Many deaths among people in their 40s and older which are attributed to heart disease and transportation accidents may actually be related to an unseen epidemic of snoring and sleep apnea.

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Sleep apnea, the phantom cause of heart disease and accidents

by Jerry Halberstadt

Sleep apnea syndrome is a major threat to health

Many deaths among people in their 40s and older which are attributed to heart disease and transportation accidents may actually be related to an unseen epidemic of snoring and sleep apnea. Apnea, a potentially deadly phantom, is the frequent stoppage of breathing caused by relaxed tissues in the throat during sleep. Snoring is caused by vibrations of the relaxed throat tissues and is often the precursor or companion of sleep apnea. Although effective medical treatment for sleep apnea exists, this information has not entered routine medical practice nor does the public recognize the dangers. Unfortunately, even when apnea is suspected, it may be difficult to obtain qualified care. As a result, 95 percent of the millions of people who suffer from sleep apnea have not and may never be diagnosed, let alone treated. Nevertheless, the informed person with sleep apnea can take the initiative to get appropriate diagnosis and treatment and take the steps necessary to assure recovery.

Some cardiological problems associated with sleep apnea are known and their risk may be diminished by treatment of the sleep apnea. They are discussed in Sleep apnea, snoring and the heart by Dr. Clive Layton, MD, a cardiologist with the London Bridge Hospital.

With the support of the National Center for Sleep Disorders Research (NCSDR) in the NIH, scientists are now examining the relationship between heart disease and sleep apnea. Dr. James Kiley, Director of the NCSDR, points to research data that justify a major series of studies to determine if apnea is a cause of heart disease including congestive heart failure, high blood pressure, and chest pain (New York Times, 20 December, 1995). Some of the research suggests that apnea may indeed be a cause of heart disease.

The NASA Ames Center and the U.S. Department of Transportation warn of the dangers of fatigue in the transportation industry, including travel on the highway, in the air, and by sea. The worst one-third of people with untreated sleep apnea has an increased auto crash rate and consequent fatalities.

Obstructive sleep apnea is overdue for public attention; it is the second leading cause of daytime fatigue, after insomnia. Poor sleep caused by sleep apnea is a major public health problem. Each night millions of men---especially over 40---and women---after menopause---wage a life and death struggle with this little-recognized illness, sleep apnea syndrome. Recent studies show that among employed people 30 to 60 years old, at least 2 percent of the women and 4 percent of the men may have severe sleep apnea syndrome using very conservative criteria. Other experts suggest much higher rates, for example, 10% of men and 5% of women. The percentages rise in older persons.

People with sleep apnea syndrome have a higher risk of death than the normal population. The price they pay includes a potentially crippling deterioration in daily functioning, an increased risk of high blood pressure and stroke, depression, and death either in accidents or in their sleep. There are terrible costs for the family of the person with sleep apnea syndrome, who may experience irritability, mood changes, lowered sexual drive and capacity, and a reduction of intellectual ability. In addition there are major business, insurance, health, and social costs including the loss of productivity, the impact of accidents caused by a driver or worker falling asleep, and the wasted health care dollars spent on alleviating symptoms like heart disease without treating their possible underlying cause.

Why sleep apnea syndrome is ignored

The most obvious symptom of sleep apnea syndrome, snoring, is seen by most people, even doctors, as an annoyance or joke, or even as a sign of good sleep. If fact, snoring and gasping may be the body's cry for help. Because breathing is such a vital function, even a minor difficulty in breathing will trigger an alarm. Just holding one's breath while awake can quickly create discomfort and distress. People with sleep apnea suffer from repeated obstructions of the throat during sleep. They literally can't breathe while sleeping. They must wake up in order to breathe (but they don't usually recall these awakenings). This repeated fragmentation of sleep patterns keeps them from having normal, restorative sleep. Recent research suggests that snoring itself may affect sleep quality and may respond to the same treatments used for apnea. A related disorder, upper airway distress syndrome (UARS), is silent and even more difficult to detect.

Why people with sleep apnea don't get treated

Effective medical treatment to overcome this epidemic is available. But people who suffer from this problem usually don't realize it. After all, they are asleep while the damage is being done. Most patients usually don't remember their nightly struggles to breathe. And the symptoms felt when awake are not related to sleep problems.

Even when people with sleep apnea report their symptoms to their doctors, most physicians aren't trained to recognize and act on this common problem. Worse, even if a patient does get referred to one of the qualified centers treating this problem, they may have a long wait. In fact, the qualified treatment centers (there are only about 250 accredited centers) would be unable to deal with more than a small fraction of sufferers. These centers have treated to date only 5% of those estimated to have sleep apnea. But there are problems even after treatment has been prescribed. Because the patient must use a treatment device every night in order to control the chronic condition which causes this epidemic, treatment may be incomplete or fail unless there is careful follow-up and very good communication between doctor and patient. Thus, even the patient who is successful in getting a correct diagnosis and treatment may need to become an educated consumer in order to make the treatment work. Nevertheless, recovery can be achieved through following seven steps.

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