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Can Sleep Apnea Cause A Heart Attack

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What Happens When You Stop Breathing

HOW SLEEP APNEA CAN LEAD TO A HEART ATTACK OR STROKE

When you stop breathing, your heart rate also tends to drop the longer your body is deprived of oxygen. Then, your involuntary reflexes cause you to startle awake at the end of that period of not breathing. When this occurs, your heart rate tends to accelerate quickly and your blood pressure rises.

These are changes that take place acutely when you stop breathing. However, your body starts to experience chronic effects if you experience frequent apnea. Data suggests increased risk, particularly when you stop breathing roughly 30 times or more per hour. But there is likely a risk at even lower frequency rates.

For example, your blood pressure tends to go up, your heart walls thicken due to increased workload and the structure of your heart changes. It tends to become stiffer and less flexible because there are more fibrous cells growing in between the muscle cells.

All of those things increase the risk that you can have either atrial or ventricular arrhythmias. They also tend to reduce the function of the heart so that its less efficient at pumping blood.

Improving Health With Current Research

Learn about the following ways the NHLBI continues to translate current research into improved health for people with sleep apnea.

  • Sleep Disorders Research Advisory Board . The NHLBI has administered this specialty program advisory panel since 1993. Board members, including medical professionals, federal partners, and members of the public, meet regularly to provide feedback to the NIH on sleep-related research needs and to discuss how to move sleep research forward. Visit the Sleep Disorders Research Advisory Board for more information.
  • National Sleep Research Resource . This resource was established by the NHLBI to provide biomedical researchers a large, well-characterized data collection from NIH-funded sleep research studies. These data can be used in new research studies to advance sleep research. Visit the National Sleep Research Resource for more information.
  • Identification of genes that increase susceptibility to obstructive sleep apnea. The NHLBI Trans-Omics for Precision Medicine program and its Whole-Genome Sequencing project is using WGS data to identify genetic variations that may increase the risk of obstructive sleep apnea. Visit the Cleveland Family Study-WGS Collaboration for more information.

Learn about some of our pioneering research contributions that have improved clinical care.

How Is Sleep Apnea Diagnosed

If your doctor determines that you have symptoms suggestive of sleep apnea, you may be asked to have a sleep evaluation with a sleep specialist or may order an overnight sleep study to objectively evaluate for sleep apnea.

  • Testing includes an overnight sleep study called a polysomnogram . A PSG is performed in a sleep laboratory under the direct supervision of a trained technologist. During the test, a variety of body functions, such as the electrical activity of the brain, eye movements, muscle activity, heart rate, breathing patterns, air flow, and blood oxygen levels are recorded at night during sleep. After the study is completed, the number of times breathing is impaired during sleep is tallied and the severity of the sleep apnea is graded.
  • For adults, a Home Sleep Test can sometimes be performed instead. This is a modified type of sleep study that can be done in the comfort of home. It records fewer body functions than PSG, including airflow, breathing effort, blood oxygen levels and snoring to confirm a diagnosis of moderate to severe obstructive sleep apnea.

An HST is not appropriate to be used as a screening tool for patients without symptoms. Its not used for patients with significant medical problems . Its also not used for patients who have other sleep disorders in addition to the suspected obstructive sleep apnea.

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Lifestyle Treatments For Sleep Apnea

For mild cases of sleep apnea, lifestyle changes may be enough to treat the issue. Your doctor will let you know if thats the right starting point. But even if you are prescribed a medical treatment, the following changes can help reduce your sleep apnea episodes and improve your sleep.

Lose weight. If you are overweight, losing weight can have an enormous impact. While it is usually not a total cure, it can reduce the number of breathing episodes you experience, reduce your blood pressure, and decrease daytime sleepiness. Even a small amount of weight loss can open up your throat and improve sleep apnea symptoms.

Exercise. Even when exercise does not lead to weight loss, it can decrease your sleep apnea breathing episodes and improve your alertness and energy during the day. Aerobic exercise, resistance training, and yoga are all good choices for strengthening the muscles in your airways and improving breathing.

Sleep on your side. Lying on your back is the worst position for sleep apnea, as it causes the jaw, tongue, and other soft tissues to drop back toward the throat, narrowing your airway. Sleeping on your stomach isnt much better, since lying face down or twisting your head to the side both obstruct breathing. Lying on your side, on the other hand, helps keep your airway open. If you find side sleeping uncomfortable or you tend to roll on to your back after youre asleep, countered side pillows or body pillows may help.

How Do I Get A Sleep Study

How Exactly Sleep Apnea Causes Heart Attack

Medical referral

If you think you might have sleep apnea, first assess your risk with some questionnaires. Scoring high on screening questionnaires such as the STOP-Bang questionnaire and the Epworth Sleepiness Scale can be useful in persuading clinicians that a sleep study is necessary.

You can then see your doctor to request further investigation into your sleep breathing problems.

As well as your screening questionnaire results, SnoreLab can often be very helpful in giving your doctor some evidence of your loud snoring or maybe even some apnea episodes.

If seeing a general practitioner for your initial consultation, you may first be referred to a sleep specialist or an ear, nose and throat clinician before being offered a sleep study.

Requesting a home study online

In some countries, there are online companies that conduct home sleep studies without you ever having to attend a medical consultation. After filling out an online assessment form and paying a fee, these companies will post your study equipment to you with instructions.

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What Caused Carrie Fishers Death

Carrie Fisher died four days after suffering a heart attack during a flight from London to Los Angeles six months ago.

Her assistant shared in a recent interview that Fisher slept most of the flight and had suffered some respiratory events during this time, which was considered normal for her.

At the end of the flight, Fisher could not be awakened easily. When she did arouse, she began to vomit before slumping over and becoming unresponsive. These are symptoms consistent with heart attack in women.

Since then, family members, friends, and fans have wanted to know the specific cause of death. Fisher suffered from mental health problems and drug addiction throughout her life. Many assumed her death would be tied to drug use.

And to some extent, it has been. The Los Angeles County coroners office released its report last Friday, which revealed a number of factors which contributed to the popular actresss death. While drug use was mentioned in the report, the announcement that sleep apnea and heart disease were major contributing factors has left many with new questions.

Monday morning, a more detailed analysis of Fishers death revealed the presence of multiple substances in her system at the time of death: cocaine, opiates, methadone, alcohol, and ecstasy. Ultimately, however, the cause of death was listed as sleep apnea with other conditions: atherosclerotic heart disease, drug use.

Sleep And Heart Failure

Heart failure is when the heart doesnt pump enough blood to supply the body with the blood and oxygen that it needs to function properly. An observational study of over 400,000 people found strong associations between sleeping problems and heart failure.

In that study, people who slept less than seven hours per night had an elevated risk of heart failure. Heart failure was also more common in people who had other indicators of unhealthy sleep including insomnia symptoms, daytime sleepiness, snoring, and being an evening person. The more of these signs of unhealthy sleep that one person had, the higher their likelihood of heart failure.

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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.

Evidence From Cpap Studies

Sleep apnea linked to heart disease and stroke

The link between sleep apnea and cardiovascular disease has been further demonstrated through treatment studies of sleep apnea with nasal continuous positive airway pressure . Those studies have shown positive results, which include reduced diurnal and nocturnal blood pressure., Among patients with heart failure and congestive heart failure, for instance, treatment of coexisting sleep apnea with CPAP reduces systolic blood pressure, improves left ventricular systolic function, and increased ejection fraction., CPAP therapy has been found to eliminate apneic episodes and associated hemodynamic changes occurring during sleep., One implication of those findings is that adverse effects of obstructive sleep apnea on cardiac functions can be lessened with CPAP administration, although it is not certain whether it could delay mortality among patients with central sleep apnea and heart failure.

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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.

Pathophysiological Consequences Of Sleep Apnea Adversely Affect Progression Of Heart Failure

In regards to sleep apnea , both CSA and OSA, is associated with three immediate adverse biological consequences: A) arterial blood gas abnormalities consisting of repetitive episodes of hypoxemia/hypercapnia which occur due to apnea, followed by reoxygenation/hypocapnia associated with recovery from apnea, and B) large negative swings in intrathoracic pressure and C) arousals. These consequences are qualitatively similar for both OSA and CSA, but more pronounced with OSA.

These nocturnal events occurring night after night, eventually adversely affect various cardiovascular functions and structure.1 These adverse effects should be most detrimental in the presence of established left ventricular systolic and diastolic dysfunction and coronary artery disease.

In regards to sympathetic activity which has a profound effect on the natural history of heart failure, multiple studies have shown that both OSA and CSA, independent of HF, are associated with increased sympathetic activity as measured by an increase in both plasma and urinary catecholamines, heart rate variability and muscle sympathetic nerve activity.

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Sleep Tips For People With Heart Problems

While theres no silver bullet solution, certain tips can often help people with heart problems get better sleep.

  • Develop strategies for relaxation: If heart concerns spur anxiety, they can keep your mind racing when you just want to ease into sleep. Techniques like deep breathing, yoga, light stretching, and mindfulness meditation are just a few beneficial approaches for people struggling with how to sleep with pericarditis , heart disease, or other heart problems that cause chest pain.
  • Plan a consistent sleep schedule: Keeping the same bedtime and wake-up time every day is widely considered to be one of the key ways to encourage healthy and stable sleep from night to night.
  • Design an accommodating bedroom: Set your sleep environment to meet your needs by ensuring that the bedroom has a comfortable mattress and pillow, a pleasant temperature, and as much quiet and darkness as possible.
  • Avoid negative influences on sleep: Alcohol and caffeine can both interfere with sleep and are best avoided at night. Excessive use of electronic devices, including your cell phone, can also throw off your sleep patterns, which is why experts recommend not using these devices for an hour or more before bed.

These tips and other elements of sleep hygiene can serve as a foundation for better sleep, creating habits that make it easier to get both the quantity and quality of sleep that you need.

Treating Sleep Apnea To Reduce The Risk Of Heart Disease

Alcohol Usage Makes Sleep Apnea Worse and Dangerous

Talking to a doctor about sleep apnea is an important step that anyone can take to protect their heart health. If a person is diagnosed with sleep apnea, treatments are often effective. Treatment for sleep apnea depends on the type of sleep apnea detected and may include:

  • Lifestyle changes: Doctors may begin by informing patients about lifestyle changes that may reduce the severity of this condition. Weight loss, exercise, limiting alcohol, quitting smoking, and even changing your sleeping position may be helpful.
  • Positive airway pressure devices: PAP devices pump air through the airway, preventing the upper airway from collapsing during sleep.
  • Mouthpieces and oral appliances: Oral appliances reduce disordered breathing by changing the position of the jaw, tongue, or other part of the body thats constricting the airway.
  • Mouth and throat exercises: Depending on the cause of a persons sleep apnea, special exercises of the mouth and throat may help tone these muscles, making them less likely to interfere with breathing during sleep.
  • Surgery: Surgery for sleep apnea may involve changing parts of the body that cause airway constriction or implanting devices that causes tightening of the muscles around the airway.
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What Is The Risk Of Atrial Fibrillation With Sleep Apnea

The stress of going periods of time during the night without breathing takes a significant toll on the heart. Sleep apnea has been shown to cause enlargement of the left atrium of the heart which is the usual source of atrial fibrillation. This left atrial enlargement then causes disruption of electrical pathways leading to a four-fold increased risk of atrial fibrillation!

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How Common Is Sleep Apnea

Obstructive sleep apnea is estimated to affect between 2-9% of adults in the United States, but many cases are believed to go undiagnosed, which fits with studies that have found considerably higher rates of OSA. Precise prevalence is hard to determine because studies have used different criteria for diagnosing the condition. A consistent finding, though, is that OSA affects men more than women. It can occur in people of any age but is more common in older adults.

Central sleep apnea has been found to affect around .9% of adults over the age of 40. It is found much more frequently in men than in women.

As this data demonstrates, OSA is much more common than CSA. For this reason, when people talk about sleep apnea, they are generally referring to OSA.

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A Heart Failure With Reduced Left Ventricular Ejection Fraction

Sleep studies of consecutive patients with stable HFrEF have been reported from various countries with either polysomnography or polygraphy .1-3

The most detailed systematic prospective study in HFrEF involved 100 ambulatory male patients with stable, treated HF.6 Each patient spent two nights in the sleep laboratory, with the first night for habituation. Polysomonography was performed during the second night. 49% of the patients had an AHI of 15 per hour of sleep. In the general population, only 9% of men have an AHI15/h. For reference, an AHI of 5 to < 15, 15 to < 30 and 30 or more are considered mild, moderate and severe sleep apnea, respectively.

In our study, 10% of the patients were taking -blockers. However, in spite of wide spread use of -blockers, the prevalence of sleep apnea in CHF has remained quite high. Combining results of studies from consecutive CHF patients from around the world shows that 52% have an AHI 15/hour .3 In most of these studies, 80% to 90% of the patients were on a -blocker. In these studies, 31% had CSA and 21% had OSA however, this distribution varies considerably among various reports, in part due to difficulties involved in differentiating central and obstructive hypopneas from each other.

What Would Cause An Enlarged Heart

Sleep apnea ruled as a cause of Carrie Fisher’s death

enlarged heartheartheartheartenlarged heartcause

Enlarged heart, depending on the cause may return to normal size if appropriate and timely treatment is given. In many cases it will not however, in which case the goal is prompt recognition and treatment to stabilize the situation and prevent further enlargement.

Similarly, what causes enlarged heart? An enlarged heart may have several causes. But itâs usually the result of high blood pressure or coronary artery disease. It may not pump blood effectively, which can bring congestive heart failure. It may improve over time.

Likewise, people ask, how do you fix an enlarged heart?

If your enlarged heart is related to coronary artery disease, your doctor may recommend coronary artery bypass surgery. Left ventricular assist device . If you have heart failure, you may need this implantable mechanical pump to help your weakened heart pump.

How long can someone live with an enlarged heart?

Life expectancy with congestive heart failure varies depending on the severity of the condition, genetics, age, and other factors. According to the Centers for Disease Control and Prevention , around one-half of all people diagnosed with congestive heart failure will survive beyond five years.

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