Sleep Apnea And The Heart And Stroke Connection

Sleep Apnea And The Heart And Stroke Connection


What do I need to know about the relationship between sleep and AFib?


Plain old snoring can get a little annoying, especially for someone listening to it. But when a snorer repeatedly stops breathing for brief moments, it can be worrisome for those listening and it may also provide an important clue about a problem that should be addressed.

Not everyone who has sleep apnea snores, so a person’s nighttime breathing habits may go unnoticed, however quality sleep is very important for heart health, and many people know very little about the quality of their sleep. The evidence is very strong for the relationship between sleep apnea and atrial fibrillation as well as an increased risk for hypertension and cardiovascular disease.

What is sleep apnea?


Imagine waking up choking and gasping for air, then catching your breath and falling back into fitful slumber – for a minute or two, until it happens again. And again. And again. Five to thirty times a night.

During an episode of sleep apnea, a person may experience pauses in breathing five to 30 times per hour or more during sleep. These episodes typically wake or startle the sleeper when he or she gasps for air, although the sleeper may never remember these struggles to breathe. Even so, it prevents restful sleep and is associated with high blood pressure, arrhythmias like AFib, stroke and heart failure.

Sleep Apnea: A Common Problem

  • Sleep apnea is commonly seen with AF.
  • People who have moderate-to-severe sleep apnea are approximately 4 times more likely to have AFib than those who do not have sleep apnea.
  • The occurrence of apneas during sleep may serve as triggers to episodes of AFib.
  • Sleep apnea is more common today and those who are overweight are more likely to be at increased risk for sleep apnea as well as AFib.
  • AFib patients with untreated sleep apnea may be more likely to revert back into afib after electrical cardioversion than other afib patients without sleep apnea.
  • For those who have AFib, treating the sleep apnea may improve the atrial fibrillation.
  • One in five adults suffers from at least mild sleep apnea, and it afflicts more men than women.
  • The most common type is obstructive sleep apnea (or OSA) in which the flow of air is blocked, sometimes attributed in part to excess body weight that causes the tissues in throat to collapse, blocking the airway.
  • The other types are: central sleep apnea (CSA) and mixed apnea, which is a combination of the other two types.


Why is there a correlation between sleep apnea and heart disease?

  • Sleep apnea, heart disease, and obesity are all linked with AFib.
  • Any type of airway obstruction increases risks. Anyone who is overweight, has large tonsils or adenoids, suffers chronic nasal congestion, or has other structural abnormalities blocking the airway has an increased risk.
  • Some people are more likely to develop sleep apnea. The most common scenario would be a man over the age of 40 who is overweight and can't button the top of his shirt collar, unless it is 17 inches or larger, but OSA can affect women or children, as well.
  • Sleep apnea and blood pressure are related. Up to half of people who have OSA also have high blood pressure-and unlike most people, their blood pressure does not fall while they're asleep. Essentially, their hearts do not get the same benefit from rest.
  • Lack of oxygen and a failure to fully rest are probable causes for increased blood pressure. Scientists aren’t sure whether the repeated awakenings from sleep apnea elevates blood pressure or if blood pressure rises because the oxygen levels in the blood are reduced. It may also come from a combination of both.
    High blood pressure increases the risks for stroke for all people, including those people with AFib who are already at increased risk.
  • About half of AFib patients have obstructive sleep apnea, a stronger correlation than between AFib and any other risk factors.
  • Chronic inflammation is correlated with sleep apnea and is suspected to be a factor for many people with AFib. High levels of C-reactive protein (CRP), a marker of inflammation, indicates the possible presence of heart disease and may exacerbate existing diseases of the circulatory system.
  • With CSA, airway blockage isn't the problem. It's that the brain doesn't send regular, continuous signals to the muscles of the diaphragm to contract and expand to enable you to inhale and exhale. Central sleep apnea may develop after a stroke, or may be caused by sedatives and narcotics and brain injury, explains Undevia. Heart failure patients are susceptible to developing a type of CSA called Cheyne-Stokes respiration.


How would I know if I have sleep apnea?

  • Listen to those snoring comments.
    • Has your spouse delicately suggested separate bedrooms because your snoring has become unbearable?
    • Has a roommate or family member ever commented that they thought you might not be breathing or that you suddenly began to gasp during your sleep? Often sleep apnea is first noticed by a roommate or sleeping partner of someone with sleep apnea. It can go unnoticed in a person who lives alone, unless a sleep study is ordered or requested.
  • Notice your level of fatigue and concentration.
    • Do you often feel sleepy despite being in bed eight hours a night?
    • Are you prone to accidents or do you fall asleep during the day?
    • Do you feel unable to function unless you have a steady stream of caffeine throughout your day?
  • In addition, consider tracking your sleep during the night for an informal self-study.
    • Although it’s no substitute for a medical sleep study, recording yourself may help you identify some specifics to discuss with your doctor.
    • Several smartphones and computer apps offer inexpensive ways to monitor your sleep and even your corresponding heart rates. Sharing what you learn with your healthcare provider can help make the case for support if a sleep study is warranted.

If you answered yes to the above, talk with your doctor or healthcare provider about doing a sleep study.

  • In addition, consider tracking your sleep during the night for an informal self-study.
    • Although it’s no substitute for a medical sleep study, recording yourself may help you identify some specifics to discuss with your doctor.
    • Several smartphones and computer apps offer inexpensive ways to monitor your sleep and even your corresponding heart rates. Sharing what you learn with your healthcare provider can help make the case for support if a sleep study is warranted.


Getting good rest is important for your heart.


Whether or not you’re in need of a sleep study, if you’re struggling to get a good night’s sleep follow some of these suggestions:

  • Get regular physical activity, but don’t do it right before bed because that gets your adrenaline pumping and can keep you awake.
  • Limit alcohol consumption to one drink per day for women and two drinks for men; too much alcohol interferes with sleep.
  • Avoid caffeine before bed.
  • Develop a pre-bedtime routine such as taking a warm bath, dimming the lights or having some herbal tea.


What is a sleep study?


You will spend a night or two in a lab hooked up to a machine that will monitor and chart your brain waves, oxygen levels, breathing and heart rate while you sleep.

The brain-wave pattern indicates whether you are asleep, and the quality of your sleep. You will be monitored for pauses in breathing, and whether you wake up during those pauses. During breathing pauses, oxygen levels are checked, and your heart rhythm is tracked to find out whether heart rate slows or becomes irregular.

Getting a diagnosis


Generally, a diagnosis is based on the number of pauses in breathing each hour.

  • 5-15 pauses in breathing an hour may be a mild case of apnea
  • 15-30 may fall in the moderate range.
  • 30+ may indicate a more severe case.


If the test shows that you have sleep apnea, certain lifestyle changes might be recommended, but you will also most likely be fitted for a continuous positive airway pressure (CPAP) or other doctor-recommended airway device while you sleep, or possibly a mouthguard if you have just mild sleep apnea.

How is sleep apnea treated?

  • You may consider using a CPAP while you sleep or other doctor-recommended airway device while you sleep.
    • As you inhale, an air compressor in the device creates enough pressure to produce a steady stream of air that keeps your airway open.
    • As an added bonus, some studies show that elevated blood pressure drops significantly after using the mask for two weeks.
    • Although the mask is effective, some patients complain of claustrophobia, or have trouble falling asleep while wearing it. Trying a mask with a different style or a different fit may solve the problem, or a mouthguard may work if you have mild sleep apnea.
    • Newer options are in development that work on the central nervous system, so ask your healthcare provider to see if any of these new treatment choices may be right for you.
  • Some opt for surgical treatment.
    • When someone with a case of sleep apnea is resistant to using the mask, there are surgical alternatives.
    • Changing the shape of your airways: Surgical procedures can make the back of the throat larger, provide support so tissues in the roof of the mouth no longer collapse, or reduce the size of tissues in the nose.
    • Using a thin, lighted scope snaked up your nose, an ear, nose and throat (ENT) surgeon will see where the blockage is, says Undevia, and then may recommend having your tonsils removed or correcting a deviated septum in the nose.
    • Check with your healthcare provider to learn more about specific options that may work for you.


Forcing the airways to remain open: Doctors used to alleviate sleep apnea by performing a tracheostomy – cutting a hole in the windpipe – which is still an option in severe cases when CPAP does not work.

Sleep apnea isn't just snoring. Left untreated, the condition can lead to serious cardiovascular problems. Fortunately, there are several non-surgical and surgical treatment options you can discuss with your doctor.

Recent Discussions From The At Home Forum
teanderson avatar

I underwent pulmonary vein isolation 11/21/17. I felt great for 2 days then went back into Afib. I ended up in ER for an IV. I had a rough 7 days, then started feeling better. EP changed all my medications just to make sure they were not the cause of my problem. I went into Afib again in late January 2018 (again not feeling well and confirmed by EKG, IV again made me feel human). At that point, I was put on Amiodarone and Digoxin. I was exhausted so PCP  changed Digoxin to MWF only. That has been working well. EP and PCP agree to keep me on both medications and Eliquis until school ends as I have no more sick days. I went to EP at the end of April and he has me on a 30 heart monitor and is talking about transitioning me to a different antiarrhythmic or considering me for an epicardial ablation and be seen by another heart specialist. I guess I was expecting another ablation but thought it would be the same type, not a different ablation by a different doctor. Has anyone else experienced this?

Girtygirl avatar

Thanks to the many great minds here along with the wonderful information gained from the “Get in Rhythm Stay in Rhythm Patient Conference 2017”, I will be heading to Texas for an ablation by Dr. Natale. I am already blown away by the efficiency, education and kindness shown by his staff.  Obviously, I will be a bit nervous, but at the same time I know I will be in the hands of the best of the best. 

Genie

BillM avatar

Hello, everyone. I’m the new guy, Bill, and have some concerns and general questions for the group. My usual symptoms are skipped beats, sometimes coming every three or four beats, lasting several minutes  

Twice within the past five weeks, I’ve been hospitalized for four days due to uncontrolled AFib. The first time, my hear returned to sinus rhythm fairly quickly, the second time, it was several hours. I’ll concentrate on the second visit, which just ended yesterday. 

I’d gone to school Saturday morning at 9:30 to conduct a review session for my AP World History students (I’m a public high school teacher) in preparation for the upcoming AP exam, but after getting there the AFib began, slowly at first, but quickly ratcheted up to a full-blown episode. 911 was called, and I was quickly on my way in an ambulance.

I was in the ER by 10:00 that morning, surrounded by six to eight doctors and nurses all working feverishly. Details are a bit sketchy as my mind was a bit occupied, as you can well imagine, but there was talk of an emergency catheterization, which was called off as my blood work showed no signs of a heart attack. After several IVs and injections that helped calm down the AFib (heart rate was 120-140) I was admitted, sent to a room and put on a monitor. Sunday, they did an echocardiogram, and scheduled me for a catheterization Monday morning. Another sleepless night, this time with no food or water after midnight, but instead of the catheterization, they did a nuclear stress test, just as they had during the stay five weeks prior. 

Two cardiologists looked at my nuke test results, and were concerned about the pictures of my lower heart, and scheduled a catheterization for the next morning (Tuesday). After yet another sleepless night in the hospital (does anyone ever get any sleep in a hospital room?), my regular cardiologist came to see me, and was puzzled by the decision to cath me, seeing no difference between yesterday’s test and the one from March, which was identical to one I’d had two years ago. Never the less, the procedure went ahead, and results were negative. I was discharged that evening, with no changes in medications, or in anything at all. 

So here I sit, at my kitchen table, wondering why I spend so much time in the hospital with no apparent results. I was to have a loop recorder installed, but the doctor who did the cath (in fact, who has done all my caths and implanted both my stents) said that seemed superfluous as the purpose of the recorder was to determine I have AFib, which I clearly do. There was also mention of new medications, and possibly an ablation down the road. But other than that, no change in my meds, no advice on how to deal with further episodes or how to avoid them, and, to be honest, I feel a bit neglected and concerned. My questions to the group, then are: How do you deal with living with AFib? How do you contend with the possibility that episodes such as I had on Saturday might recur at any time? Are there any avenues I should pursue with my cardiologist? How do you kind folks stay calm when AFib hits for brief periods?

I feel badly coming here with so many questions as the new guy, but I was quite relieved to find this group as it helps alleve the feelings of being alone with this condition. I thank you all for your time, and wish you all good health, good living, and good friends. 

Oddly enough,

Bill

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