Year after year, cardiovascular diseases claim the lives of more Americans than any other disease. Despite remarkable advances in medical technology and treatments, over half-a-million people in the U.S. die of heart disease every year. Why? What are we doing wrong? Are we missing something?

It turns out that the answer is, “Yes!” So, what have we missed?

We know about the importance of diet and exercise for heart health, as they contribute to high blood pressure, high cholesterol, diabetes and obesity. We also know about the importance of avoiding exposure to tobacco products. As a medical community, we have implemented many interventions targeting these problems, known as major cardiac risk factors.

However, we have not done enough to address sleep. Compared to the major cardiac risk factors above, our knowledge about sleep is in its infancy. The American College of Cardiology did not publish its first (and only) guidelines on the effect of sleep on heart health until 2008. As a result, many cardiologists nationwide are not fully aware of the dangers of sleep disorders such as obstructive sleep apnea (OSA).

Yet the clinical trials in the past 10 years have shown clearly that OSA not only belongs in the group of “major cardiac risk factors,” it may be one of the most important ones.  Multiple clinical trials have shown that OSA, if left untreated, can:

• Triple your risk of developing high blood pressure
• Double your risk of developing atrial fibrillation
• More than triple your risk of having angina or a heart attack

Worse yet, if you have any of a number of heart diseases, untreated OSA can make things much worse.

• If you have high blood pressure, OSA can make it much harder to control and can raise your BP by 10 points or more.
• If you have had atrial fibrillation, OSA can triple the risk that it comes back.
• If you have congestive heart failure, OSA can more than double your risk of dying.
• If you have had a stent, OSA can more than triple your risk of having more problems with your arteries and dying of a subsequent heart attack.

The good news is that studies have shown that all of these risks may be reduced (or possibly eliminated!) if OSA is diagnosed and treated. The even better news is that the diagnosis and treatment of OSA are simple and usually do not involve any medications or surgeries.

Although OSA is most often asymptomatic (over 80% of patients with OSA do not realize they have it), clues that you might have it include:

• Snoring
• Irregular breathing
• Morning headaches
• Trouble falling or staying asleep
• Unrefreshing sleep
• Excessive sleepiness during the day
• Mood disorders, such as depression
• Difficulty concentrating
• High blood pressure
• Obesity
• Heart disease
• Stroke

If you have some of these symptoms, ask your doctor about OSA. Testing usually involves an overnight “sleep study” during which you sleep while technicians use external monitors to evaluate many things including breathing, heart rhythm and oxygen levels. Treatment typically involves the use of continuous positive airway pressure (CPAP), delivered with a facial mask that is worn only during sleep.

Not only may treatment help you feel better and improve your job performance, it may save your life by lowering your risk for major heart problems. The Heart Hospital of Austin Sleep Disorders Center is a unique, cutting-edge program that is the only one in Texas to be directed by physicians who are dually boarded in cardiology and sleep medicine. This crossover of expertise allows us to fully evaluate and treat any sleep or heart issues you may face.

-Stan Wang, MD, JD, MPH
Cardiovascular Disease & Sleep Medicine, Austin Heart South
Director of Legislative Affairs, Austin Heart
Chair, Austin Heart Sleep Therapy Committee
Medical Director, Heart Hospital of Austin Sleep Disorders Center