Women with sleep apnea have increased heart risks, too
February 6th, 2012
Just as it does in men, obstructive sleep apnea can raise the risk for women of suffering from heart attacks and having other cardiovascular problems, a new Spanish study indicates.
Sleep apnea -- characterized by repeated interruptions of breathing during sleep -- affects many more men than women, up to 3 percent of middle-aged women have the disorder. One common symptom is snoring, tossing and turning, and awake not feeling rested. Most patients have daytime sleepiness because of the sleep disorder. Woman may have far subtler symptoms, such as headaches and fatigue, which lead to frequent misdiagnoses. Little research has focused on women until now. The study results show that sleep apnea is a significant disease in women as well as men. If the condition is suspected, evaluation is crucial and treatment is necessary if it is diagnosed. The new study will probably change awareness among doctors and patients, as apnea is often thought to be a man's problem.
"Women with untreated severe obstructive sleep apnea have a three-and-a-half-fold increase in the risk of dying from cardiovascular disease compared to women without (it)," said researcher Dr. Francisco Campos-Rodriguez, director of the sleep-disordered breathing unit at Valme University Hospital in Seville. The study is published in the Jan. 17 issue of the Annals of Internal Medicine. The researchers followed 1,116 middle-aged women, all sent to sleep medicine clinics in Spain for suspected apnea. The researchers determined whether they had the condition, measured the severity of the apnea, and divided them into mild-to-moderate or severe groups. Some in each group received CPAP treatment and some did not. Those found not to have sleep apnea served as the comparison or control group. They followed the women for up to 88 months (more than seven years). At the end, 41 patients, about 4 percent, had died of cardiovascular problems and 3 percent of other causes.
Deaths from cardiovascular problems were more frequent in women who had apnea that was not treated, especially when it was severe. "We have provided the first evidence in the (medical) literature that severe OSA is associated with cardiovascular mortality in women, and that treatment is associated with a decrease in mortality risk," Campos-Rodriguez said. CPAP treatment delivers a pre-set level of pressurized air through a mask that the patient wears during sleep but compliance with CPAP is poor especially with women. Alternative treatment options such an oral appliance offer comparable relief from symptoms related to sleep apnea and is the preferred option recommended by the American Academy of Sleep Medicine for the treatment of Mild to Moderate sleep apnea. Patients find the mask uncomfortable at first, some get used to it quickly but most don't and for those patients an oral appliance can provide adequate relief from the tiredness that plagues most patients. In the United States, coverage of CPAP by insurance plans is typical but more and more insurance companies are covering the oral appliance in part due to it's cost savings in medical care resulting from untreated sleep apnea.
While the CPAP can provide successful treatment, the biggest hurdle is using it. Many patients feel claustrophobic, others find wearing the mask offensive, and not easy to get up and out of bed with it on. Dr. Singh says that “ for patients who have mild to moderate sleep apnea, cannot tolerate the CPAP, refuse surgery, or have found those to be unsuccessful, an oral appliance custom-made to the patient’s bite is the correct alternative solution. The dental appliance is worn at night. It is light and comfortable to wear, and will help prevent the airway from collapsing and snoring so that the patient gets a restful sleep. I’ve seen my patients’ quality of life improve significantly” says Dr. Pankaj Singh.
