Untreated sleep apnea is associated with flu hospitalization

As we approach flu season, adults with obstructive sleep apnea may want to take extra precautions. A study published online as an accepted paper in the Journal of Clinical Sleep Medicine is the first to find that patients with sleep apnea who did not use CPAP therapy were more likely to be hospitalized with the flu.

Results of the retrospective study show that 61% of patients (17 of 28) who either weren’t prescribed CPAP to treat their sleep apnea or weren’t adherent to their CPAP treatment were hospitalized with the flu, compared with 24% of patients (6 of 25) who were adherent to CPAP therapy. Statistical analysis found that the patients who were non-adherent to CPAP were nearly five times more likely to be hospitalized with a flu infection, despite having a higher rate of flu vaccination.

“Our study would suggest that among patients with obstructive sleep apnea, those who use CPAP are less likely to be hospitalized because of an influenza infection than those who do not use CPAP,” said study coinvestigator Dr. Glen Greenough, associate professor of medicine, psychiatry and neurology at the Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire.

Greenough said the study provides further evidence that sleep is essential to health.

“These results would suggest that use of a treatment, CPAP, that improves sleep quality reduces the severity of influenza infection as determined by rate of hospitalization,” he said. “This might suggest that treating sleep apnea and thereby improving sleep quality has a beneficial effect on the immune system. It also suggests that treating sleep apnea with CPAP could help reduce hospitalizations thereby reducing health care costs.”

Nearly 30 million adults in the U.S. have obstructive sleep apnea, a chronic disease that involves the repeated collapse of the upper airway during sleep. Common warning signs include snoring and excessive daytime sleepiness. A common treatment is CPAP therapy, which uses mild levels of air pressure, provided through a mask, to keep the throat open during sleep.

The researchers at Dartmouth-Hitchcock Medical Center analyzed the medical records of 53 patients who had sleep apnea and a confirmed case of the flu between 2016-2018. The 28 patients categorized as non-adherent to CPAP treatment had a mean age of 63 years and were 54% male; the 25 CPAP-adherent patients had a mean age of about 60 years and were 52% male. CPAP use was assessed by data download, with adherence defined as usage of at least four hours per night for at least 70% of nights.

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Study: Sleep apnea treatment reduces heart problems in patients with prediabetes

A new study found that continuous positive airway pressure (CPAP) treatment at night can lower daytime resting heart rates in patients with prediabetes who have obstructive sleep apnea, reducing their risk of cardiovascular disease.

The study, published Oct. 1 in the Journal of the American Heart Association, was conducted by Esra Tasali, MD, Director of the Sleep Research Center at the University of Chicago Medicine, and Sushmita Pamidi, MD, a sleep physician-scientist at McGill University in Montreal.

The discovery could potentially help the 1 billion people worldwide with obstructive sleep apnea, in which the prevalence of prediabetes and diabetes is over 60 percent. Furthermore, the vast majority of patients with obstructive sleep apnea are undiagnosed.

The study’s findings are especially timely, given that people with diabetes or cardiovascular problems are among the most vulnerable to COVID-19.

“Any way we can improve cardiovascular health is more important than ever these days,” Tasali said.

This randomized controlled trial studied people with prediabetes, a condition where blood sugar levels are higher than normal but not high enough to be considered diabetic. Those who used CPAP treatment for two weeks had a drop in their resting heart rate by four to five beats per minute, compared to those who received placebo. Notably, with optimal CPAP treatment, their heart rates were not only lower at night, but also during the day.

“That’s significant,” Tasali said, noting that a drop of even one beat per minute in resting heart rate can lower the mortality rate and future risk of developing cardiovascular disease.

“A four- to five-beat-per-minute drop in heart rate that we observed is comparable to what you would get from regular exercise,” she added. “Our breakthrough finding is the carryover of the lowered resting heart rate into the daytime and the cardiovascular benefit of that.”

Resting heart rate is key to a person’s health and well-being. A high resting heart rate signals increased stress to the heart. It is a strong predictor of heart problems and death, the doctors said. Prior research has shown that in middle-aged people, every beat-per-minute increase in resting heart rate is associated with a 3% higher mortality rate.

Obstructive sleep apnea is a disorder that causes people to repeatedly stop breathing at night, decreasing oxygen intake and disrupting their sleep. It is a serious health concern, increasing the risk of cardiovascular conditions such as high blood pressure, stroke and heart attack. It makes people sleepy during the day and heightens their “fight or flight” stress hormones, elevating their resting heart rate all day and night.

Doctors use CPAP to treat obstructive sleep apnea. It keeps a person’s airway open and oxygen levels steady during the night, thus lowers their heart rate. However, Pamidi isn’t encouraging people to go online and buy the machine. Obstructive sleep apnea is a medical diagnosis that must be made by a doctor after a sleep study.

“Our recent findings urge people who have prediabetes, diabetes or sleeping problems to be screened for sleep apnea,” Pamidi said.

Today, about 80% of sleep apnea cases are undiagnosed. An estimated 50% to 70% of people with prediabetes or diabetes have sleep apnea.

“The majority of patients don’t make a connection as to how their sleep can affect their hearts. With regards to their sleep apnea, patients just think how sleepy they are the next day,” Tasali said. “I always explain to my patients that sleep apnea can also be harmful to their cardiovascular health.”

This study is the first to examine the impact of optimal CPAP treatment on daytime resting heart rate,” said Pamidi. Before joining McGill, she was a clinical fellow and then faculty at UChicago Medicine’s Division of Pulmonary and Critical Care Medicine.

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Study links increased exercise with lower sleep apnea risk

A study published online as an accepted paper in the Journal of Clinical Sleep Medicine found that increased physical activity is associated with a lower risk of obstructive sleep apnea, a common sleep-related breathing disorder. The study is the largest to date focused on the relationship between sleep apnea and levels of physical activity in the general community.

Researchers reviewed lifestyle, medical, socio-demographic and sleep health data collected from more than 155,000 adults participating in the Ontario Health Study. Based on the physical activity of participants with and without sleep apnea, the investigators determined that a modest increase in physical activity, including walking, is associated with a 10 percent reduction in the risk of developing sleep apnea.

“Our results highlight the importance of physical activity as a preventive measure against developing sleep apnea,” said senior author Lyle Palmer, who is professor of genetic epidemiology at the University of Adelaide in Australia. “One surprising finding was that not only vigorous physical activity but also just walking alone was associated with a decreased risk of sleep apnea.”

The authors found that adding 20 minutes to a daily walk and increasing vigorous daily activity by eight minutes would be enough to achieve a lower sleep apnea risk. The finding is independent of other known risk factors for sleep apnea such as sex, age, ethnicity and obesity.

It is estimated that more than 29 million American adults have sleep apnea, many of them undiagnosed. Untreated sleep apnea is associated with an increased risk of heart disease, stroke, high blood pressure and other potentially serious conditions.

“The rates of sleep apnea in children and adults are continuing to rise. Therefore, understanding the role of modifiable protective factors for sleep apnea is important,” said Palmer. “Exercise is one such protective factor and has many other positive effects on general health. Sleep health care professionals should be trying to get their patients to exercise more.”

The cross-sectional, population-based study analyzed baseline questionnaire data from 155,448 adult residents of Ontario, Canada (60% women and 40% men). Their mean age was 46 years, and about 75% were white. About 6.9% of participants reported being told by a doctor that they have sleep apnea. Those with sleep apnea were more sedentary, sitting for a median of 4.4 more hours per week than those without sleep apnea.

Due to the cross-sectional nature of the study, the authors were unable to make temporal inferences on the observed associations between physical activity and sleep apnea. However, they report that previous studies also have suggested that physical activity can reduce the severity of sleep apnea.

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