Osa And Metabolic Disorders
OSA and obesity commonly coexist and share multiple pathophysiological mechanisms and complications including glucose metabolism disturbance, dyslipidemia and systemic inflammation., , , , , , Although experimental evidence and emerging data in humans indicate an association between OSA and dyslipidemia, this relationship remains controversial, requiring more studies for full elucidation., Interestingly, a limited number of studies suggest that some of these pathologic alterations, such as insulin resistance may be associated with OSA independent of obesity.,
The high-density lipoprotein has an important role in reverse cholesterol transport, and also has anti-inflammatory, antioxidant, antithrombotic activity and protective and healing activities on endothelial cells. All these mechanisms are associated to cardiovascular protection, however, the dysfunction of high-density lipoprotein due to systemic inflammatory state and increased oxidative stress related to apnea may result in the loss of all these protective mechanisms and consequently increased cardiovascular risk. Besides the qualitative change in high-density lipoprotein, there is evidence that patients with severe OSA could show decreased serum cholesterol levels linked to this lipoprotein.
Continuous Positive Airway Pressure
For moderate to severe sleep apnea, the most common treatment is the use of a continuous positive airway pressure or automatic positive airway pressure device. These splint the person’s airway open during sleep by means of pressurized air. The person typically wears a plastic facial mask, which is connected by a flexible tube to a small bedside CPAP machine.
Although CPAP therapy is effective in reducing apneas and less expensive than other treatments, some people find it uncomfortable. Some complain of feeling trapped, having chest discomfort, and skin or nose irritation. Other side effects may include dry mouth, dry nose, nosebleeds, sore lips and gums.
Whether or not it decreases the risk of death or heart disease is controversial with some reviews finding benefit and others not. This variation across studies might be driven by low rates of complianceanalyses of those who use CPAP for at least four hours a night suggests a decrease in cardiovascular events.
Sleep Apnea And Atrial Fibrillation
Obstructive sleep apnea has been shown to put people at a higher risk of atrial fibrillation, or an irregular heartbeat. Atrial fibrillations can lead to multiple health issues, including stroke, heart failure, and other heart complications.
Heres how it works: Due to the uncommon pressure sleep apnea puts on your chest, you are forced to suck in air aggressively through a narrower throat. At the same time, youre sucking blood back into the chest faster, which tricks your heart into thinking its overloaded. This leads to the release of atrial natriuretic peptide in the kidney, which blocks the right atrium and can spur the disruption of the conduction system. This is how atrial fibrillation is caused.
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How To Prevent Coronary Heart Disease
Studies show that heart-healthy livingnever smoking, eating healthy, and being physically activethroughout life can prevent coronary heart disease and its complications.
Work with your doctor to set up a plan that works for you based on your lifestyle, your home and neighborhood environments, and your culture. Working with a team of healthcare providers may help with making changes in your diet, being physically active, managing other medical conditions, and helping you quit smoking.
Many Other Heart Conditions Can Ultimately Lead To Heart Failure
All of us lose some blood-pumping ability in our hearts as we age, but heart failure results from the added stress of health conditions that either damage the heart or make it work too hard. All of the lifestyle factors that increase your risk of heart attack and stroke smoking, being overweight, eating foods high in fat and cholesterol and physical inactivity can also contribute to heart failure.
Learn more about what you can do to reduce your risk for heart failure by making lifestyle changes that last.
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Sleep Disorders And Heart Health
Many sleep disorders have detrimental effects on heart health. Insomnia, one of the most common sleep disorders, is often accompanied by insufficient sleep and can lead to elevated cardiovascular health risks.
Obstructive sleep apnea is a breathing disorder that is linked to heart disease, obesity, diabetes, stroke, and high blood pressure. People with OSA have lapses in breathing during sleep when their airway gets blocked.
Interrupted breathing from OSA causes fragmented sleep, which is one reason why the condition is tied to multiple cardiovascular problems. In addition, disturbed respiration reduces the amount of oxygen in the blood, which may worsen the impacts of OSA on heart health.
Disorders of abnormal movement during sleep, such as restless leg syndrome and periodic limb movement disorder, have also been linked to heart problems. While the exact explanation is unknown, it may relate to abnormal activation of the cardiovascular system that occurs with these conditions and induces elevated and fluctuating heart rate and blood pressure.
Circadian rhythm sleep disorders, which occur when a persons internal clock is misaligned with day and night, have been associated with cardiovascular problems. For example, people who work night shifts and have to sleep during the day have heightened risks of hypertension, obesity, and diabetes as well as cardiac events like a stroke or heart attack.
Sleep And Blood Pressure
During normal, healthy sleep, blood pressure drops by around 10-20%. This is known as nocturnal dipping, and research highlights its role in cardiovascular health.
Poor sleep, whether from a lack of sleep or sleep disruptions, is associated with non-dipping, meaning that a persons blood pressure doesnt go down at night. Studies have found that elevated nighttime blood pressure is tied to overall hypertension .
In fact, nocturnal blood pressure has been found to be even more predictive of heart problems than high blood pressure during the day. Non-dipping has been tied to an increased risk of stroke and heart attack. Its also been linked to kidney problems and reduced blood flow to the brain.
Raised daytime blood pressure has been identified as a consequence of sleep deprivation in multiple studies, but it doesnt affect all people equally. The link between lack of sleep and high blood pressure is highest in middle-aged adults. People who work long hours in high-stress jobs and people with other risk factors for hypertension are more likely to have raised blood pressure after chronic poor sleep.
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How Sleep Deprivation Affects Your Heart
Its difficult to overstate the hearts importance to health. Responsible for pumping blood throughout the body, the heart powers the circulatory system that ensures that all the organs and tissues in the body get the oxygen they need.
Unfortunately, heart problems are a leading cause of illness and death in the United States. While its already well-known that factors like poor diet, limited exercise, and smoking can harm the heart, theres a growing recognition of the dangers of sleep deprivation for heart health.
Sleep provides time for the body to restore and recharge, playing a key role in nearly all aspects of physical health. For the cardiovascular system, insufficient or fragmented sleep can contribute to problems with blood pressure and heighten the risk of heart disease, heart attacks, diabetes, and stroke.
As a result, getting good sleep may help prevent damage to the cardiovascular system, and for people with heart problems, can be part of following a heart-healthy lifestyle.
Sleep Problems Lead To Heart Failure
OSA is more common among people who are overweight, but anyone can get it. The tissue in the back of your throat relaxes and blocks your airway while you sleep. You stop breathing, so your brain signals your throat muscles to contract, which opens up your airway again. This can happen dozens or even hundreds of times a night.
Researchers have also found a strong link between trouble falling or staying asleep and the likelihood of heart failure. One reason may be that insomnia triggers the body’s stress response, which could weaken your heart over time.
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Future Directions And Clinical Implications
The epidemiologic and clinical studies summarized in this paper provide a framework for future research in the underpinnings of the metabolic syndrome and related morbidities. Current studies have raised many important issues that require empirical testing, although initial questions regarding relationships between obstructive sleep apnea and cardiovascular morbidity or between obstructive sleep apnea and the metabolic syndrome have been addressed to some extent. Whether the metabolic syndrome represents a mediating factor in the link between obstructive sleep apnea and cardiovascular disease remains to be determined. Alternatively, the metabolic syndrome itself might potentiate the effects of obstructive sleep apnea on cardiovascular disease.
Future research is necessary to rank individuals with regard to their risk of sudden cardiac death and target them for educational and medical intervention. Research is also needed to establish noninvasive markers with adequate sensitivity and specificity in predicting which patients are at greater risk. For example, patients with sleep apnea showing depressed LV function should be considered at greater risk for ventricular arrhythmias and other cardiovascular events. Identification and treatment of patients with overlapping syndromes is paramount in the fight to reduce cardiovascular morbidity.
Can Sleep Apnea Cause An Irregular Heartbeat
There are numerous people who complain about waking up with a fast-beating heart. While some think this isnt anything to worry about, there are studies that link waking up with an irregular heartbeat to sleep apnea. Sleep apnea is a very common sleeping disorder that is very alarming. In fact, a;report by the National Sleep Foundation said that there are over 18 million adults in America that are diagnosed with this condition. Also, that it can be found in all age groups and for both sexes. The report also shows that a minimum of 3% of children are suspected of having sleep apnea and even up to 20% of children who snore have a higher chance of getting the condition.
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Changes In Pressure Within The Chest
When a person with obstructive sleep apnea attempts to breathe, they inhale against a narrowed or closed upper airway. These unsuccessful, forced inhalations can cause substantial changes in pressure within the chest cavity. Over time, these repetitive changes in intrathoracic pressure can damage the heart. Intrathoracic pressure changes can lead to atrial fibrillation , problems with blood flow to the heart, and even heart failure.
The Burden Of Cac And Sleep
The mean CAC score, CAC volume, and CAC mass were 193.0 ± 274.1, 132.3 ± 194.5, and 25.5 ± 35.6, respectively. Twenty-three patients had a positive CAC score. When we categorized the study population into four groups based on the quartiles of the RDI value, the CAC score was observed to be higher in patients with higher RDI values . Higher CAC scores were associated with elevated RDI value, apnea index, ODI, and STOP-BANG score. Arousal index and PLMI had no significant correlation with CAC. On the other hand, the minimum oxygen saturation was inversely correlated with the CAC score . Linear regression analysis adjusting for the potential determinants of the CAC score such as age, sex, body mass index, total cholesterol, hypertension, diabetes mellitus, and smoking status revealed that the atherosclerotic burden as measured by the CAC score was independently associated with the RDI value , ODI , and STOP-BANG score , while there was no statistically significant association between the CAC score and the apnea index or the minimal and average O2 saturation levels .
Figure 1. Differences in coronary artery calcium scores by the respiratory disturbance index quartiles.
Figure 2. Correlation between the coronary calcium score and variables related to sleep-disordered breathing.
Table 2. Multivariate analysis for determinants of the coronary artery calcium scores.
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Sleep Apnea And Heart Disease
Heart disease is the leading cause of death in the United States and globally. Several behaviors increase the risk of heart disease, including eating an unhealthy diet, not getting enough physical activity, drinking too much alcohol, and smoking. Health conditions that increase the risk of heart disease include high blood pressure, unhealthy cholesterol levels, diabetes, and obesity.
Untreated sleep apnea also significantly increases the risk of heart arrhythmias and cardiovascular disease. Its estimated that patients with sleep apnea are 2-4 four times more likely to develop heart arrhythmias than people without this condition. Sleep apnea increases the risk of heart failure by 140% and the risk of coronary heart disease by 30%.
Sleep Apnea And Cardiovascular Disease: Role Of Obesity
According to data from the National Center for Health Statistics, about two-thirds of American adults are either overweight or obese . The age-adjusted prevalence of overweight/obesity in ethnic minorities, especially minority women, is higher than in whites in the United States, reaching a critical level of greater than two-thirds of the female minority population. Blacks are at greater risks because they are disproportionately more obese than whites .
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Pathophysiology Of The Cardiovascular Consequences Of Osa
A detailed description of the diverse and complex pathways involved in the association of OSA and cardiovascular disease has been discussed in the previous chapter.
In brief, the intermittent hypoxia observed in OSA leads to oxidative stress, increased sympathetic activation, endothelial dysfunction, blood pressure surges, an increase in the levels of circulating inflammatory markers and hypercoagulability. Large negative intrathoracic swings generated by obstructed breathing efforts also place considerable mechanical stress on the heart and great vessels. Together these changes create an environment that has the potential to promote atherosclerosis and increase the risk of coronary artery disease and stroke .
Sleep Apnea Obesity And Heart Disease
Research suggests that obesity may play an important role in the development of both sleep apnea and heart disease. It is important to keep in mind that sleep apnea alone, with or without obesity, can increase the risk for heart disease. Sleep apnea and obesity independently increase the risk of health conditions that negatively affect heart health, like hypertension , unhealthy cholesterol levels, and diabetes.
Obesity is a common cause of sleep apnea, often related to increased deposits of fat in the neck that narrow or block the upper airway during sleep. Researchers have found that even a 10% increase in body weight increases the risk of OSA by six-fold. While 60 to 90% of people with sleep apnea also have obesity, only around 30% of people diagnosed with obesity have sleep apnea.
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Obstructive Sleep Apnea And Coronary Artery Disease: From Pathophysiology To Clinical Implications
Fernando De Torres-Alba
1Acute Cardiac Care Unit, Department of Cardiology, La Paz University Hospital, Paseo de la Castellana 261, 28046 Madrid, Spain
Coronary artery disease and obstructive sleep apnea are both complex and significant clinical problems. The pathophysiological mechanisms that link OSA with CAD are complex and can influence the broad spectrum of conditions caused by CAD, from subclinical atherosclerosis to myocardial infarction. OSA remains a significant clinical problem among patients with CAD, and evidence suggesting its role as a risk factor for CAD is growing. Furthermore, increasing data support that CAD prognosis may be influenced by OSA and its treatment by continuous positive airway pressure therapy. However, stronger evidence is needed to definitely answer these questions. This paper focuses on the relationship between OSA and CAD from the pathophysiological effects of OSA in CAD, to the clinical implications of OSA and its treatment in CAD patients.
Despite the reduction in mortality rates that occurred in the past decades, it still affects 6.4% of adults in any of its forms and constitutes the cause of death of nearly 17% of adult population in the United States . According to data from the Framingham Heart Study, a population-based longitudinal study, nearly one-half of males and one-third of females over 40 years of age will develop some manifestation of CAD .
2. Pathophysiological Effects of OSA in CAD
Obstructive Sleep Apnea Coronary Artery Disease And Continuous Positive Airway Pressure Therapy
Thet Hein, Germaine Loo and Chi-Hang Lee*
Cardiac Department, National University Heart Centre Singapore, 1E Kent Ridge Road, National University Health System Tower Block, Level 9, Singapore 119228
- Corresponding Author:
- Cardiac Department, National University Heart Centre Singapore1E Kent Ridge Road, National University Health System Tower BlockLevel 9, Singapore 119228
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Sleep And Coronary Heart Disease
Research has found that sleep deprivation contributes to atherosclerosis. Plaque forms as a consequence of inflammation, which involves white blood cells, which are produced by the immune system, to collect in the arteries. Poor sleep triggers chronic inflammation, which contributes to plaque formation and hardening of the arteries.
The impact of sleep deprivation on coronary heart disease is also believed to be influenced by sleeps effects on blood pressure. Hypertension strains the arteries, making them less effective at bringing blood to the heart and as a result contributing to heart disease.
Sleeping Too Much And Heart Health
The impacts of sleep deprivation on heart health receive considerable attention, but many studies have also found associations between sleeping too much, generally defined as more than nine hours per night, and cardiovascular problems.
While more research is needed, many experts believe that underlying health conditions that cause excess sleep are also the cause of this higher rate of heart issues. Nevertheless, this data is a reminder that its a myth that more sleep is always better.
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