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Snoring---can be a risk factor for hypertension and heart attack

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August 2004
Snoring---can be a  risk factor for hypertension and heart attack

Srinivas Bhadriraju, MD. FCCP

Assistant Professor of Medicine

Emory University

Director Sleep Disorders Program at Crawford Long Hospital, Atlanta GA

Sleep related problems of which snoring is one are infact very common. About 40 million Americans suffer from various sleep disorders like obstructive sleep apnea, narcolepsy or insomnia. Sleep disordered breathing which affects at least 15% of the adult population is a major public health problem. For a long time snoring was treated as nothing more than a social embarrassment to be joked about. It is now recognized in the medical community that snoring is no trifling matter. Snoring represents partial obstruction of the airway during sleep and could mean a serious clinical condition called obstructive sleep apnea.

Obstructive Sleep Apnea (OSA) is a common clinical condition estimated to effect about 35% of patients seen in primary care clinics.1 OSA is characterized by intermittent obstruction of the upper airway during sleep. The airway obstruction causes snoring, decreased oxygen levels, and disrupted sleep, resulting in daytime tiredness and excessive sleepiness. OSA is diagnosed by having the patient undergo a formal polysomnogram or sleep study. The adverse health effects of OSA are well documented and include increased frequency of motor vehicle accidents, hypertension and myocardial infarction (Heart attack) OSA constitutes a modifiable risk factor for cardiovascular disease and an independent risk factor for cardiovascular mortality. What this means is that by recognizing and treating obstructive sleep apnea we can expect to modify or reduce the risk of developing hypertension or high blood pressure in the future. Most patients with OSA are treated with continuous positive airway pressure (CPAP). CPAP therapy consists of a tight fitting mask that covers the patient's nose and that is attached by tubing to a CPAP machine that generates airflow and thereby positive pressure. This positive pressure then mechanically splints open the upper airway preventing its collapse during sleep. Patients who cannot tolerate CPAP can be offered other therapeutic options including dental appliances or surgical treatments that vary in efficacy. As a result, the effective management of patients with OSA requires prompt diagnosis and management provided by a multidisciplinary team of health care providers.

References

1. Netzer NC, Hoegel JJ et al. Prevalence of Symptoms and Risk of Sleep Apnea in Primary Care. Chest 2003; 124:1406-1414.

2. Teran-Santos, J et al. The association between sleep apnea and the risk of traffic accidents: N Eng J Med 1999; 340: 847-851.

3. Nieto FJ et al. Association of sleep disordered breathing, sleep apnea and hypertension in a large community based study: The Sleep Heart health study JAMA 2000; 283: 1829-1836.

4. Peppard PE et al Prospective Study of the association between sleep disordered breathing and hypertension. N Eng J Med 2000; 342: 1378-1384.

5. Marin JM et al. Obstructive Sleep Apnea and Acute Myocardial Infarction; clinical implications of the association. Sleep 1998; 21: 809-815.

6. Pecker et al. Respiratory Disturbance Index as an independent predictor of mortality in coronary artery disease. Am J Respir Crit Care Med 2000. Vol 162. 81-86.

7. Sleep-Related Breathing Disorders (SRBD) Source Book. Department of Veteran Affairs Veterans Health Administration.


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