Obstructive sleep apnea, characterized
by short but frequent interruptions in breathing, may raise
cardiac death risk in the small hours of the night, new
research suggests.
The study of 112 Minnesota
residents who died suddenly from cardiac causes found people
with obstructive sleep apnea were twice as likely to die
during that time than those without the condition.
That's a striking departure
from the pattern of sudden death in the general population,
which most often strikes in the hours right after awakening,
said lead researcher Dr. Virend K. Somers, a professor of
medicine and cardiology at the Mayo Clinic, in Rochester,
Minn.
"We have always been curious
about why cardiovascular deaths can occur in the early hours
of the morning, when people are peacefully sleeping," Somers
said. The study, published in the March 24 issue of the
New England Journal of Medicine,
suggests that for people with sleep apnea, sleep can be
far from a time of quiet rest.
Sleep apnea consists of frequent
stoppages of breathing lasting about 10 seconds -- not enough
to shake someone awake permanently, but enough to deprive
a person of rest and cause drowsiness and lethargy throughout
the following day.
More than 17 percent of Americans
are affected by sleep apnea, according to the researchers.
Some cases are caused by problems with the brain center
that controls sleep, but most are due to collapse and obstruction
of the air passages.
Sleep apnea disturbs heart
function in several ways, Somers said.
"If you hold your breath
as long as you can, your blood oxygen levels drops to 90
percent of normal," he said. "In sleep apnea, it drops to
60 percent of normal."
"And it is not just the fact
that the body is subjected to low levels of oxygen during
the night," Somers added. "Sleep apnea tightens blood vessels
and significantly raises blood pressure. With low levels
of oxygen and high levels of carbon dioxide, several kinds
of abnormal heart rhythms can develop during sleep apnea."
Unfortunately, the study
does not provide any new way to manage the problem, Somers
said.
"There is no clear message
that is patient-oriented," he said. "It is one more brick
in the wall about why we should be more aggressive in finding
sleep apnea and treating it."
One simple treatment is to
tell people to sleep on their side, not on their back. Another
effective method is to attack the obesity that is a major
cause of sleep apnea, Somers said, since weight reduction
can often provide significant relief. If ordinary dieting
and exercise fail, some patients may want to consider bariatric
surgery, which shrinks the stomach and reduces the body's
ability to take in calories, he said.
Surgery to reduce obstruction
of the respiratory tract usually is not effective, Somers
noted: "Surgical treatment often results in a recurrence
of apnea six months to a year later."
Some people are helped by
CPAP -- continuous positive airway pressure, in which air
is forced into the body through a mask, he said, and "in
really severe cases we can go to temporary measures such
as tracheotomy," in which surgeons implant a breathing tube.
The study "is part of a growing
body of evidence that this disease called sleep apnea is
deadly," said Dr. Steven H. Feinsilver, a member of the
board of directors of the American Sleep Apnea Association.
While the snorts and snoring
caused by sleep apnea are unmistakable to anyone in the
same room, people who sleep alone often don't realize they
have the condition, Feinsilver added.
"Most people with sleep apnea
know only that they are sleepy during the day," he said.
Treatment is necessary "not only because it improves sleep,
but also because treatment helps people live longer," he
said. "It is a major risk factor for heart disease and stroke,
and we are just beginning to learn how dangerous it is."