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[News] Sleep Apnea & Sudden Cardiac Death
Sleep Apnea & Sudden Cardiac Death
Sleep Apnea and Sudden Cardiac Death

by Dr. Michael J. Breus, Clinical Psychologist; Board Certified Sleep Specialist

There's important news for people who suffer from obstructive sleep apnea and sleep-disordered breathing: new research has shown OSA may increase the risk of sudden cardiac death. A large-scale study of more than 10,000 adults over a period of 15 years found obstructive sleep apnea associated with a significantly increased risk of sudden cardiac death.

Researchers studied 10,701 adult men and women, all of whom had undergone a polysomnogram to diagnose possible sleep apnea. Among this group, 78 percent were ultimately diagnosed with OSA. The average age of those included was 53 at the study's outset. Researchers followed the participants over the next 15 years, to assess incidents of sudden cardiac events and their possible connection to obstructive sleep apnea. They found:

* Over the 15-year follow up period, 142 people experienced sudden cardiac arrest. In some cases this was fatal, while others were resuscitated.

* Researchers' analysis found people with OSA were at significantly greater risk of sudden cardiac death.

* The three strongest predictors of risk for sudden cardiac death were: being 60 years or older, having low blood oxygen levels, and having at least 20 episodes of apnea per hour.

Apnea episodes occur when, during sleep, muscles at the back of the throat close, temporarily obstructing the airway and interrupting breathing. These episodes, which result in poor and unrefreshing sleep, are the hallmark of OSA. The severity of obstructive sleep apnea is measured by the frequency of apnea episodes, which can vary from a few times to dozens of times in an hour. A rate of 20 episodes an hour is considered moderate sleep apnea.

An earlier study conducted by some of the same researchers found that among patients with obstructive sleep apnea, sudden cardiac death frequently occurred at night. This sets these patients strikingly apart from others who suffer cardiac death. For the general population, the risk of sudden cardiac death is greatest during the morning hours. This previous study involved a review of 112 cases of sudden cardiac death in people who had also undergone polysomnography to diagnose possible sleep apnea. Researchers compared the timing of these cardiac events among those with OSA to those in the study without OSA, the general population, as well as to the expectations of chance. They found:

* Between the hours of midnight and 6 a.m., sudden cardiac death occurred in 46 percent of people with OSA, compared to 21 percent of those without OSA, 16 percent of the general population, and 25 percent expected by chance alone.

* People who suffered sudden cardiac death during the hours of midnight and 6 a.m. had more severe sleep apnea than those who experienced sudden cardiac death at other times.

* Analysis revealed that the risk of sudden cardiac death during these overnight hours was directly associated with obstructive sleep apnea.

This study was the first one to establish a directly link between OSA and sudden cardiac death. The current research both confirms and also expands evidence of this connection. Neither of these studies established a cause-and-effect relationship between sleep apnea and sudden cardiac death. But they do indicate a strong association between the two.

More than 18 million Americans suffer from obstructive sleep apnea, according to the National Sleep Foundation. The actual figure may be even higher, since there are strong indications that OSA is seriously under-diagnosed, especially among women. Sudden cardiac death strikes between 180,000 to 450,000 people a year in the United States, according to the American Heart Association. Obesity is a primary risk factor for obstructive sleep apnea, and also puts people at higher risk for sudden cardiac death. The other cardiovascular conditions associated with sleep apnea, including cardiac arrthymias and high blood pressure, also elevate risk for sudden cardiac death. In discussing their results, researchers suggest that the presence of sleep apnea may be a "tipping point" in the accumulation of risk factors for sudden cardiac death.

There's a great deal more to learn about this connection, including whether treatment for OSA, including continuous positive airway pressure therapy (CPAP), is effective in reducing risk for sudden cardiac death among patients with sleep apnea. Research has shown CPAP therapy reduces risk for other cardiovascular conditions, including high blood pressure and heart disease. So there is reason for optimism that similar benefits might extend to the risk of sudden cardiac death.

This news provides yet another reason why it's important not to ignore symptoms of obstructive sleep apnea in yourself or your partner. Snoring, daytime tiredness, and fatigue are among the most common symptoms. If you experience these symptoms, talk to your doctor. Tending to your sleep can help you protect your heart.

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RE: Sleep Apnea & Sudden Cardiac Death
Does it mention if anyone they studied were using the CPAP? I have a headache and can't read much right now.

Take a deep breath and count to zen.

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RE: Sleep Apnea & Sudden Cardiac Death
(07-18-2013, 06:15 PM)PaulaO2 Wrote: Does it mention if anyone they studied were using the CPAP? I have a headache and can't read much right now.

It sounds to me like the study was comprised of folks who were not on CPAP.
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RE: Sleep Apnea & Sudden Cardiac Death
Well, when the heck are they ever going to do a study on how WELL a CPAP prevents such stuff??!!

Take a deep breath and count to zen.

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RE: Sleep Apnea & Sudden Cardiac Death
Actually, it read to me as if all they took into account was the result of that sleep study. Whether the patients went on to use CPAP or not did not seem to matter. In fact, they had a paragraph where they lamented that there was no study on whether CPAP therapy improved the situation or not.
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RE: Sleep Apnea & Sudden Cardiac Death
It is a little soon for a definitive result on how CPAP is effective in this respect. A 25 year study is the minimum for this, and even then, because of how new CPAP is, the results from early patients will be inconclusive, since both methods and technology have massively improved since the introduction of the therapy. But early numbers (ten year baseline studies) are showing promise, to some extent.
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RE: Sleep Apnea & Sudden Cardiac Death
One also has to be careful about correlation vs causality. For example, because I am overweight, I am more likely to have OSA. Additionally, because I am overweight, I am more likely to have cardiac problems. But the OSA is not (necessarily) _causing_ the cardiac problems, even though the cardiac problems would be correlated with OSA (because of a common cause). And, of course, in the simplified situation above, whether or not I treated my OSA with CPAP would not affect the statistics.
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RE: Sleep Apnea & Sudden Cardiac Death
WOW! they have talked about this for so long. Even celebrity deaths like Mama Cass Eliott from Mamas and Papas have been put forward as being linked. How many people have died? We will never know.

This is potentially massive because it raises issues of professional competence/liability if doctors or insurance companies try to withhold treatment or don't take it seriously.

Here in Britain all medical care is free, a slightly bizzare state of affairs which isn't as great as it sounds. Many SA sufferers over here are being given the cold shoulder by the clinical establishment because it is regarded as low priority. Stuff like this means they can kick A$$
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RE: Sleep Apnea & Sudden Cardiac Death
I remember a co-worker in the 1980's, young guy (40's), very overweight, but no other health problems. Died in his sleep of "natural causes". Natural causes? Makes you wonder. /Jeff/
To err is human, but to really mess things up, you need a computer.
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