The Metabolic and Cardiovascular Costs of Untreated Sleep Apnea

Among many other diseases and conditions that commonly remain unnoticed and are not usually diagnosed at first, sleep apnea has arisen as one of the most dangerous diseases affecting a large percentage of American population. However, whether the person is aware or not about this condition, the health issues it may trigger are alarming. Some of the consequences that can be triggered by a major sleep apnea problem are:

• Increase in blood sugar levels.
• Increase in fat levels in blood.
• Increase in blood pressure

Nevertheless, there has been an increase in the awareness people has regarding this issue and it has been reflected in the projected gain sleep apnea devices which are expected to triple their volume of sales during the next 10 years. Devices and new ways to treat the condition are not the only aspects being pushed into evolution due to new findings and researches. For instance, one of the latest studies published in The Journal of Clinical Endocrinology and Metabolism, more exactly in past August’s issue has spotted the use of CPAP (Continuous Positive Airway Pressure) as one of the most effective devices to aid people suffering from sleep apnea. Said report of the findings adds extra support to modern approaches and cemented devices as effective ways to alleviate symptoms and repercussions of sleep apnea.

Jonathan Jun, M.D, who is the assistant professor of medicine at one of the most prestigious universities from Baltimore, the Johns Hopkins University School of Medicine, says that this is one of the first researches that has shown real-time effects of sleep apnea on metabolism during the sleep time.

There are different types of sleep apnea, but obstructive sleep apnea remains as the most common one, currently affecting at least 30% of the adult population according to studies held by the American Journal of Epidemiology and Lancet Respiratory Medicine. Said condition is called obstructive because it occurs when upper airways close off during sleep and interrupt breathing repeatedly for short periods of time, blocking the way for air flow. In regards to the most common consequences of obstructive sleep apnea, snoring and similar sounds while being asleep are some of the most frequent signs displayed by affected people.

Although anyone could suffer from obstructive sleep apnea, it has been demonstrated that this condition is more common in obese people and people under some specific types of medication. These reasons have brought about a tendency to believe that obstructive sleep apnea serves as a hint for when someone suffers from diabetes or some kind of heart disease.

A different way to collect information

The group of researchers from the Johns Hopkins University had a different way to approach diagnosis and metabolic studies in patients who were previously diagnosed with obstructive sleep apnea. Most studies held before usually collected metabolic data from participants while they were asleep, even though this practice may offer results and determine how the condition affects the metabolic system, it can be said that it is only a small percentage or a sample of the real effect obstructive sleep apnea can have in hormone levels.

In order to make results as accurate and precise as possible, the Johns Hopkins’ team of researchers tested participants while they were asleep, measuring the levels of free fatty acids in the blood, glucose, insulin and cortisol. The tests were done in a sleep laboratory at the Johns Hopkins Bayview Medical Center, which is conditioned and prepared to serve as a comfortable area for sleeping. The test monitors participants and allows doctors to see and record important data such as:

• Breathing pattern.
• Brain waves.
• Heart rates.
• Eye and leg movements while being asleep.

For this research the participants were selected with an average age of 51 years and their average body mass indicated obesity which is a common characteristic among people affected by sleep apnea. 66% of the participants selected were male and 25% of the entire group had a history of non-insulin dependent diabetes.

The group’s ethnicity was:

• 64.50% of the participants were Caucasians.
• 22.60% of the participants were African Americans.
• 9.70% of the participants were Asians.
• 3.20% of the participants were Hispanics.

The study may require participants be monitored for more than one night. In this case, 31 patients with moderate to severe obstructive apnea disorder (which are actually the most common levels the disease displays) where tested by the team from the John Hopkins University. The participants were people with a history of regular CPAP use and spent one night at the sleeping laboratory with a CPAP while researchers drew blood samples every 20 minutes for 10 hours. Then, a couple of weeks later, they spent another night at the lab but having stopped their CPAP for two nights before the tests.

Metabolic results and conclusions

The tests showed that obstructive sleep apnea on patients that had the CPAP withdrawn caused an elevated heart rate and reduced blood oxygen. Among other consequences caused by CPAP withdrawal there was an increase in the levels of free fatty acids, glucose, cortisol and blood pressure during sleep. The more severe the obstructive sleep apnea condition was, the more these parameters increased. Additionally, glucose increased the most in patients with diabetes while fatty acids, glucose and cortisol were linked to diabetes as well. The test also showed arteries had signs of stiffness the next morning after having withdrawn the CPAP. Stiffness in arteries is thought to be a contributor to heart diseases.

The team has stated that the research was focused on studying obese people suffering from severe obstructive sleep apnea, meaning that the findings achieved thanks to the test might not be applicable to all patients suffering from obstructive sleep apnea.

The most important finding discovered thanks to the results of the tests was that obesity, diabetes and cardiovascular disease cause the manifestation of sleep apnea in most cases but it may also aggravate said conditions. However, there are more conclusions to be found and they will keep on running tests with new participants. One of the main goals of the study is to determine which patients are more prone to suffer from sleep apnea disease and which ones are most vulnerable to its impact in the metabolic system.

However, the study also states the importance of CPAP therapy as a way to prevent obstructive sleep apnea from impacting the cardiovascular and metabolic system too hard.  Even though getting accustomed to the CPAP at first may be a little difficult the amount of benefits it offers to people suffering from the condition is undeniable. In case the discomfort when using the CPAP continues, it is recommendable to contact a sleep expert.

Complementary tips and recommendations to avoid sleep apnea at first

This list of recommendations done by the Spanish Heart Foundation aim at improving the quality of life for all those who suffer from sleep apnea syndrome:

• Staying at the weight recommended by the doctor, as overweight is one of the major risk factors causing sleep apnea and also a catalyst for the development of cardiovascular diseases.
• Abstaining from alcoholic drinks, sedatives and muscle relaxants, as they have a demonstrated tendency to obstruct the airway, especially when consumed before sleeping.
• Consult the doctor when there is a suspicion that the disease may exist, both based on the symptoms usually observed by people who see or have seen the patient sleeping (such as snoring) or those presented by the patient (morning tiredness and excessive drowsiness during the day).