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MEDICAL FILES

Snoring is not healthy

/ 02:34 AM April 25, 2017

There’s a misconception that snoring loudly means one is having a deep, relaxing sleep, and that there’s nothing wrong with it.

But nothing can be farther from the truth. Snoring is not healthy at all!

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Snoring intermittently at night may be due to a potentially serious medical condition associated with high blood pressure (BP), diabetes, heart problems and even sudden death while sleeping.

The funny thing is, you don’t even realize that you snore. Ask your sleeping companion if you snore loudly, with intermittent seconds of silence.

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The intermittent gaps could also be associated with gasping for breath from time to time.

If you snore, it’s best to consult your doctor, before potentially life-threatening complications develop.

Obstructive sleep apnea

Two of our patients have such a problem. Both have cardiovascular ailments.

The first, a 48-year-old overweight mechanic, has uncontrolled high blood pressure (BP) even if he’s on four anti-hypertensive medicines taken at optimal doses. His family physician was already at his wit’s end and ran out of options to control his elevated BP.

The second patient, whom we haven’t seen for years, came back, suffering from progressive shortness of breath, chest pains and palpitations. Workup on the patient showed an enlarged heart, irregular heartbeat and signs of heart failure.

Both patients had one thing in common—they were loud snorers. We sent them for a “sleep test” or polysomnography, which monitors the breathing pattern during sleep, including the airflow in the nose and mouth, as well as the movement of one’s chest and other respiratory muscles.
These are correlated with the levels of oxygen and carbon dioxide in the blood.

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The results of the “sleep test” of both patients showed significant obstructive sleep apnea or OSA.

Apnea means stopping of one’s breathing, and patients with OSA may have several episodes of complete cessation of airflow or stopping of breathing for at least 10 seconds each night when they sleep.

Some may not completely stop breathing and instead have hypopnea, in which the airflow decreases by 50 percent for at least 10 seconds, or decreases by 30 percent with an associated decrease in the oxygen saturation in the blood.

This is then reported as the apnea-hypopnea index (AHI), and, depending on the frequency of their occurrence per hour, the OSA is described as mild, moderate or severe.

Our two patients had severe obstructive sleep apnea. And this was the likely culprit for the first patient’s uncontrolled hypertension and the second patient’s heart disease with progressive heart failure.

In OSA, the snoring has intervals of silence. The silence occurs when the individual is apneic or he/she stops breathing.

OSA patients usually wake up in the morning feeling tired and unrested despite a supposedly long sleep. They may doze off at work, even when someone is talking to them or even while driving. This can lead to serious accidents on the road.

Other symptoms of OSA are headaches, difficulty in concentrating, mood changes such as irritability and depression, forgetfulness, increased heart rate and/or blood pressure, decreased sex drive, unexplained weight gain and heavy night sweats.

OSA is also usually associated with heart diseases, hypertension, diabetes and the so-called metabolic syndrome, which is a clustering of cardiometabolic factors that include being overweight, having increased waist circumference indicating visceral or internal obesity, hypertension, high blood sugar, high triglycerides and low high-density lipoprotein (HDL) cholesterol, which is the “good cholesterol.”

In a study by researchers at the University of Pittsburgh, 800 people between the ages 45 and 74 were surveyed about the quality of their sleep. Three years later, the researchers found out that the people who reported loud snoring were more than twice as likely to have metabolic syndrome, than quiet sleepers.

Metabolic syndrome is characterized by a cluster of cardiometabolic problems including obesity, diabetes, high BP and cholesterol problems.

Individuals with OSA are rarely aware that they have this problem. Some even deny that they snore. The problem is recognized by others, usually the spouses or bed-partners, who see and hear the individual with OSA during episodes.

Symptoms of OSA may go undetected for years or even decades, especially in those who sleep alone.

OSA is actually caused by an obstruction of the airway during sleep. Generally, the muscle tone of the body relaxes during sleep. The airway in the throat is composed of walls of soft tissue and muscles; when these relax, they can collapse, obstructing one’s breathing.

A minor degree of OSA—like a few short episodes of apnea when sleeping—can still be considered part of normal sleep. This may happen when one has nasal and throat congestion due to upper respiratory tract infection.

Transient spells of OSA may also occur due to some drugs (sedatives and tranquilizers) or alcohol.

But when the episodes become longer and more frequent (equal to or more than five times every hour of sleep) and persistent, this type of OSA can develop into something more serious.

Early diagnosis is important. Continuous positive airway pressure (CPAP) therapy is usually prescribed. During sleep, a person with OSA is made to wear a facial or nasal mask which is connected by a hose to a small device at his/her bedside.

CPAP therapy has shown positive results—eliminating snoring and breathing obstructions, improving the quality of nightly sleep, preventing or reversing serious health conditions such as cardiovascular diseases and stroke, lowering the BP during the day and at night, increasing alertness during the day, and decreasing daytime drowsiness.

The device is portable and can easily fit in one’s hand-carry luggage for long-haul trips.

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