Sleep Apnea Treatment May Help Ward Off Heart Failure: Study

TUESDAY, March 13 (HealthDay News) — A nightly breathing
treatment may not only help people with obstructive sleep apnea sleep
better, it might also lower their risk of heart failure, a new study
finds.

Obstructive sleep apnea occurs when breathing is interrupted throughout
nighttime sleep. With the new study, a team of British researchers believe
their findings could have a significant impact on the estimated 18 million
Americans with some form of the condition.

“Sleep apnea has been frequently associated with poorly controlled
blood pressure, heart failure and fatigue,” noted one expert, Dr. Justine
Lachman, director of the Congestive Heart Failure Program at
Winthrop-University Hospital in Mineola, N.Y. Lachman, who was not
involved in the new study, noted that “the stress of repeatedly waking up
at night due to a lack of oxygen results in the heart needing to work
harder. This results in abnormal thickening and relaxation of the heart’s
muscular tissue.”

The new study does suggest that moderate-to-severe sleep apnea can
reshape the heart, increasing its size, thickening its walls and reducing
its ability to pump blood throughout the body.

However, the study also found that at least six months of continuous
positive airway pressure (CPAP) treatment can help restore the heart’s
size and function to nearly normal levels. CPAP uses a mask to deliver
pressurized air into the airway of sleepers.

“To the best of our knowledge, this is the first study to provide a
comprehensive assessment of left ventricular [heart] structural and
functional parameters using advanced echocardiograms in otherwise healthy
apnea patients,” said Dr. Gregory Lip, a researcher at the University of
Birmingham Center for Cardiovascular Sciences, in England, in a journal
news release.

According to Lip, the study shows that sleep apnea “could be crucial”
to the development of a certain type of heart dysfunction “that can lead
to heart failure and increased mortality if left untreated.”

The researchers used two- and three-dimensional echocardiograms and
Doppler imaging of heart muscle tissue to examine 40 people with
moderate-to-severe obstructive sleep apnea, 40 people with high blood
pressure and 40 people with no health concerns.

The study, published March 13 in Circulation: Heart Failure,
revealed the patients with obstructive sleep apnea had abnormally shaped
hearts. The hearts of those with sleep apnea also functioned at the same
level as those of patients with chronic high blood pressure.

Patients with sleep apnea “may have cardiac abnormalities that often
are undetected, but will improve with CPAP,” Lip reasoned. “Patients also
need to understand that obstructive sleep apnea is not a benign disorder,
but that their risk of heart problems can be easily treated with
CPAP.”

For her part, Lachman said the findings came as little surprise.

“I have found that treatment of patients’ sleep apnea has made dramatic
changes in not only their quality-of-life, but also in the ability to
treat associated or piggybacked conditions, such as high blood pressure
and heart failure,” she said. “Often, treatment of sleep apnea can also
reduce the number of medications patients are required to take. So, it
would make sense that treating sleep-disordered breathing would prevent
the cascade of problems that results in serious heart problems.”

The study’s authors agreed that doctors should talk to their patients
with high blood pressure or abnormal echocardiograms about whether they
snore and other signs of sleep apnea.

They also noted that the study, which wasn’t randomized or blinded,
also showed people with sleep apnea tended to be overweight or obese. The
researchers said more research is needed to clarify their findings.

Another expert agreed that more study may be needed.

“The results are complicated by the fact the patients with sleep apnea
had higher blood pressures than the normal control group, and the fall in
blood pressure associated with CPAP therapy could be a confounding
variable,” said Dr. Neil Coplan, director of the division of clinical
cardiology at Lenox Hill Hospital in New York City.

“The study is thought provoking,” he said, “but there is need for a
much larger study with long-term follow up to assess the clinical
significance of the changes seen with therapy.”

More information

The U.S. National Heart, Lung, and Blood Institute provides more
information on sleep apnea.

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