 make a significant difference in long-term health and mortality rates. )
MASKING THE PROBLEM?: Although many cases of sleep apnea go undiagnosed, researchers have yet to prove whether current treatments (such as the continuous positive airway pressure--CPAP--system, whose mask is shown here) make a significant difference in long-term health and mortality rates.
Image: ISTOCKPHOTO/HALLOPINO
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Brief periods of interrupted breathing during sleep affect an estimated 10 to 25 percent of people in the U.S. A smattering of studies have linked the condition, known as obstructive sleep apnea, to a host of serious health risks, such as cardiovascular disease, obesity and even accidents—but long-term, population-based data on mortality overall have been lacking.
A new, 15-year-long study, published online yesterday in PLoS Medicine, followed 6,441 men and women—both with and without the condition—in the National Heart, Lung and Blood Institute's large Sleep Heart Health Study to see if there was any correlation between apnea and a higher risk of death.
During the course of the study, which followed up with subjects after an average of about eight years, 1,047 of the subjects died. After adjusting for age, race, body mass index (BMI) and smoking, the authors found that men ages 40 to 70 with severe apnea (defined as more than 30 incidents of disrupted breathing 10 seconds or longer per hour—8.2 percent of the cohort's men) had about one and a half times higher risk of dying from any cause than those who did not.
The other age, gender and apnea severity groups did not show a statistically significant increased risk, but that doesn't mean they will not be watched carefully. "Our study does not prove that women are not at risk," says Naresh Punjabi, lead study author and an associate professor of medicine at The Johns Hopkins Hospital in Baltimore. Not enough of them died or were ill enough to make a statistically sound connection, but researchers will continue to follow this cohort as long as funding allows, Punjabi notes.
The findings do not come as a surprise to the sleep research community. "It's long been believed that sleep apnea increases the rate of death," says David Schulman, an assistant professor of medicine at Emory University in Atlanta who wasn't involved in the study, noting that those with apnea are more likely to have high blood pressure and elevated cholesterol. But, he cautions, "it's hard to know for sure that apnea causes these diseases." Many of those with sleep apnea, he notes, tend to be male, older and overweight—increasing mortality rates overall—which makes it hard, he says, to conclude, "Was it the apnea, or was it that the guys were overweight and older?"
But the new research does fill an important hole in the data. Crucially, Punjabi notes: "The cohort is not patients. They actually represent individuals, people like you and me…. This is not a clinical study, but more of a community-based study." The authors even excluded those who, during the study, sought treatment for sleep apnea. Perhaps most important, it was a substantial group. "This is really the grandfather of all sleep–heart studies," Schulman says.
Punjabi and others look forward to formal clinical trials, in which researchers can start testing methods of intervention and treatment to see if they can bring the risk of mortality in check. "We do know for sure that treating apnea does make blood pressure better, but not vastly better," Schulman says. "In terms of things that kill people, heart disease is number one in this country," he notes, which makes any link with apnea a crucial line of research. "We'd love to know mechanistically why this happens."
Those with sleep apnea often suffer from increased sleepiness during waking hours, which can be dangerous when driving—or flying. Last year, two crew members overshot their Hawaiian destination on an inter-island flight after falling asleep when the plane was in cruise mode. No one was hurt, but the National Transportation Safety Board (NTSB) ruled that the pilot's undiagnosed sleep apnea was likely one of the causes. The NTSB has since recommended that the Federal Aviation Administration screen pilots for signs or previous diagnoses of the disease.
Another recent study, published last week in the Journal of Clinical Sleep Medicine, found that as many as 94 percent of adults with Down's syndrome had some sort of obstructive sleep apnea—and in 69 percent of those patients it was severe.
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6 Comments
Add CommentAs a former "middle aged", and now "elderly" person who was/is overweight, and has had heart disease (atrial fibrillation) and sleep apnea, I can share some of my own observations. While the sleep apnea was at its worst, just prior to being diagnosed with the heart problem, I noticed two things;
Reply | Report Abuse | Link to this1- That I experienced a lot of bloating
2- That I often experienced a "spine tingle" (similar to that felt during orgasm, although of lesser intensity)
Since being diagnosed with heart disease, I had been required to take diuretics to lessen the bloating that was caused by fluid retention. (As any doctor will tell you, this is S.O.P.) Shortly after I began taking the diuretics I noticed that I could breath much easier and that my nasal passages did not clog up with the frequency they formerly had. The sleep apnea disappeared, as did the "spine tingle".
When I went off the diuretics for a short time, both the spine tingle and the apnea came back.
When I returned to the diuretics they both went away again.
Had I known then what I now know, I'd have had my heart checked the instant I felt that tingle or experienced the heavy snoring precursor to apnea.
There really is a better way to deal with sleep apnea than CPAP or surgery. I spent 4 years studying sleep apnea and I believe that the root cause is due to the attenuation of the signal from the brain to the diaphragm muscles when the sleeper enters stage II sleep. This un-intended side-effect of the "reduction of muscle tonus" that occurs during this transition causes breathing to stop. Then, when the CO2 level gets too high, the sleeper makes a rapid inhalation DRAGGING the soft tissue into the airway, obstructing it and waking them up. The reduction of the signal from the brain is causing the problem.
Reply | Report Abuse | Link to thisSo... I found this herbal combination product that INCREASES the signal and keeps the breathing going. This addresses the root cause. The stuff is called Sleep Apnea Relief and I buy it from Nature's Rite. I've been using it for 4 years and it is really great. So you don't have to use CPAP. I just wanted to let you know.
naturesrite,
Reply | Report Abuse | Link to thisMay I ask if you are, in any way, associated with that company or those products?
Obviously he is, and in my opinion should not be giving medical advise. I don't think a herb is going to do anything! I have severe sleep apnea and would eventually die from it if I didn't use my bypass EVERY time I slept.
Reply | Report Abuse | Link to thisI have had the sleep apnea surgery and according to sleep studies I do not have sleep apnea, however I still sleep anywhere from 12-18 hrs a day. I can not stay awake. I have been on 412 medications over the last 2 yrs and seen many doctors including neuro, cardio, sleep, and internal medicine doctors. No one seems to know what is wrong with me. I have seizsure like spells and take an anti-seizure med, several as matter of fact. I have no answers. If anyone has any advice to share, it would be wonderful to hear.
Reply | Report Abuse | Link to thisI have had the sleep apnea surgery, and honestly I am not sure if it was worth it. I don't remember the surgery because I have short term memory loss, however from what my faily says it was a horrific ordeal. I still have problems today, 8 months later.I still sleep anywhere from 12-18 hrs a day, and that is if I even wake up that day or not. There are days I can not wake up. I can not talk or walk. I have seizure like activity, but no known seizure according to eeg reports and mri, and trust me when I say I have had my share. I may glow by now. In the past 2.5 yrs I have been on 412 different meds and none seem to work. I live with a daily migraine. No, I do not mean headache, I mean the pain of an ongoing migraine. Ihave tried every medication, diet change, anything and everything If anyone has any comment or advice, it would greatly be appreciated.
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