Sleep Apnea : Know more

Sleep Apnea : Know more

Sleep Apnea : Know more

More than 18 million American adults are estimated to have sleep apnea, and it's estimated that two to three percent of children do as well. Sleep apnea is a condition that occurs when the airway becomes blocked by relaxed tissue as the brain enters a state of sleep. This blockage prevents air from movingessentially stopping a person's breathing and causing their oxygen levels to drop. In response to these decreases, the brain will trigger arousals from sleep to reopen the airway. While these arousals often occur on a subconscious and barely noticeable level, they can occasionally be strong enough to produce snorts or gasps during sleep. Once the airway is reopened, the brain goes back to sleep, the tissues relax, the airway becomes blocked, and breathing is stopped again until the next arousal. This process is repeated many times throughout the night and produces the daytime tiredness and fatigue often associated with sleep apnea. It also places a strain on the body's cardiovascular systemso perhaps it's not surprising there's a significant link between sleep apnea and hypertension. It's estimated that 40% of people with untreated sleep apnea will develop hypertension, and 30% of all hypertension patients have sleep apneaand most are not even aware of it!

Unlike sleep apneawhose symptoms are often apparenthypertension usually does not cause any symptoms until an event such as a stroke occurs. "This is why it is often referred to as the silent killer'", explains Dr. Susan Borchers, board-certified pulmonologist, sleep specialist and medical director of the sleep lab for OhioHealth Sleep Services of Worthington. Because of this, "all patients with sleep apnea should be monitored for hypertension, and most patients with hypertension should at least be screened (i.e., sleep questionnaire, consultation, or sleep study) for sleep apnea."

Continuous Positive Airway Pressure (CPAP): An Effective Treatment

Primary hypertension affects approximately 72 million Americans. For most, medications can be used to adequately control their blood pressure. However, for people who have sleep apnea and hypertension, their blood pressure is often resistant to medications. The American Heart Association defines "resistant hypertension" as blood pressure that remains high despite the use of three medications from different classes. A 2001 study found that patients with resistant hypertension had more severe sleep apnea than those whose morning and evening blood pressures were normal. "One of the more common reasons for a sleep consultation," notes Dr. Borchers, "is for a patient with resistant hypertension requiring multiple medications."

The standard treatment for sleep apnea is Continuous Positive Airway Pressure (CPAP), which involves wearing a small mask while asleep through which air is delivered. The air is generated at a set pressure by a small machine and functions to prevent the airway from collapsing when the brain goes to sleep and the tissues relax. With the airway held open by this pressure support, normal breathing is maintained and the brain is able to achieve a much higher quality of restwhich leads to increased energy and feeling more refreshed when waking up the next day.

For people with sleep apnea and resistant hypertension, CPAP therapy has an added benefit: studies have shown significant reductions in both daytime and nighttime blood pressure after only two months of regular CPAP use. "If they have severe obstructive sleep apnea, their blood pressure really does respond to treating them with CPAP," says Dr. Borchers.This information is extremely helpful to physicians as they try to treat resistant hypertension.

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