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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. 

8 Glasses of Water Per Day: Is it Really Healthy?

In his “Really?” column in the New York Times, Anahad O’Connor brings up recent research which suggests that drinking 8 glasses of water every day can be beneficial, especially for your kidneys. The authors found that those who had the highest urine volume had lower rates of kidney disease.

On the other hand, another recent study showed that renal hyper-filtration can significantly increase your chances of stroke. They also noted that kidneys tend to overwork in people with the metabolic syndrome, and type 2 diabetes. Notice how obstructive sleep apnea by itself has been linked to increased risk of hypertension, obesity, high cholesterol, and insulin resistance (the metabolic syndrome, or Syndrome X)). In fact, Syndrome Z describes metabolic syndrome plus obstructive sleep apnea.

Knowing that untreated obstructive sleep apnea can also increase urine production by increased levels of atrial naturietic peptide/hormone, it’s not surprising that increased urine production can be linked to higher rates of stroke. Many people who go to the bathroom often at night are found to have untreated obstructive sleep apnea (which increases your risk of stroke). It’s actually been shown that people wake up due to breathing pauses, and not from too much urine production. But the overall levels of urine to go up significantly.

I think that you have to use common sense when it comes to recommending certain volumes for water intake. People have different metabolic needs, and there’s additional water in the normal food that you eat throughout the day. Drinking too much water before bedtime can also increase urine production, leading to more frequent awakenings and poor sleep quality.

Depression Ups Your Stroke Risk

A recent study revealed that having depression was found to increase the risk of having a stroke by 45% in people who were followed from 2 to 29 years. Your risk of dying from a stroke also increases by 55%. The article talks about people with depression being more overweight. What else can being overweight cause?

We know that having insomnia significantly increases your risk of developing depression later on in life. Having untreated severe obstructive sleep apnea also significantly increases your chances of having a stroke. Not sleeping well from any reason (insomnia or sleep apnea) can cause major biochemical and structural changes in your brain. Do you see the connection? 

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. 

Why Pregnant Women Have More Strokes

Rates of stroke went up 47% for expectant mothers and climbed to 83% in the first three months after delivery. This was the finding that was published in the journal Stroke: Journal of the American Heart Association. They cite rising rates of additional risk factors such as high blood pressure, obesity, and gestational diabetes, but didn’t give a plausible explanation. Here’s a story about this study published in the Wall Street Journal.

Here’s a simple explanation: Sleep-breathing problems. Whether it’s obstructive sleep apnea or more likely upper airway resistance syndrome, pregnant women tend to have more frequent breathing pauses, especially as they gain weight. One protective mechanism is through progesterone, which acts as a tongue muscle stimulant, but the forces of upper airway collapse is likely to overwhelm these protective effects. What’s even more striking is that the rate almost doubles immediately postpartum. Remember that progesterone drops soon after delivery, but you’re still left with all that additional weight. We know that obstructive sleep apnea can significantly increase your chances of stroke and heart attacks. There are even reports that suggest that preeclampsia can be successfully treated with CPAP.

Overall, the numbers are still very low, but the sudden rise in the rate of stroke in new mothers leaves researchers scratching their heads.

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 And Heart Disease: A Travesty

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.

Why Stroke Rates Are Increasing in Younger People

Researchers have shown that rates of hospitalization for ischemic strokes in young people, even in children and teens, is rising. The largest jump was a 51% increase in male ages 15 to 34. Rising rates were also seen in male ages 5 to 14 (36%), female ages 5 to 14 (31%), and female ages 15 to 34 (17%). Stroke rates actually decreased in people above 45 by 25 to 29%.

The study authors don’t give convincing explanations for the increase, but do speculate that it could be from increased awareness and earlier diagnosis, better imaging technology, and rising obesity rates. But one clear and documented condition that’s not mentioned is that untreated obstructive sleep apnea can significantly increase your risk of stroke. It’s been shown to be an independent risk factor for stroke, increasing your odds by 2-3 times normal.

Just this morning, I had a patient tell me that his wife had a stroke in her early 40s. Not too surprisingly, she snores heavily. No one ever suspected diagnosing and treating obstructive sleep apnea.

Untreated sleep apnea can significantly increase your chances of having a stroke through various different mechanisms. One way is through creating a hyper-coagulable state—blood tends to be thicker, and when stagnant, it can clot more easily. Various inflammatory factors are elevated in sleep apnea, again making you more likely to clot a blood vessel in your brain. Chronic hypoxia can also create oxidative stress, massive inflammation and clotting of smaller brain vessels.

I predict this problem will only get worse over the next few decades. Knowing what we know, it’s shocking how little we in the medical profession do to prevent this problem from happening.

Do you personally know a young person that has suffered a stroke? Does that person snore?

Obstructive Sleep Apnea And Hearing Loss

I’ve always suspected that nerve deafness may be one of the consequences of obstructive sleep apnea, but there’s been little research in this area. However, a new study out of Korea shows that in the elderly, having obstructive sleep apnea significantly increases your chances of have nerve deafness, particularly due to a problem in the central nervous system.

This finding is not surprising, since sleep apnea causes a hyper-coagulable state, with blood being more stagnant and tending to clot, in addition to additional inflammatory factors that can cause damage. It’s also been shown that blood is thicker and more viscous in people with sleep apnea. In fact, a recent study showed that people with obstructive sleep apnea had thicker blood than normal, and by diluting the blood concentration with saline, auditory brainstem reflexes improved to the point of being normal. Placing these people on CPAP also normalized hearing reflexes.

Recent brain imaging studies have shown that hypoxia in the brain from sleep apnea can cause major vascular and tissue damage, affecting critical areas of the brain, including the brainstem. The risk of stroke is also increased by more than 3 times if you have sleep apnea. Knowing all this, it’s not surprising that you can have either brainstem damage or peripheral inner ear vascular damage from untreated obstructive sleep apnea. One study showed that people with sudden one sided hearing loss from nerve damage have a higher risk of having sleep apnea.

I think that nerve deafness is part of the cardiovascular-metabolic process, going along with hypertension, diabetes, hypertension, high cholesterol, and heart disease. What you you think? If you have sleep apnea, do you have any hearing loss?

New Year’s Day Heart Attack Rates Soar

I’m willing to bet that tonight we’ll also have the highest rate of apneas during sleep due to alcohol ingestion just before bedtime. Alcohol relaxes your throat muscles, which can aggravate, if not cause obstructive sleep apnea. Sleep apnea is a major source of stress on the heart. We also know that the days after Christmas and New Years Eve have the highest rates of heart attacks.

If you’re inebriated , you won’t have the normal reflexes to wake up and turn over every time you stop breathing. You’ll also have lots of reflux due to vacuum forces suctioning up your stomach juices into your throat. This will cause a lot of sore/dry throats and even much higher rates of pneumonia, asthma, sinusitis and ear infections.

Unfortunately, this is a sad observation and commentary, but likely to be true.

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