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A number of studies have established that moderate to severe cases of the nighttime breathing problem known as obstructive sleep apnea significantly increases the risk of suffering a stroke. It is estimated that about 10% of the population have undiagnosed sleep apnea. Further, almost 75% of stroke sufferers have sleep apnea and have significantly worse functional outcomes after stroke than do patients without apnea.
In obstructive sleep apnea, a person's airway narrows, or totally collapses during sleep. As a result, a person stops breathing briefly numerous times throughout the night. The person's sleep is interrupted often, which may cause excessive daytime sleepiness or even high blood pressure.
One reason sleep apnea may increase stroke risk is that it has been shown to cause high blood pressure, which is the most common risk factor for stroke. Another possible reason is that when a person stops breathing, the lack of oxygen kicks in the body's "fight or flight" response, which increases adrenalin production. The blood pressure goes up and the blood becomes more clottable. The blood clots in the brain cause a stroke.
A recent clinical study of 1,475 people found that those with moderate to severe sleep apnea at the beginning of the study were 3 to 4 times more likely to have a stroke than a comparable group of patients without sleep apnea during the next four years. The patients in the study were defined as having moderate to severe obstructive sleep apnea if their breathing stopped or slowed at least 20 times per hour of sleep.
This study provides yet another reason why it's important to treat sleep apnea, especially given the fact that assessment and treatment of sleep apnea is not typically a part of standard therapy for stroke patients. Many stroke patients have snoring and daytime fatigue as symptoms of apnea. Despite recognition of these problems, until now awareness of sleep apnea as a factor that might contribute to functional disability in patients with strokes may be very low among health care professionals. The patient therefore, has to take a very proactive role.
Preventing Stroke by Treating Sleep Apnea
One method of preventing stroke therefore is to treat the underlying sleep apnea, of which a major symptom is snoring and daytime fatigue. Successful treatment of sleep apnea {usually with nasal continuous positive airway pressure (CPAP)} may play a significant role in preventing stroke. Since a major symptom of sleep apnea is snoring during the night and excessive daytime sleepiness, it is important to establish that you have the correct diagnosis. It is therefore important to talk to your primary care clinician about a referral to a sleep center in order to get a diagnosis, especially if you are a stroke sufferer and have symptoms of apnea.
Note: This is part one of a five-part series of short articles on sleep and health. In the next newsletter Dr. Siddique's article will be titled "Cardiovascular Consequences of Sleep Deprivation".
About the Author: Dr. Siddique is a Clinical Associate Professor of Medicine at UMDNJ- Robert Wood Johnson Medical School and Medical Director of the SleepCare Center at RWJ Hamilton. He is also the President of the Institute for Sleep and Lung Diseases. He is board certified in Internal, Pulmonary, Critical Care and Sleep Medicine. He has received multiple “Excellence in Teaching” awards at RWJ Medical School. He was selected to be on the peer-nominated Best Doctors list in Better Living magazine in NJ. He is also co-author of the book, “How to Turn Anger into Love” (www.HowToTurnAngerIntoLove.com). He can be reached at: (609)587-9944; www.sleephealthdoc.com.
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