Sleep apnea, hypertension and cardiac disease
Sleep apnea - along with other sleep-related breathing disorders - affects many people, and is now recognized as a significant, treatable condition. Sleep apnea, however, does not just affect your breathing. As with most other diseases, it has effects on the body as a whole. These effects include an increased incidence of cardiac abnormalities, hypertension and cerebral vascular accidents.
Sleep apnea and hypertension
How does sleep apnea affect blood pressure?
Normal breathing is a result of changes in the interthoracic pressures, or air pressure in the chest versus the pressure in the atmosphere. These alterations allow air to enter and exit the lungs through an open airway. If the airway should become obstructed to any degree, the amount of pressure needed to draw air though the airway is increased. Chest pressures exceeding -120 mm Hg may be reached. Over the course of time, these pressures can lead to pulmonary hypertension.
Sleep-related breathing disorders also affect systemic blood pressure. Systemically, the sleeping blood pressures of sleep disorder patients have been documented as high as 230/180. Over time, these pressures become a chronic condition, whether the patient is sleeping or not.
The connection between blood pressure issues and sleep disorders often goes undetected. Hypertensive patients are usually seen in their physician's office and treated for their symptom, without evaluation of the possible cause.
But the evaluation of all hypertensive patients should include a very thorough history and physical.
Identifying a link between hypertension and sleep apnea
The physician-patient dialogue should include questions about the patient's sleep habits; quality of sleep; snoring (bed partners are the best source of this information); nighttime anxiety attacks; abnormal breathing sounds such as coughing, gasping or wheezing; restlessness while trying to sleep; excessive daytime sleepiness; and the effects of sleep conditions on mental status and mood.
The physical exam should not address the patient's weight alone. In fact, although the morbidly obese generally have more severe degrees of sleep-related breathing disorders, many non-obese patients also suffer from the disorder.
Neck girth may be a more sensitive indicator for sleep apnea. Individuals with short, wide necks show an increased incidence of sleep apnea than those with long, thin necks.
A thorough exam of the oral pharynx and mouth may reveal a narrowed airway due to redundant tissue, or reddening of the soft tissue.
Although males with sleep apnea statistically outnumber females, the history and physical should not differ between the sexes.
A complete polysomnogram, or sleep study, is required to definitively diagnose sleep apnea.
Hypertension - such as primary hypertension - is a serious condition and must be treated. It may also be a sign or symptom of another condition, such as obstructive sleep apnea.
Complete and accurate diagnosis of the underlying cause of hypertension and cardiac disease could have a tremendous impact on treatment and restoring a more healthy life.