Sleep apnea significantly increases cardiovascular risk

Sleep apnea significantly increases cardiovascular risk


It concerns sleep but directly impacts the heart. The sleep apnea syndrome (called obstructive sleep apnea-hypopnea syndrome) is manifested by repeated and uncontrolled interruptions of breathing during sleep. The latter are the consequence of the repeated closing, for more than 10 seconds, of the air duct of the pharynx, and this more than five times per hour of sleep. These occlusions are themselves caused by a relaxation of the throat and tongue muscles during sleep, thus blocking the passage of air and preventing breathing. The person concerned is then plagued by incessant micro-clocks of which he is not aware.

If, in the immediate future, daytime sleepiness, difficulty concentrating or remembering, this results in cardiovascular complications longer term. A risk that the French Cardiology Federation wishes to recall on the occasion of the European Cardiology Days. Starting with the fact that this pathology remains underdiagnosed. ” Sleep apnea syndrome is better known today among general practitioners and even cardiologists than ten years ago. The treatment remains very insufficient: 80% of people with carriers are neither diagnosed nor treated at the present time, ”explains Dr Anne Mallart, pulmonologist at the Lille University Hospital.

Heart rate is turned upside down

What is actually happening to the patient? With each episode, the oxygen level in the blood drops (hypoxemia) with creation of an awakening or micro-awakening allowing the reopening of the upper airways. It is this succession ofhypoxemia episodes linked to sleep apnea during the nights which will cause the progressive installation of cardiovascular complications. The periods of sleep and “emergency” micro-awakenings notably cause alternation in heart rhythms : bradycardia (slower heart beat during moments of deep sleep) then tachycardia (acceleration during periods of apnea and micro-awakening).

Not to mention that hypoxemia also promotes constriction of arteries (vasoconstriction). “In patients whose coronary arteries are already sick, these episodes of vasoconstriction can cause a rupture of atheroma plaques, promote the formation of a clot and cause a myocardial infarction with possible outcome in heart failure”, specifies the FFC. This link is also established in the opposite direction, namely that the prevalence of sleep apnea syndrome is 1.5 times more frequent in people suffering from heart failure or coronary artery disease, a disease that affects the arteries that supply the heart with blood (coronary arteries).

Women who are even more fragile at certain periods of life

Although SAS is more common in men, the prevalence sleep apnea syndromel increases appreciably among women with age: 5.9% of them are affected from 40 years. The FFC also specifies that “when women suffer from moderate to severe SAS, they are 30% more likely to develop cardiovascular disease”. It is particularly during the two hormonal periods The key to pregnancy and menopause is to be careful. As with many cardiovascular diseases elsewhere, this is why these periods must in all cases constitute moments of cardiovascular screening.

“The role of the cardiologist is essential in the detection of sleep apnea syndrome, which is a real situation at high cardiovascular risk. We must systematically think about this pathology if a patient suffers from resistant hypertension, atrial fibrillation or heart failure and not to avoid the risks in women who are pregnant or menopausal “, says Professor Claire Mounier-Vehier, president of the French Federation of Cardiology. To treat it effectively, the doctor will systematically recommend optimizing the hygieno-dietetic rules: weight loss for overweight people, quitting smoking, alcohol and certain drugs …

In addition to eliminating the aggravating factors which promote sleep apnea, the practice of regular physical activity as well as good sleep hygiene are also recommended (at least 8 hours per night at fixed times). If the case is moderate to severe, the doctor may also use two forms of treatment, the aim of which is to maintain or promote the opening of the airways. The first, the continuous positive pressure (PPC) by the nasal route, is a ventilation device worn at night composed of a nasal mask connected to a machine. The second, the mandibular advancement orthosis, is a device worn in the mouth most often offered as a second intention.

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