Steve, your and your wife's perfect storm of high stressors appropriately raises a blend of empathy, sympathy and compassion. Like so many, I too find it hard to find words for such trials and have too often not said anything for fear of saying the wrong clumsy thing (as I do and seem to have recently done with a PM to another member).
I will join others, I'm sure, praying for you and your wife, here at AB, and elsewhere.
I write you a book thinking some bit of it might help you interact with your care providers. Before drafting it, I tried to revisit the Pacemaker Club at pacemakerclub.com. Wanted to raise a question there about arrhythmia and SDB co-morbities, timings of and among them, but some glitch bars my way so far. I am surprised there has not been more responses to your post.
I've not been to PC for years. Thinking about your post, I did some searching, "SDB and arrythmia" and saw a number of papers tieing SDB with arrhythmia and other cardiovascular morbities. The following linked paper, "Diagnosis and Treatment of Sick Sinus Syndrome", deals with SS and its rhythm and other disturbances.
https://www.aafp.org/pubs/afp/issues/2003/0415/p1725.pdf I think we who have rhythm problems all would do well to read the piece.
I thank you for prompting my searching because I've been told of my SS but had never understood or dug into the matter. Among much else, the piece indicates rheumatic fever (RF) is among causes of SS. RF damaged my aortic valve leading to my TAVR and bovine valve implant.
On your subject question. In short, I believe my heart disease history (below) stands as one-man's evidence that his heart damage preceded acknowledgment and treatment of sleep disordered breathing. But though I had unrelated damage from childhood rheumatic fever, I believe my overall and heart health suffered sleep apnea at some level almost lifelong. But it was not debilitating, had no noticeable effects—insidious but not noticeable, I suppose, given that I was inured to it and may never have known what truly restful sleep was.
These next points offer some support to "lifelong" SDB. A sleep MD's notation of my somewhat large soft palate and base of the tongue; two sleep tests (one in 2010 another in 2024) caution against my natural still-preferred supine sleep; my tendency to have long OA's; my wife's history awakening and elbowing me to stop snoring from marriage 62 years ago onward (until she fled my new PAP noises and cold breezes for another bedroom 10 years ago).
Only at age 76 in 2015 my had heart damage reached the point I could not deny it. I was and am blessed with the fact newer procedures, device improvements, providers, PAP, ApneaBoard and our good Lord working through them has sufficed to address the damage and keep me upright and above ground.
My vascular cardiologist wants to get me off anticoagulants because of a brief respiratory bleeding event about 2 years ago. He is concerned about my continuing the lowest dosage of Eliquis because it may be too low, but he fears brain or other bleeds would come with a higher dosage, especially if I fell. He presses for me to get that Watchman device inserted to plug what (I'll say) is a "useless appendix-like cavity" in the left atrium. It's a backwater for forming clots in A-fib. An alternative would be to have the cavity banded outside to pinch it closed outside the heart. The latter would get me off anticoagulants almost immediately, the Watchman not for six months. On the other hand, my Elecrophysiologist, who chose, implanted and quarterly interrogates my pacemaker indicates I do not have A-fib, but I doubt he'd rule it out for the future. His earlier attempt at ablation was unsuccessful.
What follows describes my combination of heart disease developments that very slowly increased after my preschool rheumatic fever in 1945 (when heart murmur began as I also had—but later outgrew—asthma and troubling allergies.) I think that murmur figured in MD referrals and some of my tests through the years.
Post high school football years, USNavy (4 years), normal worklife, episodes of hard physical labor, annual high Sierra backpacking to 1992 (11,000 mountain passes, long trips, ergo heavy packs). I continue blessed without heart attack and enjoyed unimpaired physicality until about 1995 when the CMT toll became evident, leading to my early retirement at age 62 in 2011.
circa 1970-80: treadmill test revealed S-T cardiac wave depression and, within a few years, an early-CT scan to assessed calcification of my CAD plaque.
1985 Dx CMT (Charcot Marie Tooth degenerative nerve disease).
2010 complained to PCP of nocturia, was then—strangely it seemed—sent to have an in-lab sleep test: result was AHI 17, with desaturation to 81. PAP recommended. No arryhthmias. BP 108/80, PULSE 76, RES 12, HEENT: nasal and else normal except prominent soft palate and base of tongue. I blew results off thinking I slept too little all wired up. Retired 2011 at age 62.
August 2015 home sleep study: two nights RDI (AHI) 41.6 and 51.6, CAI 13.3; report "severe sleep apnea with [inferred? 2SB] significant oxygen desaturation." September began PAP treatment with AS10 Autoset, recommendation was CPAP set at 7.0 (disaster for a couple months ensued; total time, mostly with OA, reached 40% sleep time, oftentimes characterized as CSR. High numbers of 90 to 110 second OA's, longest of all was 155 seconds if a tiny blip of TV at 108 seconds is ignored.
December 2015 go to ER with suspected onset of heart attack. Became convinced I should have an immediate angiography that had been recommended earlier. Blockages triggered implant of back-to-back stents in my 80% blocked LAD. Another finding was need for a TAVR to replace my rheumatic fever damaged aortic valve, as was done May 2015. Sick Sinus had been diagnosed too, and that Dx was followed up August 2015 with implant of a rate adjusting, MRI-conditional pacemaker. July 2020: another stent was placed in the circumflex artery.
Ensuing in parallel to the preceeding: A sequence of usual Clopidegrel and then Eliquis anticoagulant and low dose aspirin plus BP medicines, Valsartan/HCTZ and/or Propranolol. Those were introduced along the way and all but Clopidegrel continue (with propranolol having an off-label side benefit reducing hand tremor.) After a December, 2019, TIA I've been on 141 mg Repatha injections biweekly. Have availed myself of local hospital's cardio rehab gymn the past 9 years: 3 cardio machines and 10 resistance machines, 135 minutes a week. Diet: lots of salmon and chicken, some beef and pork, lots of vegetables, fruit, nuts and pumpkin and sunflower seeds, all with reduced salt and mostly reduced dairy fats and cuts in carbos and sugars (do have "pre-diabetes" from earlier eating habits to about age 45.). BMI hovers for about 30 years at 23.
