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Miscarriages & Heart Disease, From Sleep Apnea?

If you’ve been following my blog, I alluded to how infertility and miscarriages can be aggravated by obstructive sleep apnea or upper airway resistance syndrome. A recent study showed that having 3 miscarriages increases your chances of having heart disease by over 5 times normal.

If you think about the physiology, it makes sense: Breathing pauses during sleep, whether or not it’s an apnea, can cause a physiologic state of stress. In other words, you’ll have too much adrenaline, which you need to fight or run from danger. It’s also common knowledge that if you’re in a fight or flight situation, the last thing you need to do is to reproduce. Physiologically, stress has a way of diminishing or reducing nervous innervation and blood flow to your reproductive organs and digestive system (as well as your skin, hands and feet).

Since people with obstructive sleep apnea or upper airway resistance syndrome have narrowed upper airways, it’s not surprising that women who have frequent miscarriages can develop heart disease later on in life. Every time I see a patient that has a history of miscarriages or infertility, I see the same upper airway anatomy: small jaws and narrowed space behind the tongue. Most will not be able to sleep on their backs, have either cold hands or feet, or suffer from various gastrointestinal problems.

How many women with sleep apnea who are reading this blog had a miscarriage or infertility issues?

Why Do Heart Bypass Patients Have Insulin Resistance?

Here’s a study that I came across that you’d probably read and say, “that’s interesting,” and go on to reading another abstract. In my mind, I’m jumping up and down, waving my arms, screaming, “look for sleep apnea!”

Researchers showed that heart bypass patients had insulin and glucose profiles that were similar to diabetics. Not too surprising if you have undiagnosed obstructive sleep apnea. We know that untreated obstructive sleep apnea can cause or aggravate heart disease, insulin resistance, obesity, hypertension, and high cholesterol, just to name a few. If cardiologists screened all their patients for sleep apnea, I don’t know if our health care system can handle the huge increase in people needing sleep studies. Perhaps expanding the role of home-based studies including titration should be considered for a certain subset of this population.

Given what we know about sleep apnea, do you think everyone with heart disease should be screened for sleep apnea? Please enter your comments in the text area below.

Migraines, Heart Disease, & Sleep Apnea

One of the most common conditions that I see in my ENT practice is migraines. Not your typical classic migraine with the auras, light sensitivity and nausea, but the variations of migraine that involve the ears and sinuses. In fact, the vast majority of people who suffer from sinus pain and headaches are found to have migraines—if you perform CT scans, the sinuses will be completely normal. However, patients usually won’t believe me until they see the CT images, and after they respond to anti-migraine treatments.

In an often repeated study on migraines, researchers showed again that having migraines is linked with an increased risk of cardiovascular disease and even death.

These results are not surprising, since obstructive sleep apnea is strongly linked to cardiovascular disease and increased risk of death (46% in people with severe sleep apnea). Poor sleep quality that results leads to hypersensitivity of various nerve endings. If it happens in your sinuses, you’ll feel pain, pressure, headaches, nasal congestion and post-nasal drip. If in your ears, hearing loss, ringing, dizziness, fullness and sensitivity.

Having a migraine is not normal. If you suffer from migraines, it’s you’re body’s way of telling you that something is wrong, that you’re not getting quality deep sleep.

Do you suffer from migraines? If so, do your parents have heart disease or died early from cardiovascular complications? Is like to hear your response in the response box below.

Can Sleep Apnea Cause Psoriasis?

How is psoriasis connected to obstructive sleep apnea? You may think I'm crazy for even making the suggestion, but if you look at the studies, the results don't lie—you just have to connect the dots.

I've always wondered about this link, since almost every known medical condition is proven to be or possibly associated with obstructive sleep apnea. I was reminded about this connection when I read about golfer Phil Mickelson's psoriatic arthritis. I already commented on the association between sleep apnea and arthritis, and this time, I'm going to show you that psoriasis may be connected as well.

First of all, numerous studies have shown that people with psoriasis have a much higher chance of having cardiovascular disease. There are other reports that psoriasis is associated with an increased incidence of cancer, lymphoma, obesity, metabolic syndrome (also known as "Syndrome X"), autoimmune diseases (Crohn's disease and diabetes, etc.), psychiatric diseases (such as depression and sexual dysfunction), psoriatic arthritis, sleep apnea, personal behavior issues, chronic obstructive pulmonary disease (COPD).  If you have severe psoriasis, the likelihood that you'll have a heart attack is 3 times normal. Your chance of dying overall is almost doubled than if you didn't suffer from this condition. Average life expectancy is about 3 to 5 years shorter for someone with psoriasis.

We also know that obstructive sleep apnea can cause metabolic syndrome, hypertension, diabetes, high cholesterol, inflammation, heart disease, heart attack, and stroke. Your risk of dying early increases 45% if you have severe obstructive sleep apnea.

There's even a case report of someone with severe psoriasis who was completely cured after undergoing gastric bypass surgery for obesity.

Here's my take on the connection between obstructive sleep apnea and psoriasis: The chronic stress response and repeated episodes of hypoxia deprives the skin of vital blood flow and nutrients. Sympathetic activity overload preferentially shuts down certain parts of the body that are considered unessential, such as the digestive system, reproductive system, and the skin. In addition, chronic low-grade stress also causes your immune system to overreact and cause inflammation, inducing various self-destroying tendencies that are common with autoimmune conditions.

What do you think about this possible connection? I'd like to hear your opinion.

Migraines, Heart Disease & Sleep Apnea

I was going through the NY Time's excellent Patient Voices blog and multimedia piece on migraine (see my comments #30, and #584), and was reminded that people who have migraines are at a higher risk of cardiovascular disease later in life. In this 2006 study from JAMA, women who have classic migraines had significantly higher risks for major cardiovascular disease, ischemic stroke, heart attack, coronary revascularization, angina, and ischemic cardiovascular disease death. 

This is not too surprising since most migraineurs have upper airway resistance syndrome or obstructive sleep apnea, and we know that obstructive sleep apnea can significantly increase your chances of suffering from heart disease, heart attack, or stroke.

If you have migraines, does your mother or father snore or have cardiovascular disease?

Sleep Apnea, Migraines and Multiple Sclerosis: Is There a Link?

It seems like study after study is published that links two previously unlinked conditions to one another. In this study, the presence of migraines was associated with a 47% increased risk of developing multiple sclerosis (MS) later in life. Researchers again point to a genetic wastebasket explanation, with no practical implications. In a previous post, I noted that MS was linked to heart disease. Since we know that Alzheimer's is linked to heart disease, why can't migraines be linked to heart disease or even Alzheimer's? Ultimately, if you connect all the dots of all the associations between various medical conditions, then almost every medical condition can be linked in one way or another. 

 

My sleep-breathing paradigm easily explains the link between migraines and MS via the following mechanism: Migraines are a common symptom of poor quality sleep due to an inability to breathe properly at night. By definition, all modern humans are susceptible to these events, where only the extreme end of the spectrum is called obstructive sleep apnea. If you're not able to sleep deeply, then your entire nervous system is hypersensitive, causing an over-reaction to your senses, leading to symptoms such as headaches, TMJ, sinus pain and pressure. 

 

MS is thought to be an autoimmune condition with flareups of inflammation and "plaques" in any part of the brain that are seen on MRI. Sleep apnea is known to cause not only chronic sympathetic nervous system overload, but also thickening of the blood with patients being prone to either diminished blood flow or small microscopic clots in the brain. Studies have shown that sleep apnea patients have multiple areas of decreased gray matter density in various parts of the brain. This could in theory lead to either "lesions" in the brain, neurotransmitter abnormalities, or hormonal dysfunction.

 

It makes sense that in people who have sleep-breathing problems long before they go into sleep apnea, their nervous systems are overly active (waking up too quickly), whereas sleep apnea patients' nervous systems are underactive (not waking up quickly enough). Chronic low-grade stress is also known to upregulate your immune system, leading to the classic autoimmune conditions that are often seen in people with upper airway resistance syndrome (cold hands, anxiety, fatigue, etc.). 

 

Rather then reducing human illnesses down to genetic factors or biochemical deficiencies, it makes more sense to treat the patient as a whole person. But with modern medicine, that's not allowed. Yes, there has to be progress in medical research, but as a whole, are we going in the wrong direction? I'd like to know your opinion on this issue. Please enter your opinion in the comments box below.

Sleep Apnea Causes Brain Damage

A new study in the journal Sleep revealed that using special MRI imaging techniques, untreated sleep apnea patients have significantly decreased concentrations of gray matter in certain predictable areas of the brain. This means that the density of neurons is much lower than normal. The average AHI was 52, and on initial inspection of the MRI, there were no obvious structural abnormalities, with no differences in the total volume. However, gray matter density was significantly lower for sleep apnea patients in various areas of the brain that serves important functions such as memory, breathing, cardiovascular function, and autonomic function.

This study complements a prior study that showed that OSA patients have multiple dysfunctional areas of the brain.

I think the implications of this study along with various other similar studies are profound. What this means is that if you have obstructive sleep apnea, you can literally kill off certain parts of  your brain, that preferentially control your memory, executive function, your breathing patterns, and even your your heart rate. Could this be an alternate explanation for central sleep apnea? Maybe this is also why not all patients that use CPAP feel significantly better—perhaps the damage is irreversible. What's frightening is that you can suffer permanent brain damage long before your sleep apnea is even picked up and treated. 

Take a look at the abstract and read the paper if possible. What do you think about these findings? Please enter your opinions in the text box below.

The Gingivitis–Heart Disease–Sleep Apnea Connection

There have been numerous studies on your increased risk of heart disease if you have gum disease or cavities. The most common explanation is based on the antiquated germ-theory that Louis Pasteur developed over 100 years ago—that bacteria or other pathogens in the gums and the teeth can travel into the bloodstream and lodge in the heart, causing heart disease. The explanations that were given during medical school were never too satisfying. To this day, I still wonder how bacteria in your mouth can spread and reach your heart. We have hundreds, if not thousands of stains of bacteria living naturally in our bodies. Why do some preferentially reach the heart, whereas others can’t?

 

If you look at this connection through the perspective of my sleep-breathing paradigm, there’s a much better explanation. Studies have shown that acid reflux is linked to gingivitis and cavities. What’s acid reflux linked to? Right! Obstructive sleep apnea. I also mentioned in a past post that these same juices also contain bile, digestive enzymes, as well as bacteria. Imagine bathing your gums and teeth in acid, bile, digestive enzymes and bacteria all night. What do you get? Gingivitis and cavities.

 

In his book Nutrition and Physical Degeneration, Dr. Weston Price showed that in certain cultures with wide and spacious jaws, the presence of cavities was almost nonexistent. However, in cultures with narrow jaws dental crowding, cavities were rampant.

 

There are also  tons of studies strongly linking obstructive sleep apnea with heart disease, hypertension, diabetes, stroke, and heart attack. 

 

So is obstructive sleep apnea the common link? What’s you opinion on this theory? Please enter your comments in the text box below.

Are You Depressed? Check Your Heart First

Can Snoring Cause Stroke?

Snoring is so common these days that no one takes it seriously anymore. One patient commented  that even her dog snores! Yesterday, I saw a man who uses earplugs to cover up his wife’s intense snoring. When someone is caught snoring, giggles and smiles are more common than genuine concern about the snorer’s health.

 

Not all snoring is dangerous, but a significant number of snorers will have undiagnosed obstructive sleep apnea. Recent studies highlight the seriousness untreated sleep apnea. One study showed that untreated apnea patients experience similar changes in brain biochemistry as people who are having a stroke or are dying. Even moderate degrees of oxygen deprivation was found to have profound effects. The abstract can be found here.

 

Another study showed that untreated sleep apnea patients have higher blood viscosity, meaning that their blood is literally thicker than normal. This, coupled with increased inflammation that’s seen in sleep apnea, makes small vessels in the brain more likely to clot.

 

Numerous other imaging studies report finding multiple small areas of damage in different areas of the brain in people with untreated obstructive sleep apnea.

 

Studies in young children found that even very mild degrees of obstructive sleep apnea can lead to cognitive changes and maybe even permanent neurologic injury. 

 

These type of studies go on and on. While we can’t screen everyone who snores for obstructive sleep apnea, if you have any of the potential complications of sleep apnea (such as depression, anxiety, high blood pressure, or heart disease) or if there’s a strong family history of snoring with cardiovascular diseases, there’s good reason to get checked for sleep apnea. 

 

The reason I bring up this issue at all is that once in a while, I’ll see a relatively young patient (in his or her 30s or 40s) who had a stroke. Not too surprisingly, they all snore heavily. If you know anyone that had a stroke at a relatively young age, at least consider the possibility.

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