Department: Ask the Experts
Q As a patient with sleep apnea, I was alarmed by studies linking the condition to stroke. Is there anything I can do to decrease my stroke risk?
A Literally every patient who has clinically significant sleep apnea is at higher risk of stroke and heart attack. Generally, the more intense the sleep apnea, the higher is the risk of cardiovascular and cerebrovascular complications. This gets worse with the association of other risk factors, like high blood pressure, diabetes, or smoking. And of course, as you get older, the risk of stroke increases.
Studies show sleep apnea increases the risk of stroke through a variety of mechanisms. One is by increasing blood pressure, causing hypertension. Sleep apnea also causes heart dysrhythmias throughout the night. In addition, it decreases the blood flow in the brain and saturation of oxygen. If you put all of these together in a patient with atherosclerosis—the buildup of fatty material along artery walls, which may eventually lead to blockages of the arteries—you create the perfect storm for the development of stroke.
While studies on this are lacking, it seems that the best way to decrease the risk is to target the sleep apnea itself. Diagnosis of sleep apnea may initially be suspected by a primary care provider who will inquire about a variety of markers, such as very loud snoring, being overweight, and being tired during the day. The diagnosis is confirmed with an overnight test in a sleep laboratory.
A sleep specialist will then suggest lifestyle adjustments, and one of three treatments. One is to use an upper airway-patency appliance. This is a mouth device that helps people with mild sleep apnea breathe better during sleep; some research suggests this helps bring the blood pressure down. If a patient has more severe sleep apnea, the specialist will prescribe a mask called a C-PAP (Continuous Positive Airway Pressure), which blows air into the nose and facilitates breathing while asleep. This can decrease daytime sleepiness, correct oxygen desaturation, and lower the blood pressure. Lastly, in some cases, such as for people with large tonsils, surgery is recommended.
Antonio Culebras, M.D.