Obstructive sleep apnea (OSA), the most common kind of sleep apnea, has been connected with a number of other disorders and conditions—including atherosclerosis, according to a new study. At The Insomnia and Sleep Institute of Arizona, we are an outcome-driven clinic where you will find unprecedented staffing levels. Led by triple board-certified Dr. Ruchir P. Patel, we are proud to serve you as the Face of Sleep Medicine in Arizona. Here, we are staffed by sleep specialists and your initial consultation is with a sleep expert who can diagnose sleep disorders, which is the first step in testing and treatment.
OSA has long been linked to heart disease and cardiac events. Atherosclerosis occurs when there is an accumulation of cholesterol, fat, and other substances along the walls of arteries. This can cause obstruction in blood flow. The plaque buildup can also rupture, leading to clots in arteries. Unfortunately, there are no symptoms for atherosclerosis and most patients discover this condition when there is either a rupture or a buildup so severe that blood flow is blocked. Typically, it is recommended that a healthy diet and exercise be followed to prevent this condition, and in some cases medications and surgery are necessary. However, if untreated OSA leads to atherosclerosis, getting a diagnosis and treatment for this common sleep disorder is key.
A Certain Type of OSA
It is not just “any” kind of OSA that is linked to atherosclerosis, but rather rapid eye movement OSA (REM-OSA). Plus, there was a link found between severe REM-OSA and carotid intima thickness in female patients. The study, which came out of Sweden, builds upon previous studies that examined the link between OSA and a variety of other cardiac issues, such as hypertension. The investigators examined the connection between REM-OSA and carotid intima thickness amongst both men and women in order to ascertain any differences related to sex.
In total, 400 women were included in the follow-up cohort study titled “Sleep and Health in Women (SHE).” Additionally, 400 men were part of the Men in Uppsala: A Study of Sleep, Apnea, and Cardiometabolic Health (MUSTACHE), a “brother study” of sorts. The SHE group underwent a polysomnography test and the MUSTACHE group underwent a high-resolution ultrasonography of the carotid artery. Both groups took a full-night ambulatory polysomnography, too. Both groups were also tasked with questionnaires to gauge data on lifestyle decisions (such as smoking and alcohol), medical history, daytime symptoms, and medication.
Study Revelations on REM-OSA Patients
After the tests, fasting blood samples were taken to examine the C-reactive protein and low-density lipoprotein. After a few exclusions were applied, the final study included 253 women and 338 men, with 157 in total having REM-OSA. Those with severe disordered breathing were typically older, had a higher BMI, and were more likely to have hypertension. This is in keeping with what has long been known about OSA patients.
The researchers noticed a link between sleep apnea occurring during REM and a thicker carotid intima, which remained true even after adjustments. The researchers also saw that there was an intima that increased almost 10 percent in those with “severe sleep apnea” during REM. There were more women than men who had severe sleep apnea during REM. These findings led researchers to conclude that severe REM sleep apnea was “independently associated with signs of atherosclerosis,” particularly in female patients.
What to Do about REM-OSA
The researchers stress that in order to properly treat REM-OSA, treatment must take place in the early morning when most of REM occurs. “This might be especially important to protect women from additional risk for atherosclerosis from residual untreated REM-OSA,” concluded researchers. The gold standard for treating OSA is CPAP therapy, and in rare cases that this fails more aggressive options like Inspire implant may be suitable.
If you suspect you have OSA or are diagnosed with OSA and are struggling to get the right treatment, contact The Insomnia and Sleep Institute today by calling the office or filling out the online form.
