Saturday, April 16, 2016

Atrial flutter, fibrillation and sleep apnea — oh my

“I have to admit I was dismayed when I found out 'type A' refers to a category of risk for heart disease; I thought it was just a nickname my mom gave me!” — Reese Witherspoon, American actress

IT'S BEEN almost three weeks since Paul was taken my ambulance to Mercy Hospital's ER with his heart pounding erratically, and two weeks to the day that he was released from the hospital after having a catheter ablation to correct atrial flutter. (Click on this link to read that story.)


It's been an up and down journey since. Paul had a procedural followup appointment Monday of this week. Between the ablation and this appointment, he'd had a couple of bad spells — although nothing even remotely close to that which took him to the ER in the first place, but concerning nonetheless. 


We learned from Craig Hoffman, the physician's assistant who saw Paul, that flutter ablation is about 95% to 98% effective. Naturally we're hoping that Paul isn't in the 2% to 5% for whom it's ineffective. 





If the flutter procedure has been successful, then what he's experiencing when his heart is misbehaving is probably atrial fibrillation, but he's on a medication for that, so after thorough discussion, we collectively decided Paul should wear a heart monitor for a couple of days to make sure there's no flutter and see how frequent and how severe the fibrillation is. 

We learned, however, that there's a third component in the mix: sleep apnea (also known as obstructive sleep apnea). Wow, was I ever ignorant about this condition! Previously I thought, "Well sure you don't want to stop breathing altogether when you're sleeping, but if it's just a little pause that always passes, no harm, no foul." 

Wrong. 

(At the bottom, I've included an article from the National Institutes of Health National Heart, Lung and Blood Institute explaining what sleep apnea is and the dangers it poses.)

So Paul is going to have a sleep study done in the next few weeks. We'll figure out what to do from there.

What Is Sleep Apnea?

Sleep apnea is a common disorder in which you have one or more pauses in breathing or shallow breaths while you sleep.

Breathing pauses can last from a few seconds to minutes. They may occur 30 times or more an hour. Typically, normal breathing then starts again, sometimes with a loud snort or choking sound.

Sleep apnea usually is a chronic (ongoing) condition that disrupts your sleep. When your breathing pauses or becomes shallow, you’ll often move out of deep sleep and into light sleep.

As a result, the quality of your sleep is poor, which makes you tired during the day. Sleep apnea is a leading cause of excessive daytime sleepiness.

Overview

Sleep apnea often goes undiagnosed. Doctors usually can't detect the condition during routine office visits. Also, no blood test can help diagnose the condition.

Most people who have sleep apnea don't know they have it because it only occurs during sleep. A family member or bed partner might be the first to notice signs of sleep apnea.

The most common type of sleep apnea is obstructive sleep apnea. In this condition, the airway collapses or becomes blocked during sleep. This causes shallow breathing or breathing pauses.

When you try to breathe, any air that squeezes past the blockage can cause loud snoring. Obstructive sleep apnea is more common in people who are overweight, but it can affect anyone. For example, small children who have enlarged tonsil tissues in their throats may have obstructive sleep apnea.

Central sleep apnea is a less common type of sleep apnea. This disorder occurs if the area of your brain that controls your breathing doesn't send the correct signals to your breathing muscles. As a result, you'll make no effort to breathe for brief periods.

Central sleep apnea can affect anyone. However, it's more common in people who have certain medical conditions or use certain medicines.

Central sleep apnea can occur with obstructive sleep apnea or alone. Snoring typically doesn't happen with central sleep apnea.

This article mainly focuses on obstructive sleep apnea.

Untreated sleep apnea can:

— Increase the risk of high blood pressure, heart attack, stroke, obesity, and diabetes

— Increase the risk of, or worsen, heart failure

— Make arrhythmias (ah-RITH-me-ahs), or irregular heartbeats, more likely

— Increase the chance of having work-related or driving accidents

(Note from me: Other research indicates that sleep apnea can also damage the brain. The below excerpt is from The Sleep Foundation.) 

Researchers have found yet another reason why people with obstructive sleep apnea (OSA) should get tested and treated for the disease. According to a recent study published in the journal SLEEP, patients with obstructive sleep apnea syndrome demonstrated reduced brain gray matter concentration. (Gray matter refers to the cerebral cortex, where most information processing in the brain takes place.)

And here from WebMD is how OSA causes or is correlated to increased risks.

Here are seven health problems you might face if you have OSA:

1. High blood pressure. If you already have it, obstructive sleep apnea can make it worse. Waking up often during the night can cause your hormone systems to go into overdrive, which boosts your blood pressure levels. When you can’t breathe well in your sleep, the level of oxygen in your blood drops, which may add to the problem. 

Treatment does make a difference, though. Some people with high BP who get help for sleep apnea can cut back on their blood pressure medications.

2. Heart disease. People with OSA are more likely to have heart attacks. 

The causes may be low oxygen or the stress of waking up often. Stroke and atrial fibrillation – a problem with the rhythm of your heartbeat -- are also linked with the condition. 

Sleep apnea disrupts how your body takes in oxygen, which makes it hard for your brain to control how blood flows in your arteries and the brain itself.

3. Type 2 diabetes. Sleep apnea is common among people with this condition -- up to 80% of them have OSA. 

Obesity raises a person’s risk for both disorders. Although studies haven’t shown a clear link between sleep apnea and type 2 diabetes, not getting enough shut-eye can keep your body from using insulin properly, which leads to diabetes.

4. Weight gain. Extra pounds raise your chances of getting sleep apnea, and the condition also makes it harder to slim down. 

When you’re overweight, you can have fatty deposits in your neck that block breathing at night. On the flip side, sleep apnea can make your body release more of the hormone ghrelin, which makes you crave carbs and sweets. And when you're tired all the time, you might not be able to turn the food you eat into energy as efficiently, which can lead to weight gain.

2. Heart disease. People with OSA are more likely to have heart attacks. 

The causes may be low oxygen or the stress of waking up often. Stroke and atrial fibrillation – a problem with the rhythm of your heartbeat -- are also linked with the condition. 

Sleep apnea disrupts how your body takes in oxygen, which makes it hard for your brain to control how blood flows in your arteries and the brain itself.

3. Type 2 diabetes. Sleep apnea is common among people with this condition -- up to 80% of them have OSA. 

Obesity raises a person’s risk for both disorders. Although studies haven’t shown a clear link between sleep apnea and type 2 diabetes, not getting enough shut-eye can keep your body from using insulin properly, which leads to diabetes.

4. Weight gain. Extra pounds raise your chances of getting sleep apnea, and the condition also makes it harder to slim down. 

When you’re overweight, you can have fatty deposits in your neck that block breathing at night. On the flip side, sleep apnea can make your body release more of the hormone ghrelin, which makes you crave carbs and sweets. And when you're tired all the time, you might not be able to turn the food you eat into energy as efficiently, which can lead to weight gain.

5. Adult asthma. Science hasn’t proven a link to OSA, but people who get sleep apnea treatment may find they have fewer asthma attacks.

6. Acid reflux. There’s no proof that sleep apnea causes this kind of heartburn that doesn’t get better, but many people say that it’s a problem. Treating it seems to improve apnea symptoms, sleep doctors say.

7. Car accidents. When you feel groggy, that can raise your risk of falling asleep at the wheel. People with sleep apnea are up to five times more likely than normal sleepers to have traffic accidents.

1 comment:

  1. This comment has been removed by a blog administrator.

    ReplyDelete