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Sun 28 Dec 2008 04:00 AM

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The sleep that kills

Find out how interrupted breathing while you sleep can lead to heart trouble and shorten your life.

Find out how interrupted breathing while you sleep can lead to heart trouble and shorten your life.

The sounds of disrupted breathing you make while sleeping may do more than rob you of a good night's sleep. They may steal years of your life, too. That's the message from two large studies that looked at the influence of sleep apnoea, a special cause of snoring, on life span.

Together with new recommendations on sleep apnoea and cardiovascular disease, they sound the alarm that we should pay more attention to this breath-holding type of snoring.

What is sleep apnoea?

When you breathe, air usually flows soundlessly through the nasal passages and the back of the throat, and then on into the lungs. During sleep, the small muscles that hold open the pharynx relax, allowing the tissue to flop into the airway.

Air rushing through this loose tissue can make it vibrate. We hear the vibrations as snoring. It's similar to what happens when you let air out of a balloon.

In people with simple snoring, the airway remains open. The sounds, dreadful though they may be, are more a menace to others than to the snorers themselves. Sleep apnoea is a different story. People afflicted with this common condition temporarily stop breathing many times a night.

In those with the most common kind, obstructive sleep apnoea, the soft tissue of the palate or pharynx completely closes off the airway. The brain, sensing a drop in oxygen, sends an emergency "Breathe now!" signal that briefly wakens the sleeper and makes him or her gasp for air.

The pauses and gasps of sleep apnoea are hard on the snorer. An immediate effect of sleep apnoea is daytime drowsiness due to disrupted sleep. There are plenty of long-term consequences, too.

The "Breathe now!" signals fire up the same stress hormones and nerve pathways that go into hyper drive when you are angry or frightened. They make the heart beat faster and boost blood pressure. They stoke inflammation, a key player in heart disease. They can damage the delicate inner lining of blood vessels and increase the blood's tendency to clot, a root cause of heart attack and stroke.

Sleep apnoea and survival

Two major studies suggest that the changes wrought by sleep apnoea can shorten life (Sleep, August 2008). In a long-term study of the residents of the West Australian town of Busselton, those with moderate to severe sleep apnoea were six times more likely to have died over 14 years of follow-up than those without sleep apnoea.

In the Wisconsin Sleep Cohort Study, participants with severe sleep apnoea were three times more likely to have died of cardiovascular disease during 18 years of follow-up than those without apnoea. When the researchers excluded people who used a breathing machine at night, the risk jumped to more than five times higher. Silencing the snorchestra

You don't have to take sleep apnoea lying down. Everything from lifestyle changes to surgery can make a difference.

Lifestyle changes Excess weight is a big contributor to sleep apnoea. If you're carrying too many pounds, losing weight can make a big difference.

Sleeping on your side instead of your back may help with mild sleep apnoea (a tennis ball sewn into a pocket on the back of a pyjama top can help keep you from rolling onto your back during the night).

It can also help to forgo alcoholic drinks before sleeping and to minimise the use of sedatives or muscle relaxants

Breathing machines For moderate or severe sleep apnoea, most doctors recommend using a radio-sized machine that keeps the airway open by blowing pressurised air into the nose. The most common machines provide continuous positive airway pressure (CPAP).

For people who have trouble exhaling against the pressure, refinements called bi-level positive airway pressure and auto-positive airway pressure are available. Breathing machines may take time to get used to, and some people need coaching to use them correctly.

Dental devices A mouth guard may be an alternative to a breathing machine. These devices work by thrusting the jaw forward, a position that may keep the tissues in the throat from collapsing and blocking the airway. They work well for some people, not so well for others.

Surgery An operation with a name that's a mouthful (uvulopalatopharyngoplasty) can make the airway wider by removing excess tissue in the throat. Surgery isn't usually effective, and generally isn't done unless other treatments don't work or aren't appropriate.

Looking ahead

The Wisconsin study suggests, but doesn't prove, that treating sleep apnoea may help prevent heart disease, or at least keep sleep apnoea from contributing to heart disease. We'll have a better idea about this once the international Sleep Apnoea Cardiovascular Endpoints (SAVE) study is finished in the mid-2010s. It is comparing treatment with positive airway pressure against standard care

In the meantime, it makes sense for anyone with high blood pressure, angina, heart failure, peripheral vascular disease, a past heart attack or stroke, or other types of cardiovascular disease to think about being checked for sleep apnoea, says Dr David White, a professor of sleep medicine at Harvard Medical School.

Dr White helped the American Heart Association and American College of Cardiology write their new scientific statement on sleep apnoea and cardiovascular disease, which is partly aimed at raising cardiologists' awareness of sleep apnoea.

Sleeping peacefully won't guarantee you freedom from heart trouble. But it's a great way to improve your odds.

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