The speaker at the spring support group meeting was Dr. J. Julian Zaka from the Respiratory Medical Group and the Contra Costa Sleep Center. He spoke on “Sleep Apnea and Your Heart.”

(Ed note: In the following I will use the term OSA to mean untreated Obstructive Sleep Apnea). Dr. Zaka opened his talk by stating “Intermittent hypoxia and the arousal response associated with OSA are the main factors causing oscillation of the systemic and pulmonary arterial blood pressures, heart rate and cardiac function. These repetitive oscillations contribute to cardiovascular disease.”

There are five cardiovascular disorders involved:
• Systemic Hypertension
• Coronary Artery Disease
• Cardiac Arrhythmias
• Congestive Heart Failure
• Pulmonary Hypertension

There is evidence that OSA may be cause of Systemic Hypertension. Patients with mild OSA appear two times more likely to have it and those with Moderate/Severe OSA appear to be three times as likely. In one study OSA was found in 71% of patients with uncontrolled hypertension compared with 38% in those patients whose hypertension was controlled

HOW DO I STOP CPAP MASK LEAKS?

(Courtesy of cpap.com)

Air leaks are caused by masks that are too big, too old, or just the wrong style for you.

Air leaking into the eyes is usually an indication that the mask is too big (long or wide) as are leaks at the base of the nose. Leaks may also occur under the nose due to facial hair.

As the silicone in the mask cushion ages, it deteriorates and becomes too soft to hold a seal. With many masks, the cushion may be removed and replaced to extend the life of the mask.

When a cushion has softened to the point where it will no longer hold a seal, you may be able to tighten it enough to stop the leaking when you go to sleep, but during the night the seal will loosen and leak.

Mask Leaks may also be caused by the pillow pushing against the mask and changing the position and seal of the mask. There are special CPAP pillows which are designed to minimize the contact of the CPAP mask with the pillow, even when you are sleeping on your side.

How you care for your mask will also prevent leaks. Masks should be washed daily with warm water using a very gentle soap or baby shampoo, and left to air dry. Never use antibacterial soap as it will break down the silicone of the mask cushion. Avoid soaps that include lotion or lanolin which can coat the mask and cause it to lose its seal.

Remember, going to bed with a clean face will improve your seal and protect the lifespan of your mask. The best time to clean your mask is in the morning after use. This removes the oils left behind from your skin which can reduce the lifespan of your mask.
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If you have hypertension; limit how much alcohol you drink to one drink a day for women and two for men, limit the amount of salt you consume to less than 1500mg /day, reduce stress, and stay at a healthy body weight.

Evidence also indicates that treatment of OSA with CPAP reduces systemic hypertension in many patients. A decrease of only 2mmHg in blood pressure is enough to significantly reduce cardiovascular risk!

Most people with Coronary Heart Disease have no symptoms until a heart attack. A study of 1651 men over ten years revealed those with severe OSA had a higher incidence of fatal and non-fatal cardiovascular events than untreated patients with mild/moderate OSA. Severe OSA is associated with multiple vascular risk factors. OSA may also exacerbate pre-existing coronary artery disease. OSA is also associated with Nocturnal Cardiac Arrhythmias. Bradyardia and Asystole during sleep, and in some patients during waking hours, are the most prominent and significant rhythm disturbances associated with OSA. Therapy with CPAP abolishes these rhythm disturbances in most patients.

It is well know that OSA complicates Congestive Heart Failure. A study of 700 patients with heart failure revealed 36% had OSA and 40% had central sleep apnea. The increased risk appeared to be highest among men with severe OSA (AHI >30 events per hour). OSA was not associated with heart failure among women!

Sleep apnea if left untreated can lead to a complication of Pulmonary Hypertension. Pulmonary hypertension refers specifically to high blood pressure in the arteries that supply the lungs with blood. High blood pressure damages these arteries, causing them to thicken so that less blood reaches the lungs, even as the heart works ever harder to try to force blood through. Pulmonary hypertension can result in damage to both the heart and lungs.

Dr. Zaka, in conclusion stated, “For patients who have heart failure or related disorders which are complicated by OSA, positive airway pressure (CPAP) may improve cardiac function, blood pressure, excercise capability and quality of life. It is unknown whether positive airway pressure therapy improves heart failure-related mortality in patients with treated OSA.”

SEVERE OSA TIED TO CANCER RISK

Lack of oxygen from disrupted rest may be to blame
(extracted from Science News, May 21, 2012)

Untreated Obstructive sleep apnea, a disorder linked to heart disease and depression, may heighten the risk of cancer as well. A two-decade study shows that people with severe sleep apnea could be four times as likely to die of cancer as people without the condition.

The findings were unveiled May 20 at a meeting of the American Thoracic Society in San Francisco and will appear in an upcoming issue of the American Journal of Respiratory and Critical Care Medicine.

Sleep apnea results in disruptions of breathing which rob cells of needed oxygen, a condition called hypoxia. This may underlie the cancer link, says study coauthor Javier Nieto, a physician and epidemiologist at the University of Wisconsin– Madison.

(Based on) a long-term sleep study that began in the early 1990s. The 1,522 participants, who were age 30 to 60 at the start of the study, underwent an overnight sleep examination at the outset. Those tests showed that 59 people had severe sleep apnea.

By November 2011, after a median follow-up of 18 years, those with untreated severe apnea were 4.8 times as likely to have died of a cancer-related cause. Severe sleep apnea is defined as having an air interruption “every other minute or more,” Nieto says.

The effect of using nighttime breathing devices called CPAP machines to control apnea was unclear, since some apnea patients but not all began using them at various times during the study.

Depression and Sleep

(Courtesy of the National Sleep Foundation)

Feeling sad every now and then is a fundamental part of the human experience, especially during difficult or trying times, and is something we all experience. In contrast, persistent feelings of sadness, anxiety, hopelessness and disinterest in things that were once enjoyed are symptoms of depression. Depression is not something that a person can ignore or simply will away. Rather, it is a serious disorder that affects the way a person eats, sleeps feels and thinks. The cause of depression is not known, but it can be treated.

The relationship between sleep and depressive illness is complex – depression may cause sleep problems and sleep problems may cause or contribute to depressive disorders. For some people, symptoms of depression occur before the onset of sleep problems. For others, sleep problems appear first. Sleep problems and depression may also share risk factors and biological features and the two conditions may even respond to some of the same treatment strategies.

Insomnia is very common among depressed patients. People with insomnia have a ten-fold risk of developing depression compared with those who sleep well. Depressed individuals may suffer from a range of insomnia symptoms, including difficulty falling asleep (sleep onset insomnia), difficulty staying asleep (sleep maintenance insomnia), unrefreshing sleep, and daytime sleepiness. Obstructive sleep apnea (OSA) is also linked with depression. People with depression were found to be five times more likely to suffer from sleep-disordered breathing (OSA is the most common form of sleep disordered breathing). The good news is that treating OSA with continuous positive airway pressure (CPAP) may improve depression; a Study of OSA patients who used CPAP for one year showed that improvements in symptoms of depression were significant and lasting.

In many cases, because symptoms of depression overlap with symptoms of sleep disorders, so there is a risk of misdiagnosis. For example, depressed mood can be a sign of insomnia, OSA or narcolepsy. Restless legs syndrome (RLS), a neurological condition that causes discomfort in the legs and sleep problems, is also associated with depression.

Many children and adolescents with depression suffer from sleep problems such as insomnia or hypersomnia (excessive sleepiness) or both. They are also more likely to suffer from weight loss, impaired movement, and anhedonia (an inability to feel pleasure). A study which focused on children aged 11 to 17, found a strong association between negative mood and sleep problems. Among adolescents who reported being unhappy, 73% reported not sleeping enough at night.

Depression affects all types of people from all over the world, but certain people are more likely than others to develop depression. Among older adults, higher rates of depression and sleep problems may be explained in part by higher rates of physical illness. Among women, motherhood and hormonal changes throughout the life cycle (menstruation, menopause) may contribute to higher rates of depression. Among women and older adults, higher rates of depression may also be explained by higher rates of insomnia in these groups.

Seasonal affective disorder (SAD), also known as “winter depression,” is one type of depression. SAD is believed to be influenced by the changing patterns of light and darkness that occur with the approach of winter. Circadian rhythms are regulated by the body’s internal clock and by exposure to sunshine. When the days get shorter in autumn, circadian rhythms may become desynchronized and trigger depression. For most people with SAD, depressive symptoms resolve in springtime with increasing hours of daylight. when the days lengthen out.

Living with depression can be extremely difficult. Depression not only affects the way a person feels and thinks but research suggests that it is also associated with serious chronic health problems such as heart disease. If you are experiencing symptoms of depression, it is very important to seek treatment as soon as possible.