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Study Helps Explain Connection Between Sleep Apnea, Stroke And Death
January 06, 2009Obstructive sleep apnea decreases blood flow to the brain, elevates blood pressure within the brain and eventually harms the brain's ability to modulate these changes and prevent damage to itself, according to a new study published by The American Physiological Society. The findings may help explain why people with sleep apnea are more likely to suffer strokes and to die in their sleep.
Sleep apnea is the most commonly diagnosed condition amongst sleep-related breathing disorders and can lead to debilitating and sometimes fatal consequences for the 18 million Americans who have been diagnosed with the disorder. This study identifies a mechanism behind stroke in these patients.
The study, "Impaired cerebral autoregulation in obstructive sleep apnea" was carried out by Fred Urbano, Francoise Roux, Joseph Schindler and Vahid Mohsenin, all of the Yale University School of Medicine in New Haven, Connecticut. It appears in the current issue of the Journal of Applied Physiology.
During sleep apnea episodes, the upper airway becomes blocked, hindering or stopping breathing and causing blood oxygen levels to drop and blood pressure to rise. The person eventually awakens and begins breathing, restoring normal blood oxygen and blood flow to the brain.
Ordinarily, the brain regulates its blood flow to meet its own metabolic needs, even in the face of changes in blood pressure -- a process known as cerebral autoregulation. This study found that the repeated surges and drops in blood pressure and blood flow during numerous apnea episodes each night reduces the brain's ability to regulate these functions.
Condition a health risk
Up to 4% of the population suffers from obstructive sleep apnea. In a previous study, Dr. Mohsenin and his colleagues showed that people with sleep apnea are three times more likely to suffer a stroke or die, compared to people in a similar state of health but without sleep apnea.
"After we found that sleep apnea is a risk factor for stroke and death, independent of other risk factors, we hypothesized that there must be something wrong with the regulation of blood flow to the brain," Dr. Mohsenin said. Participants included people with severe sleep apnea who experienced more than 30 apneas an hour during sleep time. The participants were about 47 years old, were free of cardiac disease and had not experienced any strokes. The study also included a control group which did not have sleep apnea but was similar in most other ways.
The researchers monitored the participants' blood pressure while standing and squatting. Standing from a squatting position lowers blood pressure as can be experienced during normal daily activity. They also monitored the participants as they slept. The study found that the sleep apnea group:
* had lower cerebral blood flow velocity
* had significantly lower blood oxygen levels during sleep
* took longer to recover from a drop in blood pressure
* took longer to normalize blood flow to the brain
Identification is key
Overall, the findings indicate that repeated surges and drops in blood pressure and low oxygen levels eventually impair the body's ability to regulate blood flow to the brain. Sleep apnea may occur over a long period of time before the person becomes aware of it and seeks medical treatment. Here are the symptoms Dr. Mohsenin says to watch out for:
* After eight hours of sleep, you don't feel rested. During the day, you feel more and more tired, and by afternoon, you want to nap.
* You experience loud, habitual snoring that disturbs others.
* Your bed partner observes pauses in your breathing.
The treatment of obstructive sleep apnea with an airway pressurization mask has been shown to normalize cerebral autoregulation, although there are not yet any studies to show that it reduces the rate of stroke. Those who are being treated for sleep apnea should remain compliant with treatments, according to Dr. Mohsenin, including use of
* air pressurization mask or CPAP
* nasal inserts
* dental appliances
* weight reduction for the obese
In some cases, surgery may be advised.
American Physiological Society
During sleep apnea episodes, the upper airway becomes blocked, hindering or stopping breathing and causing blood oxygen levels to drop and blood pressure to rise. The person eventually awakens and begins breathing, restoring normal blood oxygen and blood flow to the brain.
Ordinarily, the brain regulates its blood flow to meet its own metabolic needs, even in the face of changes in blood pressure -- a process known as cerebral autoregulation. This study found that the repeated surges and drops in blood pressure and blood flow during numerous apnea episodes each night reduces the brain's ability to regulate these functions.
Condition a health risk
Up to 4% of the population suffers from obstructive sleep apnea. In a previous study, Dr. Mohsenin and his colleagues showed that people with sleep apnea are three times more likely to suffer a stroke or die, compared to people in a similar state of health but without sleep apnea.
"After we found that sleep apnea is a risk factor for stroke and death, independent of other risk factors, we hypothesized that there must be something wrong with the regulation of blood flow to the brain," Dr. Mohsenin said. Participants included people with severe sleep apnea who experienced more than 30 apneas an hour during sleep time. The participants were about 47 years old, were free of cardiac disease and had not experienced any strokes. The study also included a control group which did not have sleep apnea but was similar in most other ways.
The researchers monitored the participants' blood pressure while standing and squatting. Standing from a squatting position lowers blood pressure as can be experienced during normal daily activity. They also monitored the participants as they slept. The study found that the sleep apnea group:
* had lower cerebral blood flow velocity
* had significantly lower blood oxygen levels during sleep
* took longer to recover from a drop in blood pressure
* took longer to normalize blood flow to the brain
Identification is key
Overall, the findings indicate that repeated surges and drops in blood pressure and low oxygen levels eventually impair the body's ability to regulate blood flow to the brain. Sleep apnea may occur over a long period of time before the person becomes aware of it and seeks medical treatment. Here are the symptoms Dr. Mohsenin says to watch out for:
* After eight hours of sleep, you don't feel rested. During the day, you feel more and more tired, and by afternoon, you want to nap.
* You experience loud, habitual snoring that disturbs others.
* Your bed partner observes pauses in your breathing.
The treatment of obstructive sleep apnea with an airway pressurization mask has been shown to normalize cerebral autoregulation, although there are not yet any studies to show that it reduces the rate of stroke. Those who are being treated for sleep apnea should remain compliant with treatments, according to Dr. Mohsenin, including use of
* air pressurization mask or CPAP
* nasal inserts
* dental appliances
* weight reduction for the obese
In some cases, surgery may be advised.
American Physiological Society
Sleep Apnea Current Events and Sleep Apnea News RSSFighting Sleep, Penn Researchers Reverse the Cognitive Impairment Caused By Sleep Deprivation
A research collaboration led by biologists and neuroscientists at the University of Pennsylvania has found a molecular pathway in the brain that is the cause of cognitive impairment due to sleep deprivation.
Improved diet and exercise alone unlikely to cure obstructive sleep apnea in obese patients
A study in the Oct. 15 issue of the Journal of Clinical Sleep Medicine found that while a strict diet and exercise program may benefit obese patients with mild to moderate obstructive sleep apnea (OSA), it is unlikely to eliminate the condition.
Surgery is an option for some patients hoping to get a good night's rest
According to research recently published by an Oregon Health & Science University scientist, a form of surgery called uvopalatopharyngoplasty is effective for treating certain patients who suffer from sleep apnea, one of the most common sleep disorders.
Being overweight super-sizes both risk and consequences of sleep-disordered breathing
Overweight individuals are not just at greater risk of having sleep-disordered-breathing (SDB), they are also likely to suffer greater consequences, according to new research.
Minimally invasive procedure effective for treating snoring
Radiofrequency ablation, a procedure that uses heat to shrink the tissue of the soft palate, is an effective and minimally invasive procedure that can be used to treat patients who snore.
Many patients with sleep apnea also suffer from GI tract conditions
Patients who suffer from obstructive sleep apnea (OSA) also tend to have additional gastrointestinal (GI) tract conditions, such as gastric reflux and hiatal hernia, which form at the opening in your diaphragm where your food pipe (esophagus) joins your stomach.
Radiofrequency energy technique as effective as tonsillectomy surgery
Radiofrequncy-tonsillotomy, which enables surgeons to reduce the size of the tonsillar tissue instead of removing the tonsils entirely, seems to be an effective and safe method of treating children with symptoms of enlarged tonsils.
Stress, fatigue plague patients with allergic rhinitis and obstructive sleep apnea
Patients who suffer from both allergic rhinitis and obstructive sleep apnea (OSA) may experience escalated symptoms of stress and fatigue.
Severe sleep apnea tied to increased risk of death
Moderate to severe obstructive sleep apnea is associated with an increased risk of death from any cause in middle-aged adults, especially men, according to new results from a landmark study supported by the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health (NIH).
Obstructive sleep apnea is prevalent in adults with Down syndrome
A study in the Aug. 15 issue of the Journal of Clinical Sleep Medicine shows that adults with Down syndrome also frequently suffer from obstructive sleep apnea (OSA).
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