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Sleep Apnea, Heart Disease & CPAP Therapy

CPAP-SCOFA-11

 
Medically reviewed by
Dacelin St Martin, MD
Triple board-certified in Sleep Medicine,
Internal Medicine, and Pediatrics.

 
 
OSA and Heart Disease | Diagnosis | Risk Factors | CPAP  | Alt Management Methods | Heart Failure Therapy

 

Overview

The connection between obstructive sleep apnea (OSA) and heart disease is recognized by the medical community, yet millions of Americans go undiagnosed for this potentially fatal sleep disorder.

A recent study shows that treating OSA with continuous positive airway pressure (CPAP) is associated with a lowered risk of heart disease,[1] decreasing the likelihood of a cardiovascular event, like a heart attack or stroke.

Keep reading to find out more about OSA, heart disease, and CPAP therapy.

 

OSA and Heart Disease

OSA increases the risk of developing heart disease, while those with comorbid heart disease will be affected more greatly by the effects of OSA.

Empirical data points to an association between OSA, atrial fibrillation, hypertension, and coronary heart disease. Physiologically, what happens is that OSA alters your cardiac function and structure.

Closed airways lead to stress in your heart’s upper chambers, or atria, resulting in chaotic electrical signals or atrial fibrillation. A telltale symptom is that your heart beats erratically, either too slowly or too quickly.

When your oxygen levels drop, your blood pressure rises, causing your heart to go into overdrive to help regulate your blood pressure. This sequence of events can result in irreversible damage to blood vessels in the heart and hypertension.[2] All this stress on your heart can lead to a fatal heart attack or stroke.

Furthermore, the swelling and subsequent narrowing of the upper airway is an additional factor that complicates heart conditions.[3]

The intermittent lowering and heightening of oxygen levels in your blood can lead to further heart disease progression.

CPAP SCOFA Heart Disease

 

Diagnosis

In-laboratory overnight polysomnography (PSG) is the gold standard in diagnostic testing for OSA.

PSG measures several sleep variables, including the apnea-hypopnea index (AHI) or respiratory disturbance index (RDI), which are key measurements for an OSA diagnosis.

Home sleep testing is another option that insurers sometimes mandate. Still, it hasn’t been as well-studied in patients with heart failure as it’s usually prescribed for suspected uncomplicated OSA.

However, there is emerging data that indicates that home sleep testing may be feasible and accurate in patients hospitalized with heart failure, leading the way for expedited treatment.[4, 5, 6]

If you have heart disease, some additional investigation may be done during polysomnography to check for the presence of the following conditions:

  • Nighttime angina
  • Recurrent heart arrhythmias
  • Refractory heart failure symptoms
  • Abnormal respiratory patterns
  • Repetitive oxygen loss during sleep

 

Risk Factors

The most common risk factors for OSA are as follows:

  • Older age – The prevalence of OSA increases as we get older, then levels off after our 70s.[7, 8, 9]
  • Male gender – OSA has a 2-3 times higher prevalence in men than in women, though the difference narrows as women get older.[9]
  • Obesity – Possibly the most well-known risk factor.[10]
  • Wide neck circumference – whether obesity-related or in very muscular individuals – is considered more than 17 inches for men and over 16 inches for women.[11]
  • Craniofacial and upper airway abnormalities (such as a narrower airway).[12]

Additionally, if you have heart failure and are experiencing any of the following, speak to your doctor about the possibility of getting an OSA test:

 

CPAP Therapy

With CPAP therapy, there are a few mask styles, including a full mask that covers the mouth and nose. It helps airways remain open while stimulating breathing by pumping a steady stream of pressurized air through hoses to the mask.

Empirical data shows that management of OSA with CPAP reduces systolic blood pressure, improves left ventricular systolic function, and diminishes platelet activation.[13]

CPAP therapy may improve cardiac function, blood pressure, exercise capacity, and overall quality of life.  

A recent study shows that the risk of a cardiovascular event was 32 percent lower in patients with any severity of OSA who used CPAP therapy, and 44 percent lower in those with moderate to severe OSA who used CPAP therapy.[1]

 

Alternate OSA Management Methods 

  • Nighttime oxygen supplementation 
  • Weight loss and exercise 
  • Theophylline – is a medication used for the treatment of certain lung diseases. It relaxes and opens air passages in the lungs, making it easier to breathe
  • Oral Appliances
  • Surgery

 

Heart Failure Therapy

These therapies can improve OSA symptoms in patients who have coexisting heart disease:

  • Medical management (e.g: ACE inhibitors, beta-blockers, and diuretics)[14, 15, 16, 17]
  • Heart transplant[18, 19, 20]
  • Pacemaker[21, 22, 23]
  • Left ventricular assist device (LVAD) implantation[24]

 

Conclusion

There’s a high rate of comorbidity for OSA and heart disease. The good news is that with a sleep test diagnosis, there are several effective treatment methods.

CPAP therapy is effective as a non-invasive treatment for the management of OSA, helping prevent the development and exacerbation of heart disease.

 

References:

  1. Diego Mazzotti, Aiyu Chen, Jaejin An, Jessica Arguelles, Brendan Keenan, Greg Maislin, Amy Sawyer, Henry Glick, Allan Pack, Dennis Hwang, Jiaxiao Shi, 439 Continuous Positive Airway Pressure and Cardiovascular Risk in a Large Clinical Sample of Obstructive Sleep Apnea Patients, Sleep, Volume 44, Issue Supplement_2, May 2021, Pages A173–A174, https://doi.org/10.1093/sleep/zsab072.438
  2. Malhotra, A., Muse, V. V., & Mark, E. J. (2003). Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 12-2003. An 82-year-old man with dyspnea and pulmonary abnormalities. The New England journal of medicine, 348(16), 1574–1585. https://doi.org/10.1056/NEJMcpc030005
  3. Bucca, C. B., Brussino, L., Battisti, A., Mutani, R., Rolla, G., Mangiardi, L., & Cicolin, A. (2007). Diuretics in obstructive sleep apnea with diastolic heart failure. Chest, 132(2), 440–446. https://doi.org/10.1378/chest.07-0311
  4. Khayat, R. N., Jarjoura, D., Patt, B., Yamokoski, T., & Abraham, W. T. (2009). In-hospital testing for sleep-disordered breathing in hospitalized patients with decompensated heart failure: report of prevalence and patient characteristics. Journal of cardiac failure, 15(9), 739–746. https://doi.org/10.1016/j.cardfail.2009.05.005
  5. Kauta, S. R., Keenan, B. T., Goldberg, L., & Schwab, R. J. (2014). Diagnosis and treatment of sleep disordered breathing in hospitalized cardiac patients: a reduction in 30-day hospital readmission rates. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine, 10(10), 1051–1059. https://doi.org/10.5664/jcsm.4096
  6. Aurora, R. N., Patil, S. P., & Punjabi, N. M. (2018). Portable Sleep Monitoring for Diagnosing Sleep Apnea in Hospitalized Patients With Heart Failure. Chest, 154(1), 91–98. https://doi.org/10.1016/j.chest.2018.04.008
  7. Young, T., Palta, M., Dempsey, J., Peppard, P. E., Nieto, F. J., & Hla, K. M. (2009). Burden of sleep apnea: rationale, design, and major findings of the Wisconsin Sleep Cohort study. WMJ : official publication of the State Medical Society of Wisconsin, 108(5), 246–249.
  8. Jennum, P., & Riha, R. L. (2009). Epidemiology of sleep apnoea/hypopnoea syndrome and sleep-disordered breathing. The European respiratory journal, 33(4), 907–914. https://doi.org/10.1183/09031936.00180108
  9. Tufik, S., Santos-Silva, R., Taddei, J. A., & Bittencourt, L. R. (2010). Obstructive sleep apnea syndrome in the Sao Paulo Epidemiologic Sleep Study. Sleep medicine, 11(5), 441–446. https://doi.org/10.1016/j.sleep.2009.10.005
  10. Bixler, E. O., Vgontzas, A. N., Lin, H. M., Ten Have, T., Rein, J., Vela-Bueno, A., & Kales, A. (2001). Prevalence of sleep-disordered breathing in women: effects of gender. American journal of respiratory and critical care medicine, 163(3 Pt 1), 608–613. https://doi.org/10.1164/ajrccm.163.3.9911064
  11. Epstein, L. J., Kristo, D., Strollo, P. J., Jr, Friedman, N., Malhotra, A., Patil, S. P., Ramar, K., Rogers, R., Schwab, R. J., Weaver, E. M., Weinstein, M. D., & Adult Obstructive Sleep Apnea Task Force of the American Academy of Sleep Medicine (2009). Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine, 5(3), 263–276.
  12. Young, T., Skatrud, J., & Peppard, P. E. (2004). Risk factors for obstructive sleep apnea in adults. JAMA, 291(16), 2013–2016. https://doi.org/10.1001/jama.291.16.2013
  13. Jean-Louis, G., Zizi, F., Clark, L. T., Brown, C. D., & McFarlane, S. I. (2008). Obstructive sleep apnea and cardiovascular disease: role of the metabolic syndrome and its components. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine, 4(3), 261–272. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2546461/
  14. Bucca, C. B., Brussino, L., Battisti, A., Mutani, R., Rolla, G., Mangiardi, L., & Cicolin, A. (2007). Diuretics in obstructive sleep apnea with diastolic heart failure. Chest, 132(2), 440–446. https://doi.org/10.1378/chest.07-0311
  15. Dark, D. S., Pingleton, S. K., Kerby, G. R., Crabb, J. E., Gollub, S. B., Glatter, T. R., & Dunn, M. I. (1987). Breathing pattern abnormalities and arterial oxygen desaturation during sleep in the congestive heart failure syndrome. Improvement following medical therapy. Chest, 91(6), 833–836. https://doi.org/10.1378/chest.91.6.833
  16. Solin, P., Bergin, P., Richardson, M., Kaye, D. M., Walters, E. H., & Naughton, M. T. (1999). Influence of pulmonary capillary wedge pressure on central apnea in heart failure. Circulation, 99(12), 1574–1579. https://doi.org/10.1161/01.cir.99.12.1574
  17. Walsh, J. T., Andrews, R., Starling, R., Cowley, A. J., Johnston, I. D., & Kinnear, W. J. (1995). Effects of captopril and oxygen on sleep apnoea in patients with mild to moderate congestive cardiac failure. British heart journal, 73(3), 237–241. https://doi.org/10.1136/hrt.73.3.237
  18. Murdock, D. K., Lawless, C. E., Loeb, H. S., Scanlon, P. J., & Pifarré, R. (1986). The effect of heart transplantation on Cheyne-Stokes respiration associated with congestive heart failure. The Journal of heart transplantation, 5(4), 336–337.
  19. Braver, H. M., Brandes, W. C., Kubiet, M. A., Limacher, M. C., Mills, R. M., Jr, & Block, A. J. (1995). Effect of cardiac transplantation on Cheyne-Stokes respiration occurring during sleep. The American journal of cardiology, 76(8), 632–634. https://doi.org/10.1016/s0002-9149(99)80174-x
  20. Mansfield, D. R., Solin, P., Roebuck, T., Bergin, P., Kaye, D. M., & Naughton, M. T. (2003). The effect of successful heart transplant treatment of heart failure on central sleep apnea. Chest, 124(5), 1675–1681. https://doi.org/10.1378/chest.124.5.1675
  21. Stanchina, M. L., Ellison, K., Malhotra, A., Anderson, M., Kirk, M., Benser, M. E., Tosi, C., Carlisle, C., Millman, R. P., & Buxton, A. (2007). The impact of cardiac resynchronization therapy on obstructive sleep apnea in heart failure patients: a pilot study. Chest, 132(2), 433–439. https://doi.org/10.1378/chest.06-2509
  22. Sinha, A. M., Skobel, E. C., Breithardt, O. A., Norra, C., Markus, K. U., Breuer, C., Hanrath, P., & Stellbrink, C. (2004). Cardiac resynchronization therapy improves central sleep apnea and Cheyne-Stokes respiration in patients with chronic heart failure. Journal of the American College of Cardiology, 44(1), 68–71. https://doi.org/10.1016/j.jacc.2004.03.040
  23. Sharafkhaneh, A., Sharafkhaneh, H., Bredikus, A., Guilleminault, C., Bozkurt, B., & Hirshkowitz, M. (2007). Effect of atrial overdrive pacing on obstructive sleep apnea in patients with systolic heart failure. Sleep medicine, 8(1), 31–36. https://doi.org/10.1016/j.sleep.2006.06.012
  24. Padeletti, M., Henriquez, A., Mancini, D. M., & Basner, R. C. (2007). Persistence of Cheyne-Stokes breathing after left ventricular assist device implantation in patients with acutely decompensated end-stage heart failure. The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation, 26(7), 742–744. https://doi.org/10.1016/j.healun.2007.04.009
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