Treatment Of Obstructive Sleep Apnea
The most effective, noninvasive treatment for sleep apnea requires the use of continuous positive airway pressure . This therapy requires the patient to wear a sealed mask over the nose, or in certain cases both the nose and mouth while sleeping. The patient receives forced room air via the mask , increasing the pressure in the oropharyngeal airway, which helps to maintain airway patency. Oral-dental devices may also be used in mild cases or for patients requiring treatment for primary snoring. These are intended to reposition the mandible, thereby maximizing the diameter of the oropharyngeal airway. In other cases, surgical procedures remain viable options, albeit the least desired treatment because of their invasiveness and complexity. In severe cases of sleep apnea, especially among patients with significant episodes of bradyarrhythmias or tachyarrhythmias, gastric bypass surgery should be considered.
You Eventually Resume Breathing So Whats The Big Deal
Frequent bouts of hypoxia damage the blood vessels that supply oxygen to the heart.
Recurring hypoxia causes the release of substances that may cause constriction of blood vessels for hours.
Obstructive sleep apnea can lead to chronic heart failure via several routes:
Activating the sympathetic nervous system, including during waking hours.
Increasing left ventricular workload, including during wakefulness.
Increasing right ventricular workload.
All of this can then lead to atrial fibrillation, a rhythm disorder. And guess what: another ripple, in that atrial fibrillation is a major risk factor for stroke and heart attack!
Are you now getting the impression that sleep apneas ripples in the pond are created by a boulder?
If someone tells you they think you have sleep apnea, but theyre not a doctor, dont let that stop you from SEEING a sleep doctor.
Dont make excuses like Im old.
Regardless of cause of OSA , the damage to the body is the same, and in most cases, the treatment is the same.
The gold standard of treatment is CPAP: continuous positive airway pressure shown below.
CPAP machine. Shutterstock/Brian Chase
In some cases, OSA can be mitigated by a custom-made mandibular device to place inside the mouth overnight, fashioned by a sleep dentist.
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%.
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Increased Risk Of Heart Attack
Researches estimate sleep apnea if left untreated can significantly increase the risk of cardiovascular disease and death by heart attack by 5 times. The reason for this lies in several facts; because of shortness of breath and poor breathing quality/efforts, there isnt enough oxygen directed to the heart. Furthermore, because of abrupt awakening and apnea episodes that can happen hundreds of times during sleep, people with sleep apnea experience sleep deprivation and insomnia. And these are all the things that make you heart sick and unable to function properly.
Studies;show that 47% to 83% people experience sleep disorder and have a cardiovascular disease because of sleep apnea. Moreover, 35% of people with sleep disorders experience high blood pressure, 53% of people experienced heart failure, heart rhythm oscillations, and stroke. This clearly shows that poor sleep quality, sleep deprivation and insomnia directly affect the health of the heart. Heres a quick overview of how that exactly happens;
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Sdb And Coronary Heart Disease
Patients with OSA may also present with major cardiovascular risk factors, such as hypertension, diabetes mellitus, dyslipidaemia and obesity or overweight that all can affect cardiac structure and function . Thus, OSA and these risk factors may explain the increased prevalence of CAD in patients with OSA .
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Heart Failure Causes Sleep Problems
Complications of heart failure can affect your sleep. For example:
- Chest pain and discomfort make it hard to relax and fall or stay asleep.
- Lying in bed can make you feel short of breath.
- You may have to get up during the night to pee.
During the day, you’re standing and sitting, so extra fluid would normally settle in your legs and feet. But lie down, and it’s going to move up into your chest This can close in your lungs and airways, making it harder to breathe.
Your doctor might prescribe diuretics to help get rid of that extra fluid. But these medicines don’t stop working when you sleep, which can mean interrupting your slumber for a trip or two to the bathroom.
What Causes Cardiomegaly
Hypertension is a very common cause of cardiomegaly. By increasing the workload on the heart, the left ventricle adapts by developing hypertrophy and an increase in wall thickness. Over time, the heart wears out and becomes larger and weaker. Another very common cause of cardiomegaly is coronary artery disease. Built-up plaque inside the artery can interrupt the blood supply to the heart muscle and cause damage to the heart or a scar.;Subsequently, the heart remodels and becomes larger and weaker in proportion to the amount of scar created by this blocked artery.
The heart has four valves, and any malfunction of these valves can cause the cardiomegaly. When the aortic or mitral valves are leaking,;the left ventricle adapts to the increased volume load by getting larger. This results in cardiomegaly. If the aortic valve is narrow, this results in an obstruction to the left ventricle which develops hypertrophy and cardiomegaly. When the mitral valve is narrow, the obstruction to the blood flow results in an increase in left atrial pressure and enlargement of that chamber, causing cardiomegaly.
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How The Heart Works
Lets think of the way the heart works to explain this. ;The heart has four chambers, two atrium and two ventricles, that contract to pump blood.; I think of the heart as having two pumps made up by these four chambers.
The left side is the body pump and the right side is the lung pump.;The lung pump sends blood to the lungs to get oxygen. ;After the lungs oxygenate the blood, it is sent to the body pump. ;Then, the body pump sends this good, oxygenated blood to the body.
With sleep apnea this process to receive good, oxygenated blood does not happen properly.; None of the organs, including the heart, receive the oxygen needed.; This puts stress on the heart, causing it to have to work harder.; Essentially its comparable to a person attempting a marathon with no training or conditioning.; It is very dangerous.
This is the reason there is a higher risk of left ventricular heart failure in patients that have sleep apnea. ;The body pump works extra hard to move poorly oxygenated blood all the way to the brain and the toes.; The left side of the heart becomes enlarged and tired.
Men have a 58 percent increased risk of developing heart failure from untreated sleep apnea. ;Because the heart has to pump so much harder, blood pressure increases. ;Medication may help to control the high blood pressure, but really its just a band-aid. ;Patients with sleep apnea run as high as an 85 percent risk of having resistant hypertension.
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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What Is Sleep Apnoea
Sleep apnoea is a respiratory condition where a;persons breathing is affected during sleep, causingperiods of paused breathing. These episodes,;where breathing stops, usually last at least 10 seconds;each time, but can happen throughout sleep, hundreds;of times. It is therefore a serious condition and can;have a big impact on quality of life as well as health.
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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Sleep Apnoea And Cardiomyopathy
Having an existing heart condition can be a risk factor;for developing sleep apnoea. And sleep apnoea can;also be a risk factor for heart conditions, worsening;conditions in those who already have them, as well;as increasing the risk of developing heart conditions;in those without.
Sleep apnoea is a significant risk factor for high blood;pressure and cardiovascular disease including strokes and a;heart attack. It can also cause arrhythmias such as atrial fibrillation. In people with;existing heart condition, the repeated fluctuating;oxygen levels can increase the risk of arrhythmias.;
Sleep apnoea can cause cardiovascular problems for;the following reasons.
- The effort of trying to breathe in OSA can cause;additional pressure on the heart to pump, whichaffects how well it works.
- The repeated sudden drops in oxygen levels that;occur due to sleep apnoea can trigger an increasein blood pressure and heart rate .
- Fluctuating in oxygen levels throughout the night,;which can lead to the development of plaques inthe blood vessels which can contribute to causing;heart attacks or strokes.
What Causes Sleep Apnea
Obstructive sleep apnea is caused by a blockage of the airway, usually when the soft tissue in the rear of the throat collapses during sleep. Central sleep apnea is usually observed in patients with central nervous system dysfunction, such as following a stroke or in patients with neuromuscular diseases like amyotrophic lateral sclerosis . It is also common in patients with heart failure and other forms of heart, kidney or lung disease.
Clinical Aspects: Effects Of Treatment
From OSA to HF
The main question to address in this section is whether treatment of OSA is associated with ameliorated cardiac function and heart failure prognosis on top of the traditional treatment for heart failure.
Continuous positive airway pressure
From HF to OSA
The clinical question to be answered in this section is whether treatment of heart failure ameliorates OSA.
Drugs for heart failure
Exercise rehabilitation programmes represent beneficial therapeutic measures to increase physical performance in patients with heart failure. A 4-month rehabilitation programme has been shown, for instance, to both improve OSA and significantly decrease muscle sympathetic nerve activity .
Atrial overdrive pacing
From CSA to HF
The main question of the present section is whether treating CSA is associated with better prognosis in heart failure patients.
What Are The Most Effective Treatments
It is easy to get the treatment you need to prevent or manage sleep apnea and heart disease in your life.; Some self-help techniques involve using a snoring mouthpiece;such as zQuiet or Zyppah, avoiding caffeine, quitting smoking, and maintaining a regular sleep schedule.
Medical techniques include more evasive procedures such as medication and surgery.; Talk to your healthcare provider for more personalized information on treatment options.
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What Are The Symptoms Of Sleep Apnoea
The person themselves may not be aware of their;breathing being affected during sleep. However, thisis often identified by a sleeping partner, or if they;experience symptoms in the daytime.Typical symptoms during sleep include:
- repeatedly waking up abruptly;
- breathing stops during sleep, and starts again,;often with a gasp;
This can be very distressing for a sleeping partner to;witness.
The person may be aware of the impact of their;sleep being disturbed, which can include:
- feeling unrefreshed on waking ;
- feeling very tired during the day;
- feeling drowsy;
- having low mood and being irritable;
- waking up with a headache;
- finding it hard to concentrate; and
- frequently falling asleep during waking hours;.
The condition can also contribute to problems;with relationships due to partners having constantlydisturbed sleep.
What Would Cause An Enlarged Heart
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 it’s 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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What Is The Cardiomegaly Workup
The workup for cardiomegaly starts with a visit to your doctor. By taking a history, the doctor can be clued into a possible cause of cardiomegaly. These could include hypertension, coronary artery disease or heart attack, an infectious cause, or familial history.;The physical exam can also provide some clues as to what is the cause of the cardiomegaly, particularly if it is secondary to a right or left-sided congestive heart failure,;a valvular problem, or an irregular heartbeat.
Following this, medical professionals perform an ECG, or electrocardiogram, which can reveal the presence of LVH, or left ventricular hypertrophy, as seen in hypertension or valvular problems, right ventricular hypertrophy as seen in patients with chronic pulmonary disease,;signs of a scar or a previous heart attack, or the presence of an irregular rhythm such as atrial fibrillation or PVCs.
Treating Sleep Apnea To Reduce The Risk Of Heart Disease
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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Cardiovascular Events And Mortality
A classic study performed by Marin et al. demonstrated that male patients with untreated severe OSA have significantly increased risk of fatal and non-fatal cardiovascular events compared with healthy participants. Among those with severe OSA treated with CPAP, there was a reduction in cardiovascular mortality and the number of cardiovascular events compared with patients prescribed but not using CPAP. In other studies, females and the elderly persons exhibit similar results.,
However, the potential benefit of CPAP use in decreasing cardiovascular mortality remains controversial. In 2007, Wang et al. demonstrated that the presence of untreated severe OSA in patients with heart failure was associated with increased mortality when compared with patients having AHI <15 events per hour, irrespective of confounding factors. This same study, however, did not show significantly lower mortality rate in patients treated with CPAP compared with patients not using CPAP. Likewise, it is not clear whether CPAP treatment may retard the progression of heart failure or improve cardiovascular function.
Therefore, to properly address the effect of CPAP in reducing the cardiovascular risk, including acute coronary syndrome and stroke, prospective multicenter, randomized studies are needed.
Can Sleep Apnea Cause An Enlarged Heart
Yes, with each apnea event your body tells your heart to beat faster and your blood pressure to go up. Severe obstructive sleep apnea can also cause stress on your heart causing the heart to get enlarged. An enlarged heart can cause the heart to get less oxygen and work less efficiently.
The National Institute for Health examined the relationship between heart disease and sleep apnea. Scientists reported data that suggests that sleep apnea may be a cause of heart disease.
- 10 percent of men and 5 percent of women are estimated to have sleep apnea.
- Congestive heart failure affects 2.5 million Americans, about 10% of the population.
- In obstructive sleep apnea, often marked by snoring, the right side of the heart may suffer damage because it has to pump harder to support the extra effort of the lungs trying to overcome the obstruction of the airway. When patients with congestive heart failure were tested in a sleep laboratory, almost fifty percent had severe apnea which had not been previously diagnosed.
- Several obese patients with both obstructive sleep apnea and heart failure were treated for sleep apnea. They showed great improvement with increased energy and lessened fatigue, lower blood pressure, and a more positive outlook as a result of this treatment.
- People who snore heavily and have pauses in breathing may be at risk for heart disease.
- Central apnea may cause high blood pressure, surges of adrenaline, and irregular heartbeats.
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