September 30, 2015

House Call

Q:My husband has been diagnosed with sleep apnea. I am worried that this problem may be hereditary. We have gained weight since our college days (my husband is 30 pounds heavier than when he finished college). He is being fitted with a mask. Are there more natural treatments we could use?

A: Obstructive sleep apnea (OSA) is a generally underrecognized condition, largely because the characteristic features are often not reported to the treating physicians. OSA is usually found in overweight individuals, although abnormal anatomic variations of the breathing passage in the skull and airways may also be a cause. The patient is often unaware of the condition. It is most often brought to the attention of the physician (and even the patients themselves) by the patient’s spouse or family who are disturbed by the heavy deep breathing and loud snoring, which tends to reach a loud crescendo and is then followed by at least a 10-second cessation of breathing and airflow. This can be frightening to the one observing the process.

OSA occurs much more frequently in men than in women. The risk for women, however, increases after menopause and with obesity. Individuals over 60 years of age, those with high blood pressure, or people with a history of strokes or heart failure are at increased risk. African Americans, Hispanics, and Asians have both greater risk and severity of OSA than do Caucasians. There is a strong tendency for OSA to occur in families.

Genetic studies show that the genes associated with OSA are also linked to those for body mass index (BMI), which is a measure of body weight and obesity. There are also genetic factors that correlate with abnormalities/variations of the bony structure of the face and skull, affecting the flow of air. Specific genes for OSA per se have not yet been identified. OSA is most commonly and strongly associated with obesity.

OSA episodes are triggered by partial or complete closure of the nonrigid parts of the pharynx. This results in decreased to ultimate cessation of breathing. Decreases in the oxygen levels of the blood then force an increased effort of breathing to ensure adequate oxygen supply to the body. This may be associated with temporary arousal from sleep. Repeated episodes occur throughout the night, leaving the individual—and often the spouse as well—unrested, with daytime sleepiness and markedly decreased quality of life. Other complications include worsening of high blood pressure, heart-rhythm disturbances, and increased risk of fatal coronary artery disease.

Diagnosis is confirmed using a study called polysomnography, done in a sleep laboratory. Treatment aims to reduce the episodes of disrupted sleep, and machines and masks worn at night are currently the first choice of mechanical treatment. This is called continuous positive airway pressure (CPAP).

It is essential to adopt lifestyle interventions to lose weight, including a well-balanced vegetarian diet, exercise, and an overall temperate lifestyle. As obesity is the commonest associated risk factor for OSA, this “natural” approach will make all the difference, and even remove the need for CPAP! These changes require the positive choice to implement, determination, and family support—as well as God’s promised enabling power. Together with Him, and by His grace, you can succeed!

Peter N. Landless, a board-certified nuclear cardiologist, is director of the General Conference Health Ministries Department.