Sleep Apnea and Heart Failure
DEFINITION OF OBSTRUCTIVE SLEEP APNEA (OSA)
- OSA is a serious, potentially life-altering breathing disorder that occurs during sleep, and that may lead to life-threatening conditions.
- The upper airway repeatedly collapses, causing cessation of breathing (apnea) or inadequate breathing (hypopnea) and sleep fragmentation.
- Sleep fragmentation results in chronic daytime sleepiness.
- Patients with impaired cardiac function may suffer from sleep-related breathing disorders.
- 4% of men and 2% of women aged 30-60 (an estimated 20 million people) meet minimal diagnostic criteria for OSA with excessive daytime sleepiness. An even greater number of people have subclinical apnea/hypopnea during sleep.
- The majority of OSA sufferers remain undiagnosed and untreated.
POTENTIAL CONSEQUENCES IF OSA IS LEFT UNTREATED
- Decreased quality of life
- OSA patients, prior to diagnosis and treatment, consume 2 ½ times more health care resources than patients without OSA
- Cardiac arrhythmias
- Myocardial ischemia
- Myocardial infarction
- Increased risk of motor vehicle and work-related accidents due to sleepiness
SIGNS AND SYMPTOMS OF OSA
If a patient has two or more of the following signs and symptoms, it may be an indication of unidentified OSA.
Check the following that apply:
- Snoring, interrupted by pauses in breathing (apnea)
- Excessive daytime sleepiness
- Gasping or choking during sleep
- Restless sleep
- Intellectual deterioration
- Poor judgment/concentration
- Nocturnal angina
- Large neck/girth (>17” in men, >16” in women)
- Oropharyngeal crowding
- Nocturia or frequent urination at night
- Morning headaches
Ask your patients the following questions about their sleep. If two or more answers are positive, your patient should be evaluated for OSA.
- Are you sleepy during the day?
- Do you have disruptive snoring at night?
- Do you have pauses in breathing during the night?
- Do you wake yourself up choking or gasping?
If a patient’s signs and symptoms indicate the possibility of sleep apnea, evaluation by a physician specializing in sleep disorders is recommended. A sleep study is a painless test that provides information about how a patient breathes during sleep. The data that is collected will enable the physician to determine the type and severity of sleep apnea and treatment options.
Positive Airway Pressure (PAP) therapy is the treatment of choice for Obstructive Sleep Apnea. This therapy may include Continuous Positive Airway Pressure (CPAP), automatic CPAP, or bi-level positive airway pressure.
Less common treatments include surgery, body position modification, and oral appliances, which may be effective in certain individuals.
Any intervention should include lifestyle changes such as weight loss (if needed), good sleep hygiene, and avoidance of alcohol, sedatives and hypnotics.
IMPACT OF PAP THERAPY
PAP treats Obstructive Sleep Apnea by providing a gentle flow of positive pressure via an air mask. The positive pressure air splints the airway open during sleep to prevent airway collapse. This results in:
- Elimination of snoring and abnormal breathing events
- Absence of daytime sleepiness or fatigue
- Improved quality of life
- Decreased risk of developing common life-threatening conditions often associated with untreated OSA
OBSTRUCTIVE SLEEP APNEA IS A SERIOUS, POTENTIALLY LIFE-ALTERING HEALTH ISSUE THAT MAY LEAD TO LIFE-THREATENING CONDITIONS. IT IS EASILY IDENTIFIED AND CAN BE EFFECTIVELY TREATED.