A New York City ENT doctor deals with a variety of different conditions from performing sinus surgeries to diagnosing ear, nose & throat problems.
Sleep Apnea and Heart Disease
Sleep Apnea and Type 2 Diabetes Prove a Deadly Combination
4 years ago
Blindness is a big risk for those with type 2 diabetes and OSA.
Of the 29 million adults with diabetes, 90 to 95 percent of all diagnosed cases have type 2 diabetes, according to the CDC. Another large percentage of adults with this disease also have obstructive sleep apnea (OSA), which may or may not be the cause of type 2 diabetes. OSA is a condition that makes it hard to sleep, causing snoring and interrupted breathing during the night. These symptoms occur when you have a blockage in your throat during sleep, due to a large neck or small airways. Overall, OSA makes it difficult to breathe at night.
Researchers continue to look for the link between type 2 diabetes and OSA through several studies. The most recent study looking into the connection between the two reveals a startling discovery. Left untreated, people with both type 2 diabetes and OSA are at greater risk. These patients can develop a condition that causes blindness.
Diabetic Retinopathy
Around 40 to 50 percent of patients with diabetes have diabetic retinopathy, the most common form of diabetic eye disease. In fact, this condition is the leading cause of blindness in the western world. High blood sugar levels can cause damage to the blood vessels in your retina. When this occurs, the blood vessels will either:
- Swell and leak
- Close, stopping blood flow
- Or grow abnormal blood vessels
You can find out more from the American Academy of Ophthalmology by clicking here.
How the Condition Develops With Type 2 Diabetes and Sleep Apnea
The study at the University of Birmingham is the first to look at the impact of OSA on diabetic retinopathy. It also leads towards the theory that OSA can cause or worsen your diabetes. The researchers tested 230 patients with Type 2 diabetes, accessing them for both OSA and diabetic retinopathy.
“Firstly, we showed that sight-threatening diabetic retinopathy was more common in patients with both Type 2 diabetes and OSA compared to those with Type 2 diabetes but without OSA,” states Doctor Abd Tahrani. Dr. Tahrani is the corresponding author of the University of Birmingham’s Institute of Metabolism and System Research.
“However, more importantly, we have shown that patients with OSA and Type 2 diabetes, compared to those with diabetes only, are at increased risk of developing advanced diabetic retinopathy over a period of three years and seven months.”
Researchers found that the prevalence of diabetic retinopathy was 42.9 percent in those with OSA. This is higher than the prevalence in those with just type 2 diabetes. Meanwhile, after reviewing the patients 43 months later, the researchers discovered that those with OSA were 18.4 percent more likely to develop a moderate to severe case of the disease.
“Our findings are important because improved understanding of the pathogenesis of diabetic retinopathy is important in order to identify new treatments,” states Dr. Tahrani.
“Following our research, it is important that clinicians treating patients with Type 2 diabetes are aware that their patients who also have OSA are particularly at increased risk of developing advance retinopathy and, hence, appropriate preventative measures should be put in place.
How Sleep Deprivation Puts Your Heart at Risk
5 years ago
Both doctors and paramedics run the risk of heart disease as they work 24-hour shifts.
Suppose you put in an all-nighter at work. From your perspective, sacrificing a couple of hours of sleep is no big deal. You might feel a little sluggish in the morning, but it’s nothing that a cup of coffee can’t fix, right? Unfortunately, that’s where you are wrong. Sleep deprivation does more than just make you tired. Receiving too little sleep can have a negative long-term effect on the body, especially the heart.
The Toll of Working Long Hours
It’s no secret that people in the United States often work too much, but some jobs require that they do so. The Radiological Society of North America (RSNA) noticed that a lot of high-stress jobs were taking a toll on workers. These jobs include fire and emergency medical services, as well as medical residencies and more. Often, they have to go above and beyond to fulfill their services, and that requires working up to 24-hour shifts. Doing work like this frequently has some an impact on how the body functions and the RSNA wanted to find out exactly how.
Sleep and the Heart
In a study that included 20 radiologists (19 men and one woman), researcher tested their cardiac function before and after a 24-hour shift. They were able to do this by using a cardiovascular magnetic resonance (CMR) imaging with strain analysis. As predicted, strain, blood pressure, and heart rate increased significantly.
Study author Daniel Kuetting, M.D., from the department of diagnostic and Interventional Radiology at the University of Bonn in Bonn, Germany had this to say: “For the first time, we have shown that short-term sleep deprivation in the context of 24-hour shifts can lead to a significant increase in cardiac contractility, blood pressure, and heart rate.”
While this study needs a larger test base, it shows that further research is warranted. It is also a warning for workers in high-stress positions. The toll sleep deprivation takes on your heart can lead to further complication and if you want to remain healthy for a long time, it may be time to reconsider sleeping less than 3 hours a night.
Sleep Apnea-Related Hypertension
5 years ago
Hypertension is just one of the many conditions that can arise due to sleep apnea.
Untreated obstructed sleep apnea (OSA) is known to lead to other disorders. One condition it contributes to is hypertension. Hypertension, which is better known as high blood pressure, is a medical condition where the blood pressure in the arteries is elevated. According to a new study performed by scientists at the University of Chicago, there may be a way to manage this condition in those with sleep apnea.
How Does Hypertension Affect the Body?
Hypertension is a troubling condition. According to the CDC, 1 of 3 U.S. adults (70 million people) have high blood pressure. It is also the second leading cause of death in America — because it can lead to heart disease and stroke.
Patients with hypertension will often display the following symptoms:
- Headaches
- Lightheadedness
- Vertigo
- Tinnitus
- Altered vision
Some lifestyle choices and health conditions, like sleep apnea, may cause high blood pressure. Unfortunately, the condition can also be a part of one’s family history. This makes it harder to lower or control risk factors.
Sleep Apnea-Related Hypertension
OSA is a common cause of high blood pressure. Scientists have found that a signaling cascade associated with sleep apnea is the cause of this condition. This means that when your body doesn’t get enough blood-oxygen, the carotid bodies send signals to increase breathing and return oxygen to normal. However, blood pressure increases along with oxygen.
By nailing down which signals lead to high blood pressure, the scientists were able to offer a solution. Researchers suggest using a drug to disrupt the enzyme, known as cystathionine-y-lyase, which sends the signal (hydrogen sulfide) to increase oxygen and blood pressure.
According to the authors of the study, “Our results … suggest that inhibiting cystathionine-y-lyase to reduce hydrogen sulfide signaling in the carotid body with more potent inhibitors than L-PAG may be a novel approach to treat hypertension in patients with sleep apnea.”
Sleep Disorders Leave Heart Patients at Risk
5 years ago
Despite surgery, heart patients are still at risk for complications if they suffer from a sleep disorder.
Sleep disorders, like sleep apnea, can have a negative impact on your health. Prolonged suffering has been known to cause diabetes and cognitive deficiencies, as well as affect your overall quality of life. New research suggests that heart patients who have some form of sleeping disorder are at risk of developing further complication—and even death.
The Risk to Heart Patients
All 241 of the patients who participated in the study successfully underwent a procedure called percutaneous coronary intervention (PCI). The procedure is meant to treat acute coronary syndrome (ACS), a condition where the blood supplied to the heart is blocked. PCI seeks to remove the blockage and reopen blocked arteries.
The goal of the study was to gather more data on the link between sleep apnea and heart disease. “Sleep-disordered breathing, which includes snoring and sleep apnea, has long been recognized as an important risk factor for heart disease. However, there is limited awareness of sleep-disordered breathing among cardiologists who care for PCI patients,” said Toru Mazaki, M.D., study author and chief physician of the Department of Cardiology, Kobe Central Hospital, Kobe, Japan.
When the patients were hospitalized for the surgical procedure, researchers examined their breathing during the night. For the next 5.6 years, the patients’ health was monitored for any further complications. Here is what they found:
- 3 percent had sleep-disordered breathing.
- 4 percent of those with sleep-disordered breathing had major cardiovascular events.
- Only 7.8 percent of those without sleep-disordered breathing had major cardiovascular events.
These cardiovascular events include deaths, strokes, recurrent ACS, and heart failure. The research shows that there may be a link between the two disorders, even after the person has taken care of their heart issue.
Sleep disorders are becoming a prevalent problem for many people. The researchers hope that other doctors see sleep disorder as a warning signal for heart patients. “Doctors and patients should consider sleep studies post-PCI to rule out sleep-disordered breathing or take necessary precautions to restore healthy breathing during sleep,” says Dr. Mazaki.
The doctors even suggest that hospitalized heart patients who have undergone surgery should be routinely tested for sleep-disordered breathing. More research still needs to be done, and hopefully doctors can treat patients before their sleep disorder leads to more complications.
Heart Failure and PAP Treatments
6 years ago
Did you know approximately 5.7 million Americans suffer from heart failure every year? This is a staggering number. If you are a patient dealing with this condition, you might want to also monitor your sleep. Sleep apnea can harshly affect your heart. However, there is positive news. A new study suggests that treatment of sleep apnea may help improve progress in patients with heart failure.
Treating Both Sleep Apnea and Heart Failure
Heart failure is a condition in which the heart grows weaker. When this happens, the heart cannot pump enough blood that the body needs in order to function properly. This may cause fatigue, shortness of breath and fluid build-up in several parts of the body.
Most patients with heart failure are constantly in and out of hospitals. According to research recently published in the American Journal of Cardiology, treatment of sleep apnea may help patients with the condition.
Researchers tested 70 patients with both sleep apnea and heart failure. Of those 70 patients, 37 actively used a treatment that helps breathing, called Positive Airway Pressure (PAP) Therapy. The other 34 patients where non-compliant—and did not use the PAP ventilation machine.
A common problem with patients who undergo PAP therapy is that they don’t commit. Many find the mask required for the treatment to be uncomfortable, leading them to discontinue further treatment. However, those who did continue using PAP therapy experienced positive results.
“Our research showed that early recognition and treatment of patients hospitalized with decompensated congestive heart failure is associated with a reduction in readmissions, for patients who use their positive airway pressure (PAP) therapy on a regular basis,” said first author Sunil Sharma, M.D., FAASM, Associate Professor of Pulmonary Medicine in the Sidney Kimmel Medical College at Thomas Jefferson University.
These results heavily indicate that sleep apnea and heart failure may be connected. “Physicians should be on the lookout for sleep apnea in patients with heart failure with the goal of diagnosing and treating early, which might help prevent readmissions and emergency room visits,” Dr. Sharma said. While more research needs to be done to validate these findings, this research puts patients and doctors on alert.
Obstructive Sleep Apnea and Heart Disease More Prevalent in Women Than Men
6 years ago
Risk factors for obstructive sleep apnea (OSA) and the subsequent development of associated problems with this condition, such as cardiovascular complications have been suspected to vary by sex, but until recently, whether the effects of OSA on heart disease is similar for men and women had not been clearly established. Researchers have discovered that OSA is more dangerous for women than for men in their study.
Published in Circulation in October, the results of the research found that gender does play a role between OSA and cardio vascular disease, and that in women, sleep apnea was associated with higher blood levels of troponin (hs-TnT), a biomarker of heart disorders of which the most important is myocardial infarction (heart attack). Also, increased levels of troponin indicate cardiac muscle cell death because the enzyme is released into the blood upon injury to the heart.
“The finding that sleep apnea is associated with evidence of early heart injury and an elevation in long term risk of heart failure, coronary heart disease, enlargement of the heart muscle, and death in women highlights the importance of sleep apnea screening and treatment for women, a group who often are not routinely screened for sleep apnea,” says co-author Susan Redline, MD, MPH, and associate clinical director at the Division of Sleep and Circadian Disorders at BWH.
The study examined post-menopausal women, who are at a greater risk for sleep apnea and heart disease. The study concluded that older women may be at relatively greater risk of sleep apnea related heart disease compared to men.
The study took participants of an average age of approximately 63 years, of whom 23% were men and 10% women having undiagnosed moderate to severe OSA. Over a 14 year follow up, 46% of men and 32% of women experienced a significant adverse cardiac event, death, or had an enlarged heart. Women with moderate to severe OSA were more than 30% likely to experience these adverse heart problems compared to women without OSA. This relationship was not statistically significant in men, suggesting that factors such as age, obesity, hypertension, and diabetes explained most of the observed heart disease risk in the men studied.
“We hope these results focus attention on the importance of sleep apnea in women, who historically are under-diagnosed in this area,” Redline says. Another aspect of this study that we should pay attention to is that even among women with obstructive sleep apnea who don’t get heart disease or attacks, the condition is associated with changes in the heart, which may lead to worse ramifications.
Obstructive Sleep Apnea and Heart Procedures
6 years ago
New research has found that patients who have percutaneous coronary intervention (PCI) are at higher risk for obstructive sleep apnea (OSA). PCI, also known as angioplasty, is a procedure used to open blocked coronary arteries and restore blood flow to the heart without open-heart surgery.
One lead researcher, Luciano Drager, MD, PhD, of the University of São Paulo School of Medicine in Brazil, said: “Our findings, in a large, multicenter sample of patients, reinforce the known association between OSA and cardiovascular disease.” He added, “Nearly half of the patients in our study, who were treated with PCI for either myocardial infarctions or angina, had OSA.”
In this study, 1,305 participants had undergone PCI treatment. Most of the patients were male and came from Singapore, China and Hong Kong, India, Myanmar, and Brazil. The researchers performed an overnight sleep study on all subjects. From this test group, nearly half of the participants had moderate OSA and a little over one-fifth of the subjects had severe OSA.
For this group, the researchers administered two screening tools for OSA, and both tests offered highly differing results. From the Epworth Sleepiness Scale, only a quarter of the patients indicated a high risk for OSA. On the other test, the Berlin Questionnaire, only half of the patients were categorized as being at a higher risk for OSA. These tests suggest their unreliability. It is important to note that an estimated 80 percent of men and 93 percent of women with moderate to severe sleep apnea are undiagnosed. With such stakes involved, this study further suggests that there needs to be better tools to diagnose obstructive sleep apnea.
Besides the discrepancies in the screening tools, researchers found more connections between sleep apnea and heart disease problems. This connection has been made before, but this study further confirms this relationship. Dr. Drager added: “Earlier studies have shown strong relationships between sleep apnea and a number of cardiovascular conditions, including high blood pressure, arrhythmia, stroke and heart failure. Our study supports this strong association between OSA and heart disease and also suggests that the methods used to screen for OSA in patients with cardiovascular disease need to be improved.”
The importance of this study evaluates whether OSA contributes to the risk of several heart problems in patients who have undergone successful PCI. Dr. Drager’s research concludes that OSA does contribute to the risks of heart disease, especially for those who have had PCI treatment. He has also discovered that screening tools for OSA need to be better developed so that the highly undiagnosed population with obstructive sleep apnea can get early treatment.
also discovered that screening tools for OSA need to be better developed so that the highly undiagnosed population with obstructive sleep apnea can get early treatment.
Sleep Problems Among US Minorities
6 years ago
A recent study suggests that undiagnosed sleep disorders are common among middle-aged and older adults in the US, especially among certain minorities.
Researchers studied 2,230 ethnically diverse men and women between the ages of 54 and 93 years from six US communities. Using several tests such as the polysomnography, actigraphy and validated questionnaires during a three year period, the researchers found troubled sleeping patterns played a role in health disparities in the US.
The study indicated that black, Chines and Hispanic Americans were more likely to have sleeping problems than whites, including nighttime breathing problems characteristic of sleep apnea.
Results from this study indicate that about one-third of participants had moderate or severe sleep-disordered breathing measured by polysomnography (PSG). There are several screening tests for sleep disorders and the PSG is the gold standard for testing for sleeping disorders. From the other tests, thirty-one percent had fewer than six hours of sleep, while nearly one-quarter suffered from insomnia, and 14 percent had excessive daytime sleepiness.
“As sleep apnea has been implicated as a risk factor for cardiovascular disease, stroke, diabetes, and mortality, our findings highlight the need to consider undiagnosed sleep apnea in middle-aged and older adults, with potential value in developing strategies to screen and improve recognition in groups such as in Chinese and Hispanic populations,” said senior author Dr. Susan Redline, professor of medicine at Harvard Medical School and Division of Sleep Medicine at Brigham and Women’s Hospital and Beth Israel Deaconess Medical Center in Boston.
After adjusting for sex and age, the report revealed blacks to be most likely to have the shortest sleep patterns, less than six hours, and they were more likely than whites to have sleep apnea, poor sleep quality, and daytime sleepiness. Hispanics and Chinese were more likely than whites to have sleep-disordered breathing and short sleep patterns, but Chinese were least likely to report having insomnia.
“Our findings underscore the very high prevalence of undiagnosed sleep disturbances in middle-aged and older adults, and identify racial/ethnic disparities that include differences in short sleep duration, sleep apnea and daytime sleepiness,” said lead author Dr. Xiaoli Chen, research fellow in the Department of Epidemiology at Harvard T.H. Chan School of Public Health in Boston.
The results suggest that different kinds of sleep problems may contribute to health disparities among US adults. According to Dr. Chen and her colleagues, this is the first study that has linked sleep apnea, short sleep, and poor sleep, as well as subjective measures of insomnia and daytime sleepiness, to varying minorities in the U.S. population.
Dramatic Relief for Those with Obstructive Sleep Apnea
6 years ago
For those suffering with the disorder sleep apnea, an important device has entered the market to reduce this sleeping disorder. By implementing Inspire® Upper Airway Stimulation (UAS) therapy, researchers have significantly improved patients with obstructive sleep apnea (OSA), according to a recent study published in the New England Journal of Medicine. From this study, they found that patients with OSA could reduce their daytime sleepiness and reduce the severity of their condition by 70%.
Called the Stimulation Therapy for Apnea Reduction (STAR Trial), researchers from 22 medical centers in the US and Europe evaluated the effectiveness of upper airway stimulation for sleep apnea.
Let’s remember that OSA affects more than 8 million men and 4 million women in the US, and is twice as common in men. Characterized by repeated episodes of upper airways collapsing during sleep, this condition causes the sufferer to stop breathing on and off many times during sleep, sometimes for a minute or longer. And half of these suffers are overweight. Repeated episodes of sleep apnea can lead to daytime fatigue, and put you at risk for heart attack, stroke, high blood pressure and even death.
In this study, all patients had surgery to implant the device. This is how it works: During sleep, the device stimulates the nerve of the tongue, which enlarges and stabilizes the airways so that the patient can control his or her breathing.
One of the greatest advantages of this device is that it senses breathing patterns and then delivers mild stimulation to a patient’s airway muscles to keep the airway open during sleep. Patients also have a “controller” to turn on the device at night during sleep.
Using such sleep-disorder stimulation systems improved sleep apnea episodes by 68 to 70 percent, the research claims. Kathy Gaberson, one participant of the study, said, “My short-term memory has improved significantly, and the surgery has made a huge difference in my quality of life.” She later added, “My apnea episodes went from 23 times an hour to just two.”
In Gaberson’s case, improvements can be dramatic. While other treatments for OSA include weight loss, upper airway surgeries, oral appliances, and continuous positive airway pressure (CPAP).
Whether your general physician suggests the STAR therapy or CPAP or other surgeries, you should consult an ENT specialist for a second opinion.
Understanding How Breathing Problems and Sleep Apnea Can Lead to Heart Disease
6 years ago
Scientists have shown that those with breathing problems—and especially sleep apnea—are at a greater risk for certain heart diseases. Sleep apnea is one of the most common, and under-diagnosed, sleep disorders in the United States today. A major symptom of sleep apnea is persistent snoring, because snoring signals that the airways are being blocked in some way. While snoring is an unpleasant reminder that the person is not getting the proper sleep he or she needs, it doesn’t stop there. Many are ashamed of going to a doctor for snoring, and others are simply unaware that this is a small sign of a much larger dilemma. Many snoring cases contribute to the number of people diagnosed with sleep apnea in the US each year. Researchers have also looked at the various ways that breathing problems persist beyond sleep, particularly how breathing and sleep apnea can lead to heart disease. .
Recently researchers have found some evidence of how breathing problems and sleep apnea affect heart disease and stroke, but exactly what creates this link has eluded scientists so far. Researchers at the University of California’s San Diego School of Medicine conducted a study involving nearly 40 volunteers, with half of them having moderate to heavy sleep apnea, and the other half with mild to no sleep apnea symptoms. For all of the volunteers, the team of researchers did a full diagnostic of their sleep patterns and overall health, eliminating other sleep disorders that could corrupt the results of the study. They had all the volunteers ride on stationary exercise bikes for a long duration – to exhaustion – while at times slowly increasing the resistance of the exercise bikes in order to simulate someone riding a bicycle up a steep hill. The results of this study were startling.
The researchers measured what is called the VO2 max: a measurement of the maximum amount of oxygen the body can absorb through breathing during strenuous exercise. They measured and compared the results of those with moderate to heavy sleep apnea to those without sleep apnea of the same age, gender, and body mass index. From the comparison, they learned that those with sleep apnea had, on average, a 14% lower VO2 max than the control subjects. This deviance increased when the subjects with sleep apnea had a higher rate of breathing – for 10 seconds or more – per each hour of sleep. This shows that breathing problems persist beyond sleep for those suffering from sleep apnea, and that these results may be early indicators of the link between sleep apnea and heart disease and stroke. Since most who have sleep apnea are not diagnosed until serious complications arise and are often obese, thus already at a higher risk for complications later in life, it is imperative that people know if they have sleep apnea. The sooner you discover you have this treatable disorder, the sooner you can be on the road to recovery.