June 22, 2011

Sleep Apnea Revisited

 My husband has sleep apnea. I’ve heard that sleep apnea can be dangerous. I think he should get treatment, but he just laughs it off and says he’s fine.
Perhaps the reason your husband is not as concerned as you are is that he is unaware of the risks of this condition.
Sleep apnea occurs during sleep, when a person snores or makes noise breathing. Breathing can stop for as much as 10 to 15 seconds before the person gasps and arouses. Such interrupted breathing disturbs the rest of both the patient and anyone else sleeping in the room. In some patients a sense of suffocation leads to the gasping, but not everyone with the condition is awake enough for this sensation to register. During the interruption in breathing, or apnea, the oxygen level in the blood falls and the carbon dioxide level builds.
What happens is that throat muscles and tissues of the neck relax in sleep and block the upper airway. As the oxygen in the blood is used up, the lining of blood vessels become more at risk for atherosclerosis. This degenerative change that involves a cholesterol-rich deposit in the vessel wall, called plaque, is a serious condition. It slows blood flow, reducing oxygen delivery to tissues, and makes blood vessels stiff and incapable of reactive dilatation.
2011 1518 page22This plaque can break away from the wall and plug the smaller vessels, resulting in a heart attack or stroke, which is a “brain attack.” People with sleep apnea are more likely to have plaque that is not calcified and, consequently, more likely to break off. Not all patients with sleep apnea are overweight or obese, but many are. Weight loss would clearly be recommended. Whether being overweight causes snoring and sleep apnea, or vice versa, is not clear.
Sleep apnea is a common problem, estimated to affect between 11 and 20 million people in the United States. Research has demonstrated a link to increased risk of death from any cause, but especially from heart problems, in persons with sleep apnea. Sleep apnea is associated with high blood pressure and stroke, daytime drowsiness, and an increased risk of the metabolic syndrome.
The metabolic syndrome is a group of disorders that includes high blood pressure, raised blood sugars, raised triglycerides (fats), lowered HDL (good cholesterol), and abdominal obesity. This syndrome is clearly tied to heart disease and obesity. In the journal Sleep (December 2010), a study followed some patients with sleep apnea and snoring, and found that over about three years twice as many of these patients developed the metabolic syndrome as the control group.
It’s important for your husband to see a sleep-disorder specialist. He or she may prescribe a device called a CPAP machine, which provides continuous positive airway pressure, keeping the airways open. However, comprehensive management will evaluate your husband’s lifestyle and look for elements of the metabolic syndrome that could require corrective lifestyle changes.
Weight loss is a topic in its own right, but abdominal obesity is often related to high intake of high saturated fats and refined carbohydrates. Exercise modifies many metabolic processes. As the prime player in purchasing the food for the family, you may be in a position to alter the foods consumed by your husband. In family settings we influence each other enormously, becoming keepers of each other’s health. Eating together, playing together, living together, we can encourage healthier lifestyle patterns, and thereby enjoy our lives as families longer.
My friend died of lung cancer, yet had never been a smoker. What other things cause lung cancer besides tobacco or cigarette smoke?
Lung cancer is actually declining in men, but still increasing in women. That’s because more men have given up smoking over the past 25 years, while women smokers have increased in number. No serious student of health would ever suggest that tobacco smoke and cigarette smoking, in particular, are not major culprits in the development of lung cancer. This holds true for smokers as well as those exposed to secondhand smoke. The push to protect nonsmokers by restricting smoking to designated areas is a welcome action that will further reduce complications in nonsmokers.
2011 1518 page22There are, however, other factors that may play a role in lung cancer. Air pollution from a variety of sources plays a role in respiratory disease. Diesel exhaust fumes are particularly hazardous. Studies show that the effect of automobile air pollution is measurable in children living as far as 1.2 miles (two kilometers) from highways and freeways.
While it’s been known for decades that city dwellers have increased respiratory problems, not everyone is aware that the radioactive gas radon may also cause lung cancer.
This gas seeps from the ground and groundwater, contaminating houses through cracks in foundations and basement walls. Radon is invisible and odorless, and is felt to be a major cause of lung cancer in nonsmokers—and a major additive risk in smokers. Radon kills an estimated 20,000 people in the United States each year.
About one in 15 houses in the United States may have elevated radon levels. Modern construction, with an emphasis on airtight homes, means levels may become dangerous—especially when air exchange is reduced. A do-it-yourself testing kit for radon is available for reasonable prices at most hardware stores.
A visit to www.epa.gov/radon will provide detailed instructions and remedies. These may include the sealing of cracks and installation of special ventilation systems. Some areas of the country may have more risk of this natural pollutant than others.
Send your questions to Ask the Doctors, Adventist Review, 12501 Old Columbia Pike, Silver Spring, Maryland 20904. Or e-mail them to [email protected]. While this column is provided as a service to our readers, Drs. Landless and Handysides unfortunately cannot enter into personal and private communication with our readers. We recommend you consult with your personal physician on all matters of your health.
Allan R. Handysides, a board-certified gynecologist, is the director of the Health Ministries department of the General Conference. Peter N. Landless, a board-certified nuclear cardiologist, is an associate director of the Health Ministries department of the General Conference. This article was published June 23, 2011.