This post was written by Karin Mohs, NP, PPG – Cardiology.
Sleep apnea is an often underdiagnosed, potentially serious sleep disorder in which breathing repeatedly stops and starts, resulting in sudden drops in blood oxygen levels. If left untreated, sleep apnea can cause high blood pressure and put an individual at an increased risk for diabetes, heart attack, stroke and heart arrhythmias. In fact, if you’ve been diagnosed with heart failure, untreated sleep apnea can contribute to your heart disease progression.
At-risk populations
Multiple observational studies have found that heart failure accompanied by sleep apnea is associated with a worse prognosis than heart failure alone. The prevalence of sleep apnea may be as high as 50% among all patients with heart failure. Additionally, individuals who are male, overweight, have large neck circumference, narrow airways, smoke, use alcohol or sedatives, and have been diagnosed with high blood pressure, diabetes, stroke or COPD are all at a higher risk of sleep apnea.
Signs and symptoms
Often, patients attribute the below symptoms to diuretic medications when, in reality, what they are experiencing and feeling could be related to untreated sleep apnea. Some common indications or symptoms of sleep apnea include:
- Snoring loudly
- Wake up gasping for air
- Excessive daytime sleepiness
- Brain fog or fatigue
- Waking up with a dry mouth
- Lower extremity swelling
- Frequently waking to go to the bathroom
Diagnosis
Your doctor will likely order a sleep study to determine if you have sleep apnea. In many cases, a home sleep study is adequate, but an in-lab study may be necessary if you have severe heart failure or have recurrent admissions for heart failure. This happens because heart failure patients are more prone to central sleep apnea (where the brain doesn’t signal the breathing muscle to contract) rather than the more common obstructive sleep apnea (where an individual’s upper airways become blocked due to normal nighttime muscle relaxation). The in-lab study helps monitor brain wave activity to see which type of sleep apnea you might have.
Treatment
There are several treatment methods for sleep apnea. If your provider suspects sleep apnea, you will likely meet with a sleep specialist who will read your sleep study and recommend the best course of treatment for you. A pressure therapy machine (or CPAP) is the gold standard and has proven effective at treating sleep apnea. Studies show that a CPAP device may also improve heart failure-related outcomes in patients with persistent sleep apnea. Along with sleep apnea treatment, taking your medications, exercising, and watching your sodium and fluid intake are critical components of your overall heart failure management.
Final thoughts
It’s extremely important you understand sleep apnea’s effect on your body. Every time sleep apnea causes your oxygen levels to decrease due to closed airways or shallow breathing; your body reacts by releasing adrenaline. This adrenaline spike elevates your blood pressure and heart rate, which is particularly concerning with heart failure patients as we attempt to lower your heart rate and decrease the strain on your heart. While you may be doing everything right during the day (diet, exercise, medication), if you have untreated sleep apnea, you take a giant step backward every night. So, if you’re struggling to get a good night’s sleep and have been diagnosed with heart failure, please speak with your primary care provider or cardiologist. They can help you investigate the issue, obtain a sleep study if necessary and create a treatment plan that’s right for you.
