Obstructive sleep apnea occurs in 40% to 80% of people with cardiovascular disease, however, new research has shown that it is often underrecognised and undertreated.
Healthcare experts have now urged increased awareness of obstructive sleep apnoea in people with cardiovascular disease and other risk factors such as high blood pressure, obesity, large neck circumference, craniofacial abnormalities, smoking, family history, and nighttime nasal congestion.
The expert volunteer writing group has published its statement in Circulation, the American Heart Association’s flagship journal.
Obstructive sleep apnoea
Obstructive sleep apnoea occurs in 40% to 80% of people with cardiovascular disease, and occurs when an upper airway obstruction causes repeated episodes of disrupted breathing during sleep with around 34% of middle-aged men and 17% of middle-aged women meeting the criteria for the condition.
Chair of the scientific statement writing group Yerem Yeghiazarians, M.D., FAHA, professor of medicine and the Leone-Perkins Family Endowed Chair in Cardiology at the University of California, San Francisco, said: “Obstructive sleep apnoea can negatively impact patients’ health and increase the risk of cardiovascular events and death. This statement is to encourage increased awareness, screening and treatment as appropriate for sleep apnoea.”
Obstructive sleep apnoea is associated with several cardiovascular complications including high blood pressure; heart rhythm disorders such as atrial fibrillation and sudden cardiac death; stroke; worsening heart failure; worsening coronary artery disease and risk of heart attack; Pulmonary hypertension (PH); and Metabolic syndrome and Type 2 diabetes.
There is currently no consensus that screening for obstructive sleep apnoea alters clinical outcomes, however, the high prevalence of the condition among people with cardiovascular disease, along with evidence that treatment improves patient quality of life, are reasons to screen and provide treatment, says the group.
“Patients report better mood, less snoring, less daytime sleepiness, improved quality of life and work productivity with obstructive sleep apnoea treatment,” added Yeghiazarians. “In addition, screening advances have changed how we diagnose and treat obstructive sleep apnoea. For example, many patients do not have to go to an overnight sleep study centre anymore.
“There are now sleep devices approved by the FDA that patients use at home and send back to their doctor for assessment. And, while a continuous positive airway pressure (CPAP) machine is one form of treatment, there are numerous therapeutic options – from positional therapy and weight loss to oral appliances and surgery – depending on the cause and severity of someone’s obstructive sleep apnoea.”
Suggestions for improvement
The authors have suggested several actions that can be taken to tackle the problem, including:
- Screening for obstructive sleep apnoea in patients with resistant or difficult to control hypertension, pulmonary hypertension, and atrial fibrillation that recurs despite treatment
- Screening for obstructive sleep apnoea via a sleep study for some patients with heart failure, especially if sleep-disordered breathing or excessive daytime sleepiness are suspected
- Treating patients diagnosed with obstructive sleep apnoea with available therapies, potentially including lifestyle and behaviour modifications and weight loss
- When possible, treating patients with severe obstructive sleep apnoea with a CPAP machine
- Treating mild to moderate obstructive sleep apnoea cases with oral appliances that adjust the jaw and tongue placement during sleep to prevent obstructed breathing
- Routine follow-up including overnight sleep testing to confirm if treatment is effective
Yeghiazarians continued: “Improvements in home diagnostic tools and more research on ways to identify cardiovascular risk in people with obstructive sleep apnoea are needed. Still, the overall message is clear: we need to increase awareness about screening for and treating obstructive sleep apnoea, especially in patients with existing cardiovascular risk factors.”