Obstructive sleep apnoea is linked to cardiovascular health, and not just a lack of rest.

A good night’s sleep is vital to our mental and physical well-being. However, for many who suffer from obstructive sleep apnoea (OSA), restful sleep may be an elusive dream.

OSA affects between 10-20% of adults and is two or three times more common in men than in women. It is characterised by loud snoring and repeated interruptions in breathing (apnoea) throughout the sleep cycle, which are caused by sagging of the soft tissue in the airway that can block the airway and prevent oxygen from reaching the lungs.

How do I know if I have OSA?

According to Dr Jeeve Kanagalingam from The ENT Clinic, Mount Elizabeth Novena Hospital, there are two predictive symptoms for OSA:
(a) prolonged, persistent, and very loud snoring; and
(b) the apnoea events, when the patient stops breathing. These pauses last anything from 10 to 30 seconds or longer, and often end with the patient starting awake, perhaps with a jerk and throat-clearing noises, or gasping for air. This may be followed by a change of position, rolling over, moving pillows, etc.

However, most patients are unaware of these symptoms themselves, though their partners may have witnessed, and been bothered by, these incidents.

The patient themselves will feel tired all the time, even when they have just woken up in the morning. They may be irritable, have trouble concentrating and be prone to dozing off during the day. Frequent morning headaches and waking up with a very dry or even sore throat, are also indicators.

From left: Dr Jeeve Kanagalingam, ENT Clinic and Dr Reginald Liew, Harley Street Heart & Vascular Centre

Link between OSA and Cardiovascular Health

According to Dr Reginald Liew, a Senior Consultant Cardiologist at the Harley Street Heart & Vascular Centre at Mount Elizabeth Novena Specialist Centre, sleep apnoea can lead to hypertension because when the apnoeas occur they cause sudden drops in blood oxygen levels.

“As the brain’s oxygen levels drop it tells the heart to pump more blood to increase its supply of oxygen, and that increases blood pressure (hypertension). However, as the patient has stopped breathing or is breathing extremely shallowly, the increased heart rate and blood pressure don’t increase oxygen supply to the brain; it decreases it, as the heart is now using more oxygen. Eventually the brain is forced to startle the person awake to restart the breathing cycle.”

OSA sufferers rarely recall waking during the night, but the apnoeas and waking incidents can occur hundreds of times each night, leading to hypertension, arrhythmias and general straining of the cardiovascular system.

Risk factors

The list of risk factors is long and includes obesity, age/being older, gender, family history, alcohol consumption before bedtime, smoking, and nasal congestion, among other things.

The more risk factors you have, the greater your risk for OSA. For example, if you are an obese male over 60 who smokes and likes an alcoholic drink (or three) before bed you are at very high risk.

“Maintaining a healthy weight, eating a diet high in vegetables, fruit and fibre, regular exercise, not smoking, reducing alcohol consumption, managing stress levels and sleep, all help reduce your risk of developing not just sleep apnoea, but also heart disease, cancer and even Alzheimer’s,” says Dr Jeeve.

When should I see a doctor?

If you suspect that you or your partner may have sleep apnoea, it is wise to see a doctor, particularly if you already have any form of heart disease or diabetes.

There are several home-testing options available today that you can use prior to visiting your doctor. Recent studies have demonstrated that some models of the Apple watch can detect sleep apnoea with 90% accuracy, and they can also detect arrhythmia and hypertension.

Another option would be to record yourself sleeping with a home security camera or nanny cam with sound; the snoring should be easily audible and the starting awake from apnoea events easy to see. Take these along when visiting your doctor to assist them in making the diagnoses.

The gold standard clinical test for OSA is a polysomnogram, which is a multi-parametric test that measures heart rate, blood pressure, air flow, brain waves and other metrics. However, it requires an overnight stay in a specialist sleep laboratory with all the costs that entails.

Most of the time, particularly in mild and recent onset cases, OSA can be treated with simple lifestyle changes. For more severe cases there are a variety of treatment options available, from CPAP machines to surgery, depending on the severity of the condition. In short, the sooner you get your condition treated, the better you can sleep at night.


Featured photo by Dreamstime
Dr Jeeve photo by ENT Clinic.
Dr Reginald Liew photo by Harley Street Heart & Vascular Centre.

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