Heart Disease, Dementia and Sleep Apnea

April 3, 2013

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. 


High Blood Pressure In Pregnancy Raises Child’s Heart Risk

May 28, 2012

Having high blood pressure during pregnancy (also called preeclampsia) was found to increase the offspring’s risk of having high blood pressure in childhood and young adulthood. This study published in Pediatrics analyzed 18 studies and looked at cardiovascular risk factors in people exposed to high blood pressure during pregnancy. Those that were exposed had a systolic blood pressure that was 2.39 mm Hg higher compared to those whose mothers had healthy pregnancies. The diastolic pressure was 1.35 mm Hg higher. They calculated  that over time, these figures would increase one’s risk for dying from heart disease by 8% and from stroke by 12%.

What’s my take on this study? It’s not surprising, since many women with preeclampsia have sleep-breathing problems such as obstructive sleep apnea and upper airway resistance syndrome. It’s been shown that treating with CPAP can lower blood pressure in women with preeclampsia. Despite this knowledge , sleep apnea is almost never considered when treating preeclamptic women in the US. Having hypoxia and physiologic stress from the mother’s poor sleep quality can be detrimental to the developing fetus. Since the offspring will also inherit the mother’s upper airway anatomy, it’s not surprising that the child will be predisposed to the consequences of obstructive sleep apnea, such as high blood pressure, diabetes, heart attack and stroke. It’s also likely that environmental and dietary factors during pregnancy  may carry over into the household which can also affect the child’s diet.

The Missing Link Between Gum Disease and Heart Disease

April 19, 2012

It’s medical dogma that having gum disease can cause heart disease. The most common explanation is that bacteria from your mouth can spread through the bloodstream and infect your heart valves (called endocarditis). The problem with this explanation is that endocarditis is a tiny fraction of people who have heart disease. Just because there’s an association, it doesn’t mean that one causes the other.

The American Heart Association recently reviewed 537 articles on this subject and published a review, stating that there’s no scientific evidence that gum disease causes heart disease, heart attacks, or stroke. Past studies were mainly observational, and not based on prospective studies. They also state that there’s no evidence that treating periodontal disease can prevent heart disease.

What’s the missing link? You guessed it: Obstructive sleep apnea. We know that obstructive sleep apnea can cause reflux and inflammation in the mouth. Mouth breathing due to craniofacial narrowing and inflammation also dries out saliva, which helps to protect your mouth from pathogens. If you’re missing teeth, then your mouth gets smaller, narrowing your airway even further. We also know that obstructive sleep apnea significant increases your risk of heart disease, heart attack, stroke, and death.

So it makes sense that if you treat sleep apnea, you’ll have less gum disease, and less heart disease. Obviously a prospective, randomized, placebo-controlled, double-blinded study is needed to prove this point.

Another Link Between Heart Disease, Depression, & Sleep Apnea

March 9, 2012

Here’s a study showing that having both heart disease and depression can significantly increase your chances of cognitive decline later in life.  This makes absolute sense if you have obstructive sleep apnea to begin with, since this is what can aggravate or cause both heart disease and depression. There are also many studies showing how damaging untreated obstructive sleep apnea is on the brain.

High Blood Pressure In Children Predicts Heart Disease In Parents

January 30, 2012

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. 


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Insomnia Significantly Raises Your Heart Attack Risk

October 31, 2011

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.

How Erectile Dysfunction Can Cause Alzheimer’s

September 28, 2011

Not too surprisingly, focusing on lifestyle habits that control heart disease or taking medications to lower high blood pressure or cholesterol levels can also help symptoms of erectile dysfunction (ED). 

Dr. Stephen Kopecky, professor of medicine and cardiovascular diseases at the Mayo Clinic, and author of the paper published in Archives of Internal Medicine, quotes, “It’s a fascinating thing, but all the arteries are connected. We know that the risk factors for stroke are the same as for heart disease. We know that the risk factors for ED are the same as for heart disease. And we are finding that the risk factors for dementia and Alzheimer’s are the same as for heart disease.”

It’s frustrating that doctors are connecting all the dots, but rarely ever include obstructive sleep apnea as a major component of all these conditions. In this vein, having ED could mean that you’re at higher risk for obstructive sleep apnea, which causes diminished circulation to various parts of the body, including the penis and the brain. You can make a strong argument that everyone with ED should be screened for obstructive sleep apnea. 

What’s your opinion on this issue? Please enter your viewpoints in the text area below.


Why Having Depression Can Raise Stroke Risk in Postmenopausal Women

August 15, 2011

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. 

How Hot Flashes in Women Protects Against Heart Disease

February 26, 2011

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 And Heart Disease: A Travesty

February 18, 2011

February is American Heart Month, and one thing that’s being stressed more this year is the fact that many women’s heart problems go undiagnosed, especially if they have atypical symptoms. The American Heart Association just recently came out with revised guidelines of cardiovascular disease prevention for women. The two interesting points they make is that women have a higher proportion of strokes to heart attacks compared with men. The other point they at emphasize is the fact that if  you had a complication during pregnancy, your risk of heart disease later in life is significantly higher.

What was surprising to me is that we have lots of studies showing that most cases of pregnancy-related complications such as preeclampsia and gestational diabetes may be caused by untreated obstructive sleep apnea. Since weight gain is a major risk for sleep apnea, why should pregnant women be excluded from having a sleep-breathing disorder? By definition, pregnancy will cause you to have temporary sleep-breathing problems, whether or not it’s officially obstructive sleep apnea.

The one thing that protects against sleep apnea during pregnancy is the rise in progesterone, which acts as an upper airway muscle stimulant, but this can only help so much. As progesterone drops after delivery, what do you think will happen to women who still have most their pregnancy weight? I’m willing to bet that if you do the same study looking at post-partum complications such as postpartum depression, you’ll see the same increased rate of heart disease later in life.

The shocking thing was that nowhere in these general guidelines do they even mention looking for obstructive sleep apnea. I won’t begin to talk about the link between stroke and sleep apnea–there are just too many studies to mention. I encourage you to take a look at the recommendations of the American Heart Association’s website. Tell me what you think about this glaring omission.

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