Sleep apnea doubles risk of stroke, death - study

Reuters on Yahoo ^ | 11/09/05 | Gene Emery

[NormsRevenge]

BOSTON (Reuters) - The common form of sleep apnea, in which the throat closes off throughout the night, at least doubles the risk of stroke or death, a study released on Wednesday showed.

The researchers at Yale University also raised questions about whether existing apnea treatments reduced that risk, the study published in The New England Journal of Medicine showed.

A separate Canadian study also published in the journal concluded that breathing machines used to treat a form of apnea common in people with heart failure do not prevent death or the need for a heart transplant.

About 4 percent of Americans suffer from extreme daytime fatigue because their sleep is disrupted by sleep apnea, forcing them to repeatedly wake up if only for a second. Another 16 percent of Americans have apnea without fatigue.

A seven-year study, led by Klar Yaggi of the Yale University School of Medicine, found that people with apnea were twice as likely to die or have a stroke. The risk more than tripled among volunteers with the worst apnea.

The study involving 1,022 people also showed that the risk persisted even with treatment to keep the throat open during sleep, mostly through a continuous positive airway pressure (CPAP) machine. Other study volunteers lost weight or had surgery to ease their symptoms.

REDUCING CARDIOVASCULAR RISK

The results of the study notwithstanding, the machines are still worth it for people with apnea that produces excessive fatigue, Yaggi said.

"We're really treating you to improve how you feel. Walking around exhausted is a just a horrible quality of life," he said.

"But also we now are realizing that sleep apnea is an independent risk factor for cardiovascular disease, for high blood pressure, for heart disease, and also for stroke, and we believe and hope that treating you will help to reduce your cardiovascular risk, much like we would treat your cholesterol or your blood pressure or your diabetes."

The Canadian study evaluated 258 people with central sleep apnea, where fluid in the lungs caused by heart failure makes sleepers hyperventilate, which temporarily prevents the accumulation of enough carbon dioxide to trigger the breathing reflex. In short, people forget to breathe.

About one third of the 5 million Americans with heart failure also have central sleep apnea.

Douglas Bradley of the University of Toronto and his colleagues said they were surprised to find that heart failure patients with apnea who used CPAP machines were just as likely to die or receive a heart transplant as those who went untreated.

In fact, in the early part of the study, people breathing through CPAP machines seemed to fare worse.

Bradley told Reuters that heart failure patients are given the machines to drive water out of the lungs and reduce the work of breathing. They also may help the heart beat more effectively.

Although using the machines during the 5-1/2-year study did not help patients live longer, they did improve the efficiency of the heart and let patients exercise more.

"As long as it didn't cause any harm, those are the kinds of things we look to do when we treat patients with heart failure with other kinds of therapy," said Bradley.

[Caipirabob]

Does every heavy snorer have this?

No, but a high percentage of serious snorers do.

I don't snore much at all, and had sleep apnea. We have a fair idea that it lead to the death of my father and grandfather, who died in his sleep. Both were monumental snorers while I am not.

I use a CPAP to breath at night. I swore I would never use one, but I sleep so well now that I won't go to bed without putting it on. I think the device has saved me and given me some of the best sleep that I've had in year.

Seriously, if you know someone and suspect they have this, they need a sleep test.

[Caipirabob]

I don't have one of those nifty CPAPs because they're expensive and my insurance won't cover it ...

Hey there, fellow sufferer. Can you try to rent one? That's what my insurance does. It's better to rent it because they are sensitive devices and renting is like having a permanent warranty. Check it out and Freepmail me.

The problem is that you have to get it preset by your doctor. Following that I can recommend a unit and mask.

It will change your life.

these units are only $800-1200. It's definitely worth pursuing. I'll help with research. Let me know.

[Slump Tester]

Have you seen the mask with the front mounted hose that swivels 360 degrees?

WAY better than my old one! I can turn over and it stays on!

[listenhillary]

My insurance covered surgery for obstructive sleep apnea. I had to get a representative for the HMO to help them see the light.
I had chronically swollen tonsils and so I told them, it would be money well spent to fix the rest while they were in there. I managed to avoid the CPAP. I had a uvulectomy, tonsils removed, excess tissue in the throat removed and they fixed a deviated septum.

Best money that I've never spent in my life. Knowing what I do now, I'd pay for it out of my own pocket.

It does have mixed results in the success rate. Mine improved my sleep and life dramatically. An end to bruised ribs from my wife elbowing me in the ribs to get me to start breathing again.

If you have apnea, get it treated. You'll have more energy when you get good sleep.

[Nubbytwanger]

Sleep apnea is a potentially deadly disease. Unfortunately, what the NEJM article about the use of CPAP in heart failure really said was that it was totally useless and doesn't work for these people. The truth is that a significant number of apnea sufferers do not have obstructive sleep apnea but rather a different, more dangerous condition called complex sleep apnea. The problem is that CPAP is of little or no use in treating that form of the disease. Little wonder that more than half of all people who get a CPAP stop using it within weeks. Here is a link to something about complex apnea. I know, I have it myself and CPAP only made me worse. Now I sleep with a new kind of machine and I sleep great.

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=16217173&query_hl=1

[allen08gop]

Snoring is an indicator of Obstructive Sleep Apnea (OSA).

It does not mean that if you snore, even heavily, that you have OSA. However, virtually all OSA sufferers snore to some extent.

Pulse Oximetery devices are considered less than reliable for detection of OSA. They also have had a more difficult time with dark skinned people.

Bottom line: If you snore, you should be screened for OSA.

[allen08gop]

Hi Nipplemancer,

How do you know you have OSA? Did you go to a sleep lab?

There is more than one kind of SA though the current treatments are about the same.

[wolfcreek]

My Wife not only snores but, makes wheezing noises that drive me insane. She's lucky to be alive, apnea or not.

[WIladyconservative]

Wow - didn't realize there were so many apnea sufferers here.

I am married to one who uses a CPAP and it saved our marriage - I used to sleep down the hall with a pillow over my head and I could STILL hear him snore.

We call it the sleep-happy machine.

[GOPJ]

I don't have one of those nifty CPAPs because they're expensive and my insurance won't cover it because it's not 'medical necessity.'

If you live in a large city, start calling folks who are having "estate sales". My guess is you could pick up one cheap and have it renovated and cleaned. It's an outrage that a $19 machine would be sold for thousands of dollars. People understand unions ruined industry, but few understand how the AMA (the world strongest Union) ruined medical care. It's an outrage.

[allen08gop]

Hi,

You might try getting a prescription to a device used to see if you might have SA. It was about $50 but I am out of the country.

www.slp-med.com/SleepStripIntro.htm

This little device is quite effective screening for SA. I wore it overnight and when I woke up, I took it off to stop the test. You have to wait 30 minutes or so while the little display develops your score.

I showed no signs of SA but I'll be screening for it every few years since I fit the profile of a large neck size, a little over weight and over 40.

By the way, since veterens day is tomorrow, research shows that Vets are 4 times more likely to have SA than civilians.

Good luck.

[notsofastmyfriend]

I had the same surgery, but my main problem was an unusually large uvula. Post op was fun, wasn't it?

It seemed to completely cure my apnea, though I do still snore if I have any kind of congestion. I don't think my ENT quite got my septum right.

That said, I would gladly go through the surgery again tomorrow. It really changed my life.

[allen08gop]

Hi,

Wrong advice for OSA patients. They might find relief by sleeping on their side.

Sleeping on their back only makes the condition worse for patients with OSA as their throats close off due to gravity. The tongue moves back in the throat and you have an obstruction as one example.

[FNU LNU]

You'll need a perscription, and perhaps a sleep test before that, but buy your machine online and save about 80%. After 6 years, I just replaced my first machine. I shopped medical outlets here in Amarillo, saw my same machine for $1400, found the exact same machine online for $360.

The name of the outfit was CPCP Plus Direct, with which I have no affiliation.

They didn't get all the crooks during Watergate, you know...

[Jaysun]

Wrong advice for OSA patients. They might find relief by sleeping on their side.

Sleeping on their back only makes the condition worse for patients with OSA as their throats close off due to gravity. The tongue moves back in the throat and you have an obstruction as one example.

That makes sense. However, I was told just the opposite. I used to be a "belly snoozer" and forced myself to become a "ceiling gazer". My sleep seems to be much more effective now, although I only lay down for a few hours a night.

[cooldog]

Do you sleep on your back? If not, try that for starters.

Whoa!!! *BAD* advice ... on your side is the best way to keep your airway open. If I could always sleep on my side, I might not need my CPAP machine. This is common.