Sleep Disordered Breathing
Sleep disordered breathing is a term describing a range of breathing difficulties that can occur during sleep. It can be as simple as common snoring or as severe as sleep apnea. Obstructive sleep apnea occurs when the passage of air is partially or fully blocked due to lack of muscle tone or excess tissue in the upper airway. Central sleep apnea is a central nervous system disorder characterized by reduced ventilatory drive resulting when a patient’s breathing control mechanisms have been affected by a stroke, tumor or other pathological condition. In addition to loud snoring, other symptoms of sleep disordered breathing include episodes of breathing cessation, difficulty staying asleep and excessive daytime drowsiness.
Consequences
One of the more obvious dangers associated with sleep apnea is that it more than doubles the risk for automobile accidents due to daytime drowsiness. Many patients are not aware that it also has significant consequences for the heart. According to the Wisconsin Sleep Cohort Study in 2015, those with severe untreated sleep disordered breathing are 2.6 times more likely to have coronary heart disease or heart failure than those without it. Obstructive sleep apnea also increases the risk for hypertension and diabetes.
Diagnosis and Treatment
The diagnosis of sleep disordered breathing is usually made after a sleep study. It is important to determine whether the patient has central sleep apnea or obstructive sleep apnea, because the treatment for each is different. Patients with obstructive sleep apnea are usually treated with CPAP (continuous positive airway pressure) administered by a pump through a mask worn by the patient during sleep. Most individuals notice immediate improvement. They usually experience increased energy and improved alertness during the day and, of course, the benefits for their sleep partner is obvious as well. Weight loss in obese patients with obstructive sleep apnea can also be beneficial. Fortunately, most insurance companies cover the cost of a sleep study and CPAP equipment.
A Special Consideration for Patients with Heart Failure
Patients with existing heart failure often have central sleep apnea which is an independent marker for poor prognosis in these individuals. While interruptions in ventilation can be harmful to a failing heart, studies have shown that treatment with adaptive servo ventilation (a type of CPAP where pressure is adjusted) in patients with heart failure can sometimes be harmful. If you have any questions about sleep disordered breathing or think you may be experiencing obstructive sleep apnea, in particular, it is important to consult your health care provider. Both the risk of doing nothing and the benefit of treatment can be substantial.