The Dangers of Uncontrolled Sleep Apnea

Severe Sleep Apnea Linked to Resistant Hypertension

The Dangers of Uncontrolled Sleep Apnea | Johns Hopkins Medicine

Severe obstructive sleep apnea may interfere with blood pressure (BP)–lowering treatment in patients at high cardiovascular disease risk or with established cardiovascular disease, results of a multicenter clinical trial suggest.

Doctors should consider that severe obstructive sleep apnea (OSA) may be the reason why they cannot get their hypertensive patients to respond to optimal antihypertensive treatment, lead author, Harneet Walia, MD, from the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, told Medscape Medical News.

“We found an association between severe untreated obstructive sleep apnea and resistant elevated BP, despite the use of antihypertensive medications in patients who have cardiovascular risk or cardiovascular disease,” Dr Walia said.

“If someone has high BP and it is resistant to antihypertensive medication, this should be one of the warning signs telling the physician to screen that patient for severe obstructive sleep apnea,” she said.

Dr. Harneet Walia

Their findings were published in the September issue of the Journal of Clinical Sleep Medicine.

HeartBEAT Trial

Dr Walia and her team analyzed data from the baseline examination of the patients participating in the Heart Biomarker Evaluation in Apnea Treatment (HeartBEAT) multicenter randomized controlled trial.

The goal of the HeartBEAT trial is to compare conservative medical therapy, supplemental nocturnal oxygen therapy, and positive airway pressure therapy on cardiovascular biomarkers in OSA. Participating sites are Brigham and Women's Hospital, Case Medical Center, Johns Hopkins Medical Center, and Veterans Affairs Boston Healthcare System.

Their analysis included 284 HeartBEAT participants (mean age, 63 years [range, 56 – 70 years]).

Of these patients, 23.6% had severe OSA, as defined by a score on the apnea hypopnea index (AHI) of 30 or greater; 61.6% (175 patients) had controlled BP, 28.5% (81 patients) had uncontrolled elevated BP (≥130/80 mm Hg), and 9.9% (28 patients) had resistant elevated BP. Blood pressure values were obtained from ambulatory BP monitoring.

Among patients receiving an intensive antihypertensive regimen, resistant elevated BP was more prevalent in those with severe obstructive sleep apnea (58.3%) than in those with moderate obstructive sleep apnea (28.6%) (P = .01).

Patients with severe obstructive sleep apnea had a 4-fold higher odds of resistant elevated BP despite receiving an aggressive antihypertensive mediation regimen, even after consideration of well-recognized hypertension risk factors, including age, sex, race, body mass index, smoking, diabetes mellitus, and cardiovascular disease (adjusted odds ratio, 4.1; 95% confidence interval [CI], 1.7 – 10.2).

CPAP Plus Spironolactone?

In an accompanying Commentary in the same issue, Susan M. Harding, MD, from the University of Alabama, Birmingham, discusses some of the mechanisms that may drive this relationship and suggests it may be bidirectional.

Of note is the fact that in this cohort, none of the 28 participants with elevated blood pressure despite intensive antihypertensive treatment was receiving an aldosterone blocker, she writes.

“Our laboratory has noted a correlation between plasma aldosterone levels and OSA severity in resistant HTN [hypertension] patients.

We also observed that spironolactone reduced OSA severity in these patients, despite remaining on a thiazide diuretic,” Dr Harding writes.

“Aldosterone excess mediates chronic fluid retention, so our data support the hypothesis that aldosterone-mediated chronic fluid retention could impact (worsen) OSA severity.”

Further, their group found that increased dietary sodium correlated with sleep apnea severity in patients with resistant hypertension and hyperaldosteronism, she added.

“Although this finding needs to be verified in a randomized controlled trial, we postulate that the aldosterone-induced worsening of OSA may be mediated through increased fluid retention in the surrounding soft tissues of the upper airway.”

Other researchers have also found a “significant spontaneous fluid shift” from the legs to the neck during sleep in patients with drug-resistant hypertension, she points out, which may partly explain the more severe sleep apnea in those with resistant hypertension, she notes.

Previous work has shown that 12 weeks of CPAP therapy can result in a “mild” reduction of 3.1 mm Hg in the mean 24-hour BP in patients with resistant hypertension, and an AHI or more than 15/hour, change that can reduce cardiovascular risk, she concludes.

“Since spironolactone has the potential to improve BP control and AHI in patients with resistant HTN, spironolactone should be considered, along with CPAP therapy, in these patients,” Dr Harding concludes. “Future research will define the best management strategies for OSA patients with resistant hypertension; hopefully it will not take another 30 years.”

Aggressive Management

Commenting on this study for Medscape Medical News, Mary Ann Bauman, MD, medical director for Women's Health and Community Relations, INTEGRIS Health, Oklahoma City, Oklahoma, said the study raises an interesting question about patients with cardiovascular disease and severe OSA.

“These patients were taken from cardiologists' practices, and presumably the cardiologists were being very aggressive with their antihypertensive management. The criteria for BP control, 130 over 80, is very strict but is considered appropriate for patients with cardiovascular disease,” Dr Bauman said.

She added that she would to see more evidence that treating severe OSA would indeed make a difference in patients with significant cardiovascular disease.

Also, Dr Bauman observed, from her standpoint as a primary care physician, treating sleep apnea is often problematic.

“It is often very difficult to get patients to continue treatment for sleep apnea. Some patients those CPAP [continuous positive airway pressure] machines, but many patients hate them.

They feel they are choking when they use them, the machines make it uncomfortable to sleep with a partner, those kinds of things,” she added.

“So I think we do want to know if treating sleep apnea really helps with BP control.”

“If we have convincing data that treating severe obstructive sleep apnea actually does result in improved BP control, and as a result, improved cardiovascular disease risk, it may be an incentive to get patients off of their intensive antihypertensive regimens where they are taking 3 meds. They may be willing to give CPAP a try and persevere with it.”

Also commenting on the findings, Shirin Shafazand, MD, from the Division of Pulmonary Critical Care and Sleep Medicine, University of Miami, Miller School of Medicine, Florida, noted that the study adds to the existing body of literature that suggests a significant association between obstructive sleep apnea and hypertension.

Dr Shafazand points out that the study was not able to compare patients with severe OSA to those with mild or no OSA and that it did not evaluate the effect of CPAP therapy, the gold standard of therapy for obstructive sleep apnea, on BP.

She cited a recent study (JAMA. 2013;310:2407-2415) suggesting that among patients with OSA and resistant hypertension, CPAP treatment for 12 weeks compared with controls resulted in a decrease in 24-hour mean and diastolic BP and an improvement in the nocturnal BP pattern.

“The mean improvement in 24 hour BP measurements was around 3 mmHg,” she told Medscape Medical News. “This is in keeping with several other studies looking at BP and OSA treatment.

The cumulative literature to date appears to support the authors conclusions that for patients, especially those at high CV [cardiovascular] risk, with resistant hypertension on 3 or more medications, diagnosing and treating severe OSA ly has a beneficial impact on BP control.”

The study was supported by the National Institutes of Health National Heart Lung Blood Institute. Dr Walia, Dr Bauman, Dr Harding, and Dr Shafazand have disclosed no relevant financial relationships.

J Clin Sleep Med. 2014;10:835-843. Abstract Editorial


Sleep Apnea: An Often Hidden & Dangerous Condition

The Dangers of Uncontrolled Sleep Apnea | Johns Hopkins Medicine

For many of those who suffer, sleep apnea is a hidden condition. People might go for years, or even decades, before officially being diagnosed with this condition.

And ignoring this condition doesn’t come without its consequences. According to Johns Hopkins Medicine, uncontrolled sleep apnea could be a cause of habitual distracted behavior, mood swings, and loss of productivity. Studies have also shown a link between sleep apnea and a host of dangerous, even life-threatening problems, such as diabetes, strokes, and even heart attacks.

So what is sleep apnea? How can it be diagnosed? And most importantly, what can be done to treat it?

The Root of the Problem

According to the National Sleep Foundation, sleep apnea is a condition in which breathing is interrupted for short durations throughout sleep. The interruption is brief but significant: lasting for at least ten seconds.

The condition is also called “obstructive sleep apnea” because breathing is obstructed, where the muscles located in the back of the throat/upper airway “fail” and do not allow for a normal breathing pattern.

(Note: Some may be afflicted with a different variant of the condition – “central sleep apnea” – in which the brain fails to control the breathing muscles properly, during sleep.)

Evidence of the Problem

As discussed briefly, sleep apnea may result in feeling distracted during the day, mood swings, and more… so if you’re experiencing some of those issues, you might not want to rule out this condition.

You may also find more obvious evidence if you sleep with a bed partner, or if you record yourself while you’re sleeping; those with sleep apnea may often snore or even make frightening “choking sounds” as they struggle to take in air.

Sufferers of sleep apnea may wake up with a headache, from an insufficient nightly air intake; or they may immediately need water, as their mouths might be incredibly dry.

Some people who suffer from sleep apnea may find it very difficult to stay awake during the day – resorting to naps or quick “shut-eye” sessions to restore some semblance of wakefulness.

Diagnosing the Problem

You never want to self-diagnose sleep apnea; your nightly breathing problems, snoring, or dry mouth might have a different cause. But if you suspect you might have sleep apnea, we urge you to see a doctor. You may need to engage in a sleep study in which measurements are taken throughout the night in a sleep study facility.

Cases of sleep apnea can range from mild to severe, as diagnosed by a doctor, and are the severity and number of breathing pauses you experience throughout sleep.

Treating the Problem

This is not a problem you want to treat on your own.  As discussed earlier, sleep apnea can lead to chronic and/or dangerous consequences, including diabetes, stroke, and even cardiac issues.

Many people diagnosed with sleep apnea are prescribed a CPAP machine, which is a “continuous positive airway pressure” machine. Not only can this machine improve sleep, but it can also reduce the risk potential for other chronic illnesses. People using CPAP machines frequently find themselves needing fewer naps or rest periods throughout the day.

There are three types of CPAP machines that doctors typically recommend to their patients:

  • Nasal CPAP mask: This covers the nose from the upper lip area to the bridge, and works well for those who move around in their sleep. It doesn’t work well for people who breathe through their mouth.
  • Nasal Pillows: These work well for people who want minimal facial coverage, as they are less restrictive.
  • Full Face CPAP machines: These are more restrictive but work well for mouth-breathers. They also work well for users who may sleep on their back.

It’s important not to mess around with your sleep; if you think you might have sleep apnea, contact your doctor.

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Severe Sleep Apnea: Symptoms, Risk Factors, Treatment, and More

The Dangers of Uncontrolled Sleep Apnea | Johns Hopkins Medicine

Obstructive sleep apnea is a severe sleep disorder. It causes breathing to stop and start repeatedly while you sleep.

With sleep apnea, the muscles in your upper airway relax while you’re sleeping. This causes your airways to become blocked off, keeping you from getting enough air. This may cause your breathing to pause for 10 seconds or longer until your reflexes initiate breathing to restart.

You’re considered to have severe sleep apnea if your breathing stops and restarts more than 30 times an hour.

The apnea-hypopnea index (AHI) measures obstructive sleep apnea to determine a range from mild to severe, the number of breathing pauses per hour you have while sleeping.

Read on to learn more about severe sleep apnea and how it’s treated.

According to the Nolo legal network, the Social Security Administration (SSA) doesn’t have a disability listing for sleep apnea. It does, however, have listings for breathing disorders, heart problems, and mental deficits that might be attributed to sleep apnea.

If you don’t qualify for the conditions listed, you may still be able to receive benefits through a Residual Functional Capacity (RFC) form. Both your doctor and a claims examiner from Disability Determination Services will fill out an RFC form to determine whether you’re able to work due to:

  • your sleep apnea
  • the symptoms of your sleep apnea
  • the effects of those symptoms on your day-to-day life

You are at a higher risk for obstructive sleep apnea if:

  • You have overweight or obesity. Although anyone can have sleep apnea, obesity is considered by the American Lung Association (ALA) to be the most important risk factor. According to Johns Hopkins Medicine, sleep apnea affects over 20 percent of people with obesity compared to about 3 percent of people of moderate weight. According to the Mayo Clinic, obstructive sleep apnea can also be caused by conditions associated with obesity, such as polycystic ovary syndrome and hypothyroidism.
  • You’re male. According to the ALA, men are 2 to 3 times more ly to have obstructive sleep apnea than premenopausal women. The risk is about the same for men and postmenopausal women.
  • You have a family history. If obstructive sleep apnea has been diagnosed in other family members, according to the Mayo Clinic, you may be at higher risk.
  • You’re older. According to the ALA, obstructive sleep apnea becomes increasingly frequent as you age, leveling off once you reach your 60s and 70s.
  • You smoke. Obstructive sleep apnea is more common in people who smoke.
  • You have certain medical conditions. Your risk of developing obstructive sleep apnea may increase if you have high blood pressure, diabetes, or asthma.
  • You have chronic nasal congestion. Obstructive sleep apnea occurs twice as often in people with chronic nasal congestion at night.
  • You have a crowded pharynx. Anything that makes the pharynx, or upper airway smaller — such as large tonsils or glands — can result in a greater chance for obstructive sleep apnea.

The ASAA estimates that between 1 and 4 percent of American children have sleep apnea.

Although surgical removal of the tonsils and adenoids is the most common treatment for pediatric obstructive sleep apnea, positive airway pressure (PAP) therapy and oral appliances are also prescribed.

Make an appointment with your doctor if you’re exhibiting any of the symptoms of obstructive sleep apnea, especially:

  • loud, disruptive snoring
  • episodes of stopped breathing while sleeping
  • abrupt awakenings from sleep that are frequently accompanied by gasping or choking

Your doctor may refer you to a sleep specialist, a medical doctor with additional training and education in sleep medicine.

Treatment for severe obstructive sleep apnea includes lifestyle changes, therapies and surgeries, if needed.

Lifestyle changes

Those with an obstructive sleep apnea diagnosis will be encouraged to, if necessary:

  • maintain a moderate weight
  • quit smoking
  • participate in regular exercise
  • reduce alcohol consumption


Your doctor may recommend surgery, such as:

  • uvulopalatopharyngoplasty (UPPP) to remove tissue to create space
  • upper airway stimulation
  • jaw surgery to create space
  • tracheostomy to open the neck, usually only in the case of life-threatening obstructive sleep apnea
  • implants to reduce upper airway collapse

Severe obstructive sleep apnea is a serious sleep disorder that involves breathing that repeatedly stops and starts while you sleep.

Obstructive sleep apnea left untreated or undiagnosed can have serious and life-threatening consequences. If you’re experiencing any symptoms, make an appointment to see your doctor for a diagnosis and treatment options.


4 Dangers of Sleep Apnea That May Surprise You

The Dangers of Uncontrolled Sleep Apnea | Johns Hopkins Medicine

While excessive snoring can be a problem for your partner, it may signal something more serious for some people. It could mean you have sleep apnea.

It is estimated that nearly 22 million Americans suffer from sleep apnea each year. Sleep apnea happens when upper airway muscles relax during sleep, pinching the airway and preventing you from getting enough air.

With each signal failure, the brain awakens the sleeper in small bouts to signal for breathing to resume. These pauses can last from a few seconds to a minute or more. As a result, the quality of sleep is poor and can affect your health in various ways.

Unexpected health dangers

While obesity is the main factor for sleep apnea, there are many potential risks that make people more prone to sleep apnea, including age, smoking, and family history. It’s important that you know the associated dangers of untreated sleep apnea.

High blood pressure

When blood oxygen drops suddenly and frequently, as it often does with this condition, it can increase the blood pressure and strain your cardiovascular system. Overall, this problem increases your chances of hypertension, a condition where the force of blood against the artery walls is too high.

Heart diseases

Along with high blood pressure, other associated risks could include chronic heart failure, atrial fibrillation, stroke, and other cardiovascular problems. In fact, according to the Journal of Clinical Sleep Medicine, obstructive sleep apnea increases the risk of heart failure by more than 100 percent and the chance of stroke is increased by 60 percent of those with the condition.

Traffic accidents

Because your breathing is interrupted during periods of rest, the lack of oxygen to the brain can lead to poor sleep and grogginess upon waking.

This drowsiness can be persistent, and in some cases, lead to car accidents and other potentially hazardous situations.

According to the 2015 study by the American Academy of Sleep Medicine (AASM), those with sleep apnea were nearly 2.5 times more ly to be the driver in a motor vehicle accident.

Teeth Grinding

Sometimes, people begin grinding their teeth with sleep apnea because the tense jaw and sensation can signal the brain to wake up so you can breathe. Other signs in the mouth could include dry mouth, tongue with scalloped edges or redness in the throat as a result of mouth breathing.

How can a dental professional help with sleep apnea?

While some doctors may recommend wearing a nightly CPAP, continuous positive airway pressure, machine to help you breathe better, other treatments may include custom-fitted mouth appliances, such as a nighttime guard or mandibular advancement device.

These devices can push the lower jaw or tongue forward and stimulate nerves to help keep airways open. This treatment can be effective and non-invasive. Many people consider oral appliance therapy to be comfortable, quiet, and easy to wear, care for, and travel with.

The last thing you want to do is put your heart and health at risk, or cause additional stress to your mouth or oral health. Our trained dental professionals in Huntington, Long Island can assess your situation and advise you as to whether an oral appliance can help you get a better night’s rest.

Contact Dr. Elliot and Dr. Nick at Long Island Implant and Cosmetic Dentistry to find out about sleep apnea treatment in Huntington, LI, and to start moving towards a healthier you.


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Sleep Apnea Sufferers: Dental Solutions to Help Improve Quality of Life

The Dangers of Uncontrolled Sleep Apnea | Johns Hopkins Medicine

© kudosstudio / Adobe Stock

Do you find yourself waking up during the night because you snore, and it is affecting you and your partner? Have you ever had to watch your child sleep and fear that your child will stop breathing due to pauses in breathing during their sleep? Snoring and pauses in breathing during sleep can be one of the first signs of sleep apnea. It is estimated that over 18 million Americans suffer from sleep apnea, and over 80% of people are untreated.3

What is Sleep Apnea?

According to the Mayo Clinic, sleep apnea is defined as a potentially serious sleep disorder in which breathing repeatedly stops and starts. Sleep apnea is a sleep breathing disorder characterized by interruptions of breathing during sleep.

“Apnea” is a Greek word for “no breathe,” where a person stops breathing for up to 10 seconds with each pause.2 There are many different types of sleep apnea, but the most common is obstructive sleep apnea (OSA).

2 If left untreated, it can cause serious medical complications such as heart attack, stroke, and even death.

Symptoms of Sleep Apnea 

  • Loud snoring
  • Teeth grinding or clenching
  • Excessive tiredness during the day
  • Observed episodes of stopped breathing during sleep
  • Constant awakening during sleep due to gasping or choking
  • Dry mouth or sore throat
  • Morning headaches
  • High blood pressure
  • Nighttime sweating
  • Depression, mood swings, or irritability

Research shows that you may have an increased risk of sleep apnea if you have diabetes, high blood pressure, or are considered overweight.6 You can have one or more of these symptoms and suffer from mild to severe sleep apnea. If you suffer from any of the symptoms, ask your doctor or dentist about sleep apnea. Detecting this condition can improve your health, your daily activities, and your mental and physical wellbeing. It can even increase your lifespan.

How to Treat Sleep Apnea

The most effective way to treat sleep apnea is with a CPAP machine. But many people cannot tolerate the machine, and other options are available. The next option could be a dental sleep apnea appliance from your dentist. Many dental professionals are trained in treating sleep apnea, and dental professionals are experts and highly qualified to check your mandible for an optimal airway.

As dental hygienists, we are trained to provide an extra- and intraoral exam on the head and neck during hygiene visits. With this exam, we are able to check for visual signs and symptoms that could potentially cause this condition.

We look for signs of grinding and clenching of your teeth, and we check the size of your tonsils and uvula to see if they are enlarged and blocking the airway. We check for swollen lymph nodes, and we check your medical history for diabetes and high blood pressure.

We will also ask if you snore or have ever had a sleep test done − a polysomnography.

After the dental hygienist’s evaluation, the dentist will review findings prior to their examination. This helps our dentists to evaluate if the patient would benefit to have a sleep test done, which can be done at home or in a medical facility. Once results come back, dentists can decide if a dental sleep appliance would be a viable solution.

What is a Dental Sleep Appliance?

A dental sleep appliance is called a mandibular advancement device (MAD). It looks a mouthguard that people use when they play sports. But this device snaps over the upper and lower dental arches and has metal hinges that make it possible for the lower jaw to be moved forward, which helps to open the airway. Some appliances allow the dentist to control the degree of advancement.4

This is a great alternative for those who cannot tolerate a CPAP machine. It also can be another less invasive way to prevent having surgery to open up the airway. The American Academy of Dental Sleep Medicine recommends that if you get fitted for a dental sleep appliance, you will want to make sure you get regular checkups to make sure it is working and for adjustments if needed.5

There are some disadvantages with wearing a dental sleep appliance. But the small disadvantages outweigh the chance to relieve airway blockage. The impediments may be dry mouth, excessive salivary flow, soreness, or maybe a slight change in your bite. These can be adjusted and improved with your dentist’s help.

The goal of a dental sleep appliance is to open your airway so you can breathe better at night and get better quality sleep. Many medical (not dental) insurance companies can help with the cost of this dental sleep appliance treatment if proper medical information and determination are sent to their medical insurance company.7

Sleep plays a vital role in good health and wellbeing. During sleep, our bodies work to fight infection and work to support healthy brain function. It also helps to maintain better physical health. Sleep deprivation, over time, has been associated with a shortened lifespan.

Your dental professional does not just provide a healthy smile or optimal oral health; they can improve your overall health.

So if you believe that you may suffer from sleep apnea, ask your dental professional about any sleep apnea concerns, so you can enjoy a good night’s sleep and add some extra years to your life.

Now Listen to the Today’s RDH Dental Hygiene Podcast Below:



Untreated sleep apnea shown to raise metabolic and cardiovascular stress

The Dangers of Uncontrolled Sleep Apnea | Johns Hopkins Medicine

Sleep apnea, left untreated for even a few days, can increase blood sugar and fat levels, stress hormones and blood pressure, according to a new study of sleeping subjects.

A report of the study's findings, published in the August issue of The Journal of Clinical Endocrinology & Metabolism, adds further support for the consistent use of continuous positive airway pressure (CPAP), a machine that increases air pressure in the throat to keep the airway open during sleep.

“This is one of the first studies to show real-time effects of sleep apnea on metabolism during the night,” says Jonathan Jun, M.D., assistant professor of medicine at the Johns Hopkins University School of Medicine and the paper's senior author.

Obstructive sleep apnea (OSA) affects 20 — 30 percent of adults, according to studies published in the American Journal of Epidemiology and Lancet Respiratory Medicine.

It occurs when the upper airway closes off during sleep, temporarily interrupting breathing.

While it is known that OSA is associated with risks for diabetes and heart disease, there has been no consensus on whether OSA is a cause of these disorders or just a marker of obesity, which predisposes one to diabetes and heart disease.

Previous metabolic studies in patients with OSA, the Johns Hopkins researchers say, usually collected data while participants were awake, thus obtaining only a snapshot of OSA's aftermath, not the actual sleep period when OSA occurs.

To better understand how OSA affects metabolism, researchers measured free fatty acids in the blood, glucose, insulin and cortisol (a stress hormone) while participants slept in a sleep laboratory at the Johns Hopkins Bayview Medical Center. Participants' brain waves, blood oxygen levels, heart rates and breathing, along with eye and leg movements, were also recorded each night of the study.

In total, Jun and colleagues drew blood samples from 31 patients with moderate to severe OSA and a history of regular CPAP use for two nights. The researchers drew samples every 20 minutes starting at 9 p.m. and until 6:40 a.m. Every participant spent one night at the lab with CPAP or after CPAP had been stopped for two nights, in random order, separated by one to four weeks.

The average age of all participants was 50.8 years old and the average body mass index indicated obesity, a common characteristic of those with sleep apnea.

Two-thirds of the study group was male and a quarter had a history of non-insulin dependent diabetes. Some 22.6 percent of participants were African American, 9.7 percent Asian, 64.5 percent Caucasian and 3.2 percent Hispanic.

Jun and colleagues found that CPAP withdrawal caused recurrence of OSA associated with sleep disruption, elevated heart rate and reduced blood oxygen. CPAP withdrawal also increased levels of free fatty acids, glucose, cortisol and blood pressure during sleep. The more severe the OSA, the more these parameters increased.

In addition, glucose increased the most in patients with diabetes. Increases in fatty acids, glucose and cortisol have all been linked to diabetes. The Johns Hopkins team also found that blood pressure increased and the arteries showed signs of stiffness in the morning without CPAP.

Over time, increased blood pressure and vascular stiffness can contribute to cardiovascular disease.

Jun emphasized that the study was limited by studying people with severe OSA and obesity, thus limiting the ability to apply the findings to all OSA patients. The researchers also did not compare CPAP use to a sham CPAP control group to exclude a potential placebo effect.

But Jun says that the study provides further evidence that sleep apnea isn't just a manifestation of obesity, diabetes and cardiovascular disease — it can directly aggravate these conditions.

They are continuing to recruit patients in order to answer more questions about which patients are most vulnerable to the impacts of OSA.

This study emphasizes the importance of CPAP therapy for OSA to prevent its metabolic and cardiovascular consequences. Sometimes, patients with OSA have a hard time tolerating CPAP. It is important that these patients contact a sleep specialist who can assist them with CPAP use, or who can recommend alternative therapies.

Story Source:

Materials provided by Johns Hopkins Medicine. Note: Content may be edited for style and length.


Johns Hopkins study adds to evidence that sleep apnea causes cardiovascular, metabolic stress

The Dangers of Uncontrolled Sleep Apnea | Johns Hopkins Medicine

Untreated sleep apnea can contribute to a range of conditions associated with heart disease and diabetes, according to a new study conducted by Johns Hopkins Medicine researchers.

The study found increases in blood sugar, fat levels, stress hormones, and blood pressure in patients with obstructive sleep apnea—a condition that affects 20 to 30 percent of adults.

The study found increases in blood sugar, fat levels, stress hormones, and blood pressure in patients with obstructive sleep apnea—a condition that affects 20 to 30 percent of adults.

The findings, published in this month's issue of The Journal of Clinical Endocrinology & Metabolism, may help to refine the scientific debate over whether sleep apnea is just a manifestation of obesity, or in fact an active contributor to associated health problems diabetes and heart disease.

While the link between sleep apnea and these diseases is well known, study senior author Jonathan Jun, an assistant professor at the Johns Hopkins University School of Medicine, says the new findings add to evidence that sleep apnea can directly aggravate the health problems.

The report also emphasizes the importance of CPAP, or continuous positive airway pressure, as a treatment solution. CPAP machines increase air pressure in the throat to prevent sleep apnea's effect of closing off the upper airway and interrupting breathing.

As opposed to many previous studies that collected data from participants who were already awake, the Johns Hopkins teams studied patients while they were sleeping.

“This is one of the first studies to show real-time effects of sleep apnea on metabolism during the night,” Jun says.

Researchers found that withdrawing CPAP in the sleeping patients increased levels of free fatty acids, glucose, and cortisol (a stress hormone)—all conditions linked to diabetes. The more severe the sleep apnea, the more these parameters increased. The team also found increases in blood sugar and vascular stiffness, two conditions that can contribute to cardiovascular disease over time.

Jun emphasized that the study was limited in analyzing patients with severe obstructive sleep apnea and obesity. But the team is continuing to recruit patients in order to produce findings with broader applicability.

The report highlights consistent use of CPAP therapy as an important way to prevent the metabolic and cardiovascular consequences of sleep apnea. During the study, CPAP withdrawal caused recurrence of obstructive sleep apnea associated with sleep disruption, elevated heart rate, and reduced blood oxygen.

For patients with a hard time tolerating CPAP, researchers recommend working with sleep specialists who can assist with the machine or recommend alternative therapies.

Read more from Johns Hopkins Medicine

Posted in Health

cardiovascular health, sleep, diabetes, sleep apnea


Obstructive Sleep Apnea

The Dangers of Uncontrolled Sleep Apnea | Johns Hopkins Medicine

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Obstructive sleep apnea occurs when your breathing is interrupted during sleep, for longer than 10 seconds at least 5 times per hour (on average) throughout your sleep period.

These periods are called hypopneas when your breathing is reduced and you're not taking in enough oxygen. They're called apneas if your breathing completely stops.

Your breathing typically stops because something is blocking your upper airway, such as the muscles, tongue, and other body tissues.

Obstructive sleep apnea can range from moderate to severe, a measurement and rating system called the apnea-hypopnea index (AHI). The AHI measures an average number of apnea and hypopnea episodes that you experience per hour that you sleep.

Obstructive sleep apnea is classified by severity:

  • Severe obstructive sleep apnea means that your AHI is greater than 30 (more than 30 episodes per hour)

  • Moderate obstructive sleep apnea means that your AHI is between 15 and 30

  • Mild obstructive sleep apnea means that your AHI is between 5 and 15

More than 60 million Americans suffer from poor sleep quality, and more than 40 million meet the diagnostic criteria for sleep disorders. Sleep is critical to a healthy mind and body – learn how to get a better, more restful night’s sleep in the Johns Hopkins Healthy Sleep portal.

When you sleep, your body is completely relaxed — even the muscles that help you breathe. In people with sleep apnea, these relaxed muscles combine with a narrowed airway to interrupt breathing.

Anyone at any age can have obstructive sleep apnea, but it's most common in middle-aged and older adults. Only about 2% of children have obstructive sleep apnea. It's also more common in men than in women.

But what's frightening is that as many as 90% of people who have obstructive sleep apnea don't know that they have it. Untreated, sleep apnea can lead to serious health problems.

Who is at risk for obstructive sleep apnea?

Knowing the risk factors for obstructive sleep apnea can help you get a diagnosis. Risk factors include:

  • Family member with obstructive sleep apnea

  • Large or thick neck (greater than 16 inches for women and 17 inches for men)

  • Chronic nasal congestion

  • Thyroid disorder or other endocrine condition

  • Postmenopause

  • Being overweight

  • Defect of the tissues that support the head and neck

  • Down syndrome

  • Smoking

  • Swollen or large adenoids and tonsils (in children)

What are the symptoms of obstructive sleep apnea?

Some people have obstructive sleep apnea with no symptoms. Others find that they just don't feel rested after a night of sleep and feel sleepy during the day.

Snoring is one of the biggest symptoms of obstructive sleep apnea. Other symptoms include:

  • Snoring that's interrupted with periods of quiet (called an apnea episode)

  • Snoring that resumes with a loud sound as breathing starts again

  • Morning headache

  • Frequently falling asleep during the day

  • Being easily irritated

  • Depression

  • Difficulty remembering things

How is obstructive sleep apnea diagnosed?

Diagnosis of obstructive sleep apnea usually involves participating in a sleep study, in which you're observed as you sleep.

You may participate in a test called a polysomnogram at a hospital or sleep center. But you may also use a take-home version of the test.

Your doctor may give you a monitor to wear when you sleep that measures your oxygen levels and heart rate, to help diagnose sleep apnea.

Your doctor will also typically do a physical exam, including an exam of the throat, neck, and mouth, and take your medical history. You'll probably also have to answer questions about your sleep and bedtime routine, as well as your symptoms.

How is obstructive sleep apnea treated?

These are common treatments to maintain consistent breathing and stop or reduce apnea episodes:

  • Sleeping with a CPAP (continuous positive airway pressure) machine and mask – this treatment provides a constant flow of air to help keep your airway open

  • Wearing an oral appliance, a custom-fit mouthpiece your dentist or orthodontist can make for you to keep airways open while you sleep

Several types of surgery can be done to treat obstructive sleep apnea:

  • Surgery to repair defects in facial structures

  • Surgery to get rid of extra tissues that can block airways

  • Surgery to repair abnormalities that cause obstructions when you breathe or to create a wider airway

  • Removal of adenoids and tonsils; this is most effective in children

Making a few changes to your sleep and other behaviors can also help manage obstructive sleep apnea:

  • Shed any excess weight.

  • Sleep on your side instead of on your back.

  • Avoid alcohol.

  • Limit your use of sedatives.

What are the complications of obstructive sleep apnea?

Letting obstructive sleep apnea continue untreated is risky — you can get in a serious accident if you fall asleep while operating machinery or driving a car.

Health problems may develop as a result of obstructive sleep apnea, including:

  • Increased blood pressure

  • Instability of oxygen levels

  • Changes in your body's response to insulin and glucose

  • Changes in mental function and mood

  • Cardiovascular problems heart failure, stroke, or abnormal heartbeat (arrhythmia)

Can obstructive sleep apnea be prevented?

Avoiding behaviors that relax your muscles can help prevent apnea episodes. Don't drink alcohol or take sedatives to help you sleep, and maintain a healthy weight.

When should I call my healthcare provider?

If your bed partner hears symptoms of apnea episodes or your snoring is problematic, it's a good idea to visit your doctor to talk about your symptoms and ask about a sleep study. Feeling drowsy or falling asleep frequently during the day are also signs that you should call your doctor.

Key points about obstructive sleep apnea

  • Don't risk falling asleep in a dangerous situation, such as while driving.

  • Try to set up an appointment with your doctor if your fatigue continues.

  • If obstructive sleep apnea persists over a long period without treatment, you're at risk for major health problems and serious events. These can include cardiovascular problems heart failure and increased blood pressure.