Obstructive sleep apnea (OSA) affects between 40% and 80% of individuals with cardiovascular diseases. However, according to the American Heart Association(AHA), this condition is frequently undiagnosed and untreated. OSA occurs when the upper airway becomes obstructed, interrupting breathing multiple times throughout the night. Its symptoms include snoring, breathing pauses, fragmented sleep, and daytime drowsiness. It is estimated that 34% of middle-aged men and 17% of middle-aged women meet the diagnostic criteria for OSA.
“Obstructive sleep apnea can negatively impact a patient’s health and increase the risk of cardiovascular events and mortality. With this statement, we aim to raise awareness and encourage proper screening and treatment of the condition,” says Yerem Yeghiazarians, MD, FAHA, chair of the writing committee, professor of medicine, and Leone-Perkins Chair in Cardiology at the University of California, San Francisco.
The American Heart Association Links OSA to Cardiovascular Diseases
Key points from the scientific statement:
- Between 40% and 80% of people in the U.S. with cardiovascular disease also have obstructive sleep apnea (OSA), yet it is underrecognized and undertreated in cardiovascular practice.
- Sleep apnea can cause a negative feedback loop whereby it worsens cardiovascular conditions, which then worsen the sleep apnea.
- OSA affects 30% to 50% of people with high blood pressure and is a risk factor for atrial fibrillation.
- OSA is also associated with Type 2 diabetes, worse outcomes from heart failure and even sudden cardiac death.
- People with cardiovascular risk factors or conditions should be screened for OSA with treatment as appropriate, which may include continuous positive airway pressure (CPAP), oral appliances, modifying lifestyle behaviors and weight loss.
Risk Factors for Sleep Apnea
Primary risk factors include obesity, large neck circumference, craniofacial abnormalities, smoking, family history and nighttime nasal congestion. According to the AHA’s scientific statement, OSA is associated with several cardiovascular complications:
- High blood pressure: OSA is present in 30-50% of people with high blood pressure, and up to 80% of those who have resistant, or hard-to-treat high blood pressure.
- Heart rhythm disorders: Such as atrial fibrillation and cardiac arrhythmia.
- Heart failure: OSA contributes to disease progression.
- Coronary artery disease: OSA increases the risk of a heart attack.
- Pulmonary hypertension (PH): As many as 80% of people with PH have OSA.
- Metabolic Syndrome and Type 2 diabetes.
Screening and Treatment: An Urgent Need In Cardiovascular Care
Although there is no definitive consensus that screening for OSA directly improves clinical outcomes, its high prevalence among cardiovascular patients and the evidence that treatment enhances quality of life support the need for evaluation and intervention.
“Patients report better mood, less snoring, less daytime sleepiness, improved quality of life and work productivity with OSA treatment,” Yeghiazarians said. “In addition, screening advances have changed how we diagnose and treat obstructive sleep apnea. 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.”
The AGA suggests:
- Screening for OSA in patients with resistant or difficult-to-control hypertension, pulmonary hypertension, or recurrent atrial fibrillation despite treatment.
- Ordering sleep studies for patients with heart failure, particularly if respiratory sleep disorders or daytime drowsiness are suspected.
- Treating diagnosed OSA with available therapies, including behavioral changes, lifestyle modifications, and weight loss.
- Prioritizing CPAP for patients with severe OSA.
- Considering oral appliances for patients with mild to moderate OSA to reposition the jaw and tongue during sleep and prevent airway obstruction.
- Conducting routine follow-up, including nighttime sleep testing, to ensure treatment effectiveness
“The overall message is clear: we need to increase awareness about screening for and treating OSA, especially in patients with existing cardiovascular risk factors”, Yeghiazarians emphasizes.
Untreated sleep apnea can have a significant impact on overall health. It is essential to recognize when to seek professional help. Common signs and symptoms of OSA include:
- Loud and frequent snoring or gasping for air during sleep.
- Breathing pauses or shallow breathing during sleep.
- Excessive daytime drowsiness and persistent fatigue.
- Difficulty concentrating.
- Dry mouth or morning headaches.
- Sexual dysfunction and reduced libido.
- Frequent nighttime awakenings to urinate.
Speaking with a healthcare practitioner about sleep apnea is a crucial step in protecting cardiovascular health. When diagnosed early, treatment is often highly effective.
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