This can make heart disease worse but often goes untreated

By Chris Dyer

Sleep apnoea makes heart disease worse but is often left untreated by sufferers, scientists warned.

Health experts have urged patients with obstructive sleep apnoea they are at risk if they also suffer from cardiovascular disease or conditions such as high blood pressure.

Obstructive sleep apnoea (OSA) affects between 40 to 80 percent of people with cardiovascular disease, but it is not as recognized and is undertreated, according to a new study.

OSA occurs when an obstruction in the upper airway causes repeated episodes of disrupted breathing during sleep.

Symptoms include snoring, lapses in breathing, fragmented sleep and daytime sleepiness.

In general, about 34 percent of middle-aged men and 17 percent of middle-aged women meet the criteria for OSA, figured show.

Risk factors for the condition include obesity, large neck circumference, craniofacial abnormalities, smoking, family history and night-time nasal congestion.

OSA is associated with several cardiovascular complications, scientists said.

Dr. Yerem Yeghiazarians, professor of medicine and the Leone-Perkins Family Endowed chair in cardiology at the University of California, San Francisco, chaired the scientific statement writing group that issued the warning.

He said: "Obstructive sleep apnoea can negatively impact patients’ health and increase the risk of cardiovascular events and death.

"This statement is to encourage increased awareness, screening and treatment as appropriate for sleep apnoea."

Some 30 to 50 percent of patients suffering from high blood pressure also have OSA and up to 80 percent of those who have resistant, or hard-to-treat high blood pressure, scientists said.

The same people in the bracket also suffer heart rhythm disorders such as atrial fibrillation and sudden cardiac death, strokes, worsening heart failure as well as coronary artery disease and risk of heart attacks.

As many as 80 percent of people with pulmonary hypertension (PH) have OSA, plus metabolic syndrome and Type 2 diabetes, the scientists said.

While there’s no consensus that screening for OSA alters clinical outcomes, the high rates of OSA among people with cardiovascular disease, along with evidence that OSA treatment improves patient quality of life, are reasons to screen and treat it, according to the experts.

Dr. Yeghiazarians said: “Patients report better mood, less snoring, less daytime sleepiness, improved quality of life and work productivity with OSA treatment.

“In addition, screening advances have changed how we diagnose and treat obstructive sleep apnoea.

“For example, many patients do not have to go to an overnight sleep study center anymore. There are now sleep devices approved by the FDA that patients use at home and send back to their doctor for assessment.

“And, while a continuous positive airway pressure (CPAP) machine is one form of treatment, there are numerous therapeutic options - from positional therapy and weight loss to oral appliances and surgery - depending on the cause and severity of someone’s OSA.”

Screening for OSA in patients with resistant or difficult to control hypertension, pulmonary hypertension and atrial fibrillation that recurs despite treatment is recommended by the study authors.

Testing for OSA using a sleep study for some patients with heart failure, especially if disturbed breathing during or excessive daytime sleepiness are suspected, was also suggested.

Patients diagnosed with OSA should be treated with available therapies, potentially including lifestyle and behavior changes and weight loss, the researchers added.

When possible, treating patients with severe OSA with a continuous positive airway pressure (CPAP) machine, the scientists said.

Treating mild to moderate OSA cases with devices to open the airways that adjust the jaw and tongue placement during sleep to prevent obstructed breathing can also help, researchers said.

Routine follow-up including overnight sleep testing to confirm if treatment is effective can also be used, the recommendations stated.

Dr. Yeghiazarians added: “Improvements in home diagnostic tools and more research on ways to identify cardiovascular risk in people with OSA are needed.

“Still, the overall message is clear: we need to increase awareness about screening for and treating OSA, especially in patients with existing cardiovascular risk factors.”

This study was written by the volunteer writing group on behalf of the American Heart Association’s Council on Clinical Cardiology and a string of other scientific bodies.

It was published in Circulation, the association’s flagship journal.