008, respectively) groups. CONCLUSIONS: The results of this study suggested that SAS affected nocturnal BP elevation even in SAS patients without HTN. The diurnal BP showed no difference in the severity of SAS; however, the severe-SAS group revealed significant nocturnal BP elevation. Copyright © 2009 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

PMID: 20122554 [PubMed - as supplied by publisher]

Heart Vessels. 2010 Jan;25(1):63-9. Epub 2010 Jan 21.
Efficacy of continuous positive airway pressure on arrhythmias in obstructive sleep apnea patients.
Abe H, Takahashi M, Yaegashi H, Eda S, Tsunemoto H, Kamikozawa M, Koyama J, Yamazaki K, Ikeda U.

Division of Cardiovascular Medicine, Shinshu University Graduate School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan.
The purpose of this study was to determine the relationship between obstructive sleep apnea (OSA) and cardiovascular disorders in a large Japanese population, and to assess the efficacy of continuous positive airway pressure (CPAP) in the treatment of OSA-associated arrhythmias. The study population comprised 1394 Japanese subjects (1086 men and 308 women) who were divided into four groups on the basis of polysomnography (PSG) analysis as follows: the no sleep apnea (N-SA) group (n = 44, apnea-hypopnea index [AHI] < 5), the mild OSA (Mi-OSA) group (n = 197, 5 < AHI < 15), the moderate OSA (Mo) group (n = 368, 15 < AHI < 30), and severe OSA (SOSA) group (n = 785, AHI < 30). The following baseline characteristics were significantly associated with OSA: age (P < 0.001), gender (P < 0.001), body mass index (P < 0.001), hypertension (P < 0.001), diabetes (P = 0.009), and hyperlipidemia (P = 0.013). In the OSA group, PSG revealed the predominance of paroxysmal atrial fibrillation (PAF) (P = 0.051), premature atrial complex short run (P < 0.005), premature ventricular complex (PVC, P = 0.004), sinus bradycardia (P = 0.036), and sinus pause (arrest >2 s, P < 0.001) during the PSG recording. A total of 316 patients from the group underwent CPAP titration and were then re-evaluated. Continuous positive airway pressure therapy significantly reduced the occurrences of PAF (P < 0.001), PVC (P = 0.016), sinus bradycardia (P = 0.001), and sinus pause (P = 0.004). The results of this study demonstrate a significant relationship between OSA and several cardiac disorders, and also demonstrate the efficacy of CPAP in preventing OSA-associated arrhythmias in a large population of Japanese patients.

PMID: 20091401 [PubMed - in process]

Curr Opin Pulm Med. 2009 Aug 26. [Epub ahead of print]
Heart failure and sleep-disordered breathing: mechanisms, consequences and treatment.
Kee K, Naughton MT.

Department of Allergy, Immunology and Respiratory Medicine, Alfred Hospital and Monash University, Melbourne, Victoria, Australia.
PURPOSE OF REVIEW: This review examines the recently published articles pertaining to sleep-disordered breathing (SDB) and heart failure. RECENT FINDINGS: The recent findings can be classified into pulmonary, upper airway and treatment trials. Pulmonary complications of heart failure include loss of surfactant, increased pulmonary dry weight and reduced lung volume, which are likely to increase plant gain and thus predispose to central sleep apnea with Cheyne-Stokes respiration. Upper airway narrowing in normal individuals has been shown to occur with lower limb compression and the supine body position, thus suggesting that rostral fluid shifts may narrow the upper airway and aggravate obstructive sleep apnea. Extrapolating this to congestive heart failure (CHF), it is possible that CHF fluid status may impact upon obstructive sleep apnea severity. Following the Canadian Continuous Positive Airway Pressure for Patients with Central Sleep Apnoea and Heart Failure trial, further SDB intervention studies have been reported using adaptive servo-ventilation. Although encouraging, small, short-term studies are discussed, however long-term randomized trials with objective cardiac outcomes are still lacking. SUMMARY: The relationship between CHF and SDB is likely to be bidirectional, CHF impacting on SDB severity and vice versa. Identification of SDB in the CHF population appears to be important as it is probably associated with greater mortality, but whether SDB intervention significantly influences CHF survival still remains to be determined.

PMID: 19713849 [PubMed - as supplied by publisher]

Anonymous has left a new comment on your post "SWEDISH EPIDEMIOLOGY: OBSTRUCTIVE SLEEP APNEA INC...":

Nice post and this enter helped me alot in my college assignement. Say thank you you on your information.

Dr Shapira: I get dozens of thank you's from high school and college students who use my site as a research source. I take pride in supplying the highest quality information. I recently spoke at Integrate Chicago a course on integrative medicine for medical stuents and many who attended my lectures had spent a considerable amount of time doing research on treatment of sleep apnea. The general response was that it was one of the best sites on the internet if you were looking for alternative treatments for sleep apnea.

Dr Shapira

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posted by Dr Shapira at 7:07 PM