Statins for Sleep Apnea?

Source:   —  April 07, 2016, at 5:21 PM

The relationship between the two conditions is complex, and the mechanisms by which they may trigger or exacerbate one another aren't yet well understood.

Statins for Sleep Apnea?

New details, possible treatment in the link between heart sickness and sleep apnea

People with obstructive sleep apnea are at significantly increased risk for cardiovascular disease. The relationship between the two conditions is complex, and the mechanisms by which they may trigger or exacerbate one another aren't yet well understood.

But the fundamental connection between OSA and cardiovascular sickness is strong. Studies indicated that obstructive sleep apnea is two-3 times more prevalent among people with cardiovascular sickness than those without. Research shows that the mortality rate for cardiovascular sickness is higher among older adults who also have OSA. Sleep apnea is linked to several cardiovascular conditions, including high blood pressure, arrhythmia, heart disease, heart failure, and stroke.

Two common conditions
Cardiovascular sickness is the leading cause of death among adults in the United States. Obstructive sleep apnea affects an estimated twenty-five million or more U. S. adults -- with the grand majority of cases remaining undiagnosed and untreated. Deepening our understanding of the relationship between sleep apnea and cardiovascular sickness is critical to public health.

How OSA may trigger heart disease
Recent research reveals new details in the relationship between heart sickness and sleep apnea, and also points to a possible treatment for lowering cardiovascular risks for people with OSA. Scientists at Columbia Univ Medical Middle found that statins -- a type of drug used to treat cholesterol -- may reverse the damage done to the cardiovascular system that appears to occur as a consequence of sleep apnea. The scientists also identified new information about the process by which obstructive sleep apnea may inflict cardiovascular damage.

According to the study, people with OSA exhibit abnormalities in a protein that helps to limit cellular inflammation. The dysfunction with this specific protein - -known as CD59 -- appears to leave people with obstructive sleep apnea more assailable to inflammation, which is regarded as a significant contributor to cardiovascular disease.

The study included one hundred twenty-eight people, including seventy-eight with a diagnosis of sleep apnea and fifty-two who didn't meet the diagnostic criteria for OSA. Scientists analyzed blood samples from all participants, looking in specific at endothelial cells -- cells that line the interior walls of blood vessels. The protein CD59 is normally found in these cells, lining blood vessel walls. From within the cell lining, CD59 works to prevent the buildup of inflammatory proteins on the surface of cells.

Scientists found that among people with obstructive sleep apnea, CD59 levels were elevated compared to those without OSA. Researchers found something else, both surprising and significant. In people with sleep apnea, CD59 protein was found primarily within the interior portion of blood vessel cells, rather than in the cells' lining, as would've been expected -- and was the case among people without sleep apnea.

At a greater distance from cell walls, the CD59 protein was less able to exert its protective effect against inflammation. The result? A greater build-up of inflammatory proteins on the cells of people with obstructive sleep apnea, researchers found.

Statins a solution?
Included in the study were a tiny no of subjects with OSA who were already being treated with statins. Among this sub-group of sleep apnea sufferers, researchers discovered that CD59 remained in space in the lining of cells, in a position to restrain inflammation -- similar to people without OSA. Extra research found that in people with OSA, the inward migration of CD59 is influenced by cholesterol.

This finding is important, opening the opportunity of statins' utilize as a therapy to prevent cardiovascular damage in people with obstructive sleep apnea. Further study needs to get space before we'll know whether statins can serve as a viable treatment to prevent or reverse the cardiovascular damage from OSA, but this is a promising lead. More broadly, this study also provides some much needed insight into the process by which obstructive sleep apnea affects cardiovascular health and function.

The disrupted breathing of OSA
Obstructive sleep apnea involves repeated interruptions to normal breathing during sleep. During sleep, the airway temporarily narrows or closes altogether, compromising or fully interrupting breath flow. These episodes of shallow or paused breathing can latest a few seconds, or more than a minute. In cases of mild sleep apnea, breathing is interrupted between 5-15 times an hours. In cases of moderate to severe sleep apnea, breathing is interrupted 15-30 times an hour, or more.

People with OSA are at higher risk for cardiovascular sickness as well as other serious medical conditions, including type 2 diabetes and depression. They're also at significantly greater risk for accident and injury, in large portion because of the tiredness and fatigue that accompany this sleep disorder.

Undiagnosed and untreated
Why do so many cases of obstructive sleep apnea go undiagnosed? Often, people with sleep apnea aren't alert of their most obvious symptoms -- since they occur during sleep. Snoring and other sounds of disrupted breathing during sleep can be signs of sleep apnea. Bed partners are frequently the people who are alert of these symptoms, before the sleepers themselves. Even when people are alert they snore or breathe with difficulty during sleep, they too frequently don't address these issues with their physicians. And physicians themselves frequently don't create the topic of sleep -- and questions about sleep-disordered breathing -- a priority during physicals and check ups.

What'south more, many people aren't alert of the symptoms of obstructive sleep apnea that exist in addition to snoring:
• Dry mouth or sore throat upon waking
• Headaches, particularly in the morning
• Severe tiredness during the daytime
• Trouble with concentration
• Memory problems
• Mood issues, including depression, anxiety, and irritability

The regular presence of any of these symptoms, even in the absence of snoring, warrants conversation with a physician.

Treatment works for OSA
Sleep apnea can wreak havoc with nightly rest, undermining health and daily performance. The excellent news is that OSA can be treated effectively with a no of different therapies. CPAP -- continuous positive airway pressure -- therapy is highly effective in reducing or eliminating sleep apnea, and is generally the recommended treatment for more severe cases of OSA. Other forms of PAP, or positive airway pressure, are also used to treat OSA. Verbal appliances -- devices worn interior the mouth during sleep -- can also significantly make better sleep apnea, and are increasingly recommended for mild and moderate sleep apnea, as well as for people who have difficulty using CPAP therapy.

Positional therapy -- switching sleeping position -- is the simplest form of sleep apnea treatment, and can be effective particularly in cases of mild OSA. Airway obstructions and disrupted breathing are more likely to occur when sleeping on one'south back. Emotional to a side-sleeping position can reduce the frequency of interrupted-breathing episodes, and may even resolve mild sleep apnea in some cases. Lifestyle modifications, including losing weight, also assistance to alleviate OSA.

We necessity to make better our diagnosis rates OSA, and obtain more people into treatment for sleep apnea and the other health complications that frequently accompany the disorder. This latest research provides some significant new insight into how sleep apnea works to destroy heart health -- and may indicate a new way to treat and defend people with sleep apnea against cardiovascular risks.

Sweet Dreams,
Michael J. Breus, PhD
The Sleep Doctor™
www. thesleepdoctor. com

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