Exploring the Connection between Sleep Apnea and Heart Disease

According to a study presented at the 2010 meeting of the Radiological Society of North America (RSNA), people with obstructive sleep apnea (OSA) tend to have more extensive and noncalcified coronary plaque. Recent studies have linked sleep apnea with coronary artery disease, and we have long known about the connection between sleep apnea and heart disease. To attempt to explore the mechanism for the connection between sleep apnea and heart disease, researchers looked at the coronary arteries of 49 people with sleep apnea and 46 people without. All patients had complained of atypical chest pain or had prior equivocal physiological testing. Here are the results of the imaging:

Extent of Coronary Artery Disease	OSA	No OSA
One-vessel CAD	6%	15%
Two-vessel CAD	27%	7%
Three-vessel CAD	22%	13%
Four-vessel CAD	33%	24%

 

The trend had a significance of p=0.0017. In addition, the imaging showed that OSA sufferers were more likely to have noncalcified and mixed plaque, or buildup in the arteries. These soft plaques are more likely to break loose to cause acute cardiac events, such as a heart attack or sudden cardiac death.

The results of this study are compelling, and another good reason why people should seek treatment for sleep apnea early, before they develop life-threatening coronary artery disease. The main weakness of this particular study is that the body mass index of the two populations may have been a significant confounder. The average BMI of the OSA population was 33 whereas that of the non-OSA population was only 30, a potentially significant difference that was not addressed in press releases about the study. Nonetheless, the connection between cardiac death and sleep apnea continues to strengthen.

If you think you may suffer from sleep apnea, you are encouraged to seek treatment that works. To learn more about the full range of treatment options, please contact a local sleep dentist today.

CPAP NOT WORKING? WHAT TO DO WHEN YOUR CPAP DOESN'T IMPROVE YOUR SYMPTOMS.

CPAP is extremely successful at treating sleep apnea. Why do 60% of patients abandon such a successful treatment?

There are many reasons given by patients, but a very common response is that their CPAP did not work? When patients report that their CPAP does not work they usually mean that the symptoms of sleep apnea were not relieved. They may still be tired or wake with morning headaches. Often they find that they cannot sleep with the CPAP or they actually had their sleep disturbed by CPAP.

It is not uncommon to see patients who no longer have sleep apnea but have as many arousals as they did before CPAP. Some patients display a higher arousal index with CPAP than with their apnea untreated.

Another common problem is complex sleep apnea where following treatment with CPAP there is breakthru central sleep apneas. These may be due to over-titration of the CPAP pressure blowing off the CO2 (carbon dioxide) which decreases the urge to breathe.

THE MOST COMMON REASONS TO ABANDON CPAP ARE ABOUT COMFORT NOT THAT CPAP IS INEFFECTIVE! I HATE CPAP! is a common complaint.

Many patients complain about mask comfort. Some patients have acne, facial irritation or rashes from the masks. Other patients have trouble being tethered to the hose while others complain about CPAP noise.

Whatever the complaint if CPAP is ineffective or the patient cannot tolerate it an alternative to CPAP is important. Oral Appliances are considered a first line treatment for mild to moderate sleep apnea that patients almost always prefer to CPAP. Oral Appliances are not a first line treatment for severe sleep apnea but are considered an alternative to CPAP when patients cannot tolerate CPAP.

The severity has little effect on how well patients tolerate CPAP and so it can be expected that 60% of severe apneics will also abandon CPAP use.

Medicare is now going to accept the use of oral appliances for treating severe sleep apnea after CPAP fails.