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Heart Disease, Dementia and Sleep Apnea

Here’s an interesting study showing that the presence of heart disease may predict dementia better than cognitive tests. This finding is not surprising since we know that untreated obstructive sleep apnea can cause major injury to multiple areas of the brain. We also know that the older you get, the more likely you’ll develop sleep apnea. In fact, based on some recent population studies, more than half of people over 50 had some degrees of sleep apnea. 

 

If You Had Cancer, Would You Put Off Treatment Until It’s Convenient For You?

Once or twice a month, I have patients that are diagnosed with severe obstructive sleep apnea (50 to 90 apneas per hour) and when told that it’s important to treat it, they are reluctant, saying that they’ll take care of it once school ends, or when they get vacation time. I even go as far as to tell them that insurance actuaries rank sleep apnea at the same level as cancer. In fact, a recent study showed that for untreated obstructive sleep apnea, your relative risk of dying from cancer is much higher than that for heart attack or stroke. Another study showed that your life expectancy is about 20 years shorter, and still another study showed that your risk of getting into a car accident is 15 time higher than normal.

There’s a lot of psychology involved when you’re dealing with obstructive sleep apnea. What are your stories that involve friends or family members? Is there a lot of denial or refusal to act when told they have severe obstructive sleep apnea?

Did Lenin Die of Sleep Apnea?

In my periodic quest to find famous people and celebrities who might have obstructive sleep apnea, I came across someone who died over 88 years ago:  Vladimir Lenin.

In a recent article in the New York Times, various experts describe his medical ailments that lead up to his massive stroke and death at the age of 53. His cerebral arteries were found to be almost completely clogged. He supposedly had major sleep problems and had chronic headaches. He also had a strong family history of cardiovascular diseases, with his father dying of a cerebral hemorrhage at age 54, and siblings dying of a heart attack and stroke.

Lastly, notice that he had a mustache and a goatee. Many men with weak chins grow facial hair to make their chins more prominent. It’s not surprising that he also had narrow, triangular facial features. Take a look at his picture in the New York Times. It seems like he had a fat neck as well. 

What do you think about my theory?

Why Hypertension Is More Lethal For African Americans

Blacks with high blood pressure were found to be twice as likely to suffer sudden cardiac death compared to other racial groups. A study published in HeartRhythm found that this was the case regardless of other other factors such as age, gender, family history, weight, diabetes or previous history of heart disease. What they don’t mention is that blacks are also at significantly increased risk for having obstructive sleep apnea, which more than doubles one’s chances of having a heart attack or stroke. I wish more studies like this would also control for the presence of obstructive sleep apnea. 

High Blood Pressure In Children Predicts Heart Disease In Parents

You may be thinking that I mixed up the words in the title. Yes, I did mean to say that children who have high blood pressure or high cholesterol have higher chances that their parents have diabetes or heart disease later on in life. Researchers found that 26 years after screening these children for health problems, 47% of parents of these same kids had suffered a heart attack, stroke, or underwent a procedure to unclog blocked arteries. Thirty-seven percent of parents developed diabetes.

Again, there’s not one mention of the likelihood that there’s any chance of obstructive sleep apnea. 

 

Searching for a drug rehab Florida program? 

Insomnia Significantly Raises Your Heart Attack Risk

Millions of people have chronic insomnia. Billions are spent on pharmacologic and natural treatment options every year. Now a study shows that if you have chronic insomnia, you have up to a 45% increased risk of having a heart attack. 

This study followed over 52,000 Norwegians who initially complained about insomnia. After 11 years of follow-up, those that said they had trouble falling asleep daily for over one month were 45% more likely to have suffered a heart attack. Those that couldn’t stay asleep all night had  a 30% increased risk, and those that reported unrefreshing sleep had a 27% increased risk. After adjusting for age, sex, marital status, education, blood pressure, cholesterol, diabetes, weight, exercise, shift work, depression and anxiety, people with sleep troubles were found to have the highest risk of having a heart attack.

Something to sleep on.

Why Having Depression Can Raise Stroke Risk in Postmenopausal Women

Here’s another study that shows an interesting observation, but an explanation using my sleep-breathing paradigm is much more satisfying. Researchers found that postmenopausal women who have a current history of depression, past history of depression, or use of antidepressant medications had a significantly higher overall risk of stroke (29% over 6 years). Having a current history of depression alone increased your risk to 41%. The authors speculated that this increased risk may be due to medication use, weight gain, or increased cardiovascular complications that’s seen in people with depression. It’s been already shown in a past study that depression increases your risk of sudden death and fatal coronary heart disease.

It you accept the fact that postmenopausal women will have a higher likelihood of developing obstructive sleep apnea, then it’s likely that they will also be at higher risk of having depression, anxiety, hypertension, heart disease, etc. The researchers have done a great job in linking two of the end consequences of untreated obstructive sleep apnea, but failed to look at the common root of both conditions. 

When Do You Want To Die?

If you had to choose between dying in your sleep or dying after having breakfast in the morning, which would you choose? Most of you would probably choose to die in your sleep. Unfortunately, the vast majority of us are most likely to die anywhere between 7 AM and 12 PM, with a nadir between midnight and 6 PM. However, if you have untreated sleep apnea, you’re more likely to die in the middle of the night, from midnight to 6 AM. Since sleep apnea causes major breathing pauses and struggles to breathe, it’s not surprising to see this correlation. The overall risk of sleep apnea patients dying from cardiac sudden death was found to be over 2.5 times higher than those who don’t have sleep apnea. 

How Hot Flashes in Women Protects Against Heart Disease

Hot flashes and night sweats are common symptoms of menopause. Interestingly, in a study of 60,000 post-menopausal women, those that suffered the worst night sweats and hot flashes at the start of menopause had a 17% lower chance of stroke and 11% lower chance of heart disease when followed for 10 years, compared with those who had no symptoms. Heart attack deaths were 24% lower. The authors could not give a clear explanation for their findings. Here’s my explanation:

I’ve written before that I often see hot flashes and night sweats in young men. They also have irritability, mood swings and insomnia. These symptoms are neurologic events that occur due to a relative change in the status of the involuntary nervous system. These young men are typically gaining weight quickly. This causes a rapid relative change in their sleep-breathing status, due to more frequent breathing pauses at night. Rapid weight gain is known to contribute to obstructive sleep apnea.

In menopausal women, not only do most gain some amount of weight, their progesterone levels begin to drop in their early 40s. Progesterone is a known upper airway muscle dilator, increasing muscle tone to the tongue. As progesterone slowly drops, the tongue relaxes more, especially when in deep sleep. This causes more frequent micro-obstructions and arousals, leading to the typical neurologic (vasomotor) symptoms commonly seen in perimenopausal women. It’s this relative change in the sleep-breathing status that irritates the involuntary nervous system (which regulates temperature, sweating, heart rate, blood pressure, digestion, and various other body functions).

Dr. Guilleminault of Stanford University states that people with obstructive sleep apnea have diminished nervous systems in the throat. Vibrations from snoring or reflux from obstructive events can damage the protective pressure and chemical sensors in the throat. If you already have some degree of obstructive sleep apnea as you approach menopause, it’s plausible that as progesterone levels drop, the additional breathing pauses don’t have as much of an effect on the involuntary nervous system, since it’s been happening already for years or decades. If your nervous system is intact, then the sudden increases in breathing pauses can lead to more severe vasomotor symptoms.

What this study suggests is that the more you’re susceptible to obstructive sleep apnea, the less likely you’ll suffer hot flashes and night sweats early in menopause. This can explain the higher rate of cardiovascular disease in post-menopausal women.

This is another example of interpreting scientific studies based on my sleep-breathing paradigm. If you’re not familiar with this concept, you can read my articles, or for a more in-depth explanation, take a look at my book, Sleep, Interrupted.

What do you think about my line of reasoning? Please enter your feedback below in the comments box.

Women & Heart Disease: A Travesty, Part II

Carolyn Thomas over at her blog Heart Sisters just wrote about my comments to a KevinMD post on heart attack symptoms in women. It’s an issue that needs much more awareness by physicians and the lay public.

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