Obstructive Sleep Apnea — A Risk Factor for Coronary Artery Disease

An on-going study taking place in Sweden has released preliminary findings that suggest that obstructive sleep apnea (OSA) may be an even stronger risk factor for coronary artery disease than diabetes, obesity, hypertension and even smoking.

At the European Respiratory Society 2010 Annual Congress last week, Swedish pulmonoligist Yuksel Peker from the Skaraborg Hospital in Sweden presented his latest finding from the ongoing Randomized Intervention with CPAP in Coronary Artery Disease and Sleep Apnea (RICCADSA) trial.

Although the study is on-going, he acknowledged, he also stated “analyses of baseline demographics and comorbidity profiles continue to strongly support OSA as a risk factor for CAD.” The study was started in 2005 to analyze the impact of continuous positive airway pressure (CPAP) on patients who had undergone revascularization for CAD and who also had OSA. ”Not only is the prevalence of OSA ‘surprisingly high,’” Dr. Peker said, but "these patients do not always show typical symptoms such as sleepiness.“

OSA was found in 64% of those with CAD. Comparitively, 58% had hypertension, and 28% were obese, making OSA much more common that was before thought of as more “conventional” risk factors. In addition, CAD patients with OSA were older than those without, were more obese, we mostly male, and had higher incidents of hypertension, diabetes, and atrial fibrillation.

Dr. Peker looked at both OSA syndrome (or "sleepy OSA," because of daytime sleepiness symptoms) and "nonsleepy OSA." He found that the CAD risk increase was present with both types of OSA.
The good news seems to be that those CAD patients that were studied with OSA had better compliance to the CPAP treatment. Dr. Peker indicated, “if we ask the CAD patients to use CPAP so far, they appear motivated enough to follow treatment.” At this point there is no proof that CPAP treatment actually reduces the risk for cardiovascular disease, however Dr. Peker suggested that it should be thought of as a “secondary cardiovascular prevention method.” The final results of the study are due out in 2012.

European Respiratory Society (ERS) 2010 Annual Congress: Abstract 5374. Presented September 22, 2010.

More Veterans are Suffering from Sleep Apnea

The Veterans Administration announced that from 2008 to 2010, the number of veterans who receive benefits for sleep apnea increased by 60%, and that more than 20% of military veterans suffer from the sleeping disorder, compared to the estimate of 5% for those not in the military.

Although one of the main causes can be excess weight, the VA doctors suspect that repeat deployments to Iraq and Afghanistan are exposing the military service members to dust and smoke which are contributing to the increase in cases.

More than 63,000 veterans receive benefits for sleep apnea, which can cause daytime drowsiness, heart disease, and even strokes. The most common treatment is the continuous positive airway pressure (CPAP) mask. Although the Social Security Administration recognizes sleep apnea as a disability and pays benefits to those who can’t work, the VA says veterans can receive benefits and hold jobs.

The Department of Veterans Affairs is expected to spend approximately $500 million a year to treat veterans with sleep apnea, and it is expected to rise in the upcoming years. Considering that sleep apnea is linked to serious conditions such as heart disease, diabetes, hypertension, obesity, and daytime sleepiness which can cause memory loss and decrease work productivity, it is critical that these veterans receive appropriate care.