Almost Two-Thirds of Pacemaker Users Have Sleep Apnea

Monday, December 11, 2006
NEW YORK (Reuters Health)
The results of a preliminary study suggest that memory deficits that are common among people with
sleep apnea can improve when they are treated with positive airway pressure.
Sleep apnea occurs when breathing passages become obstructed during sleep, often when soft
tissues around the larynx and throat collapse inward. Breathing can be interrupted temporarily but
frequently, often accompanied by snoring. A proven treatment is a face or nose mask connected to
a machine that delivers continuous pressurized air to keep the airways open during sleep.
Dr. Molly E. Zimmerman at Albert Einstein College of Medicine in Bronx, New York, and her
associates screened 179 people diagnosed with sleep apnea, and identified 58 with measurable
memory impairments.
All 58 subjects were prescribed treatment with a positive airway pressure (PAP) device, with an
internal microprocessor to monitor compliance. The results are reported in the December issue of
the medical journal Chest.
After 3 months of treatment, the investigators classified subjects according to treatment adherence:
14 used positive airway pressure on average of less than 2 hours per night (poor users); 25 who
used PAP 2 to 6 hours per night (moderate users); and 19 who used the device more than 6 hours
per night (optimal users).
Zimmerman’s team found that 21 percent of poor users, 44 percent of moderate users, and 68
percent of optimal users achieved normal memory performance after 3 months.
“The information obtained from these results could be used as a potential motivator for sleep
apnea patients struggling with poor positive airway pressure adherence,” the investigators suggest.
SOURCE: Chest, December, 2006.

Friday, April 20, 2007
NEW YORK (Reuters Health) - The more alcoholic drinks that men have at any time of day -- not
just before bedtime -- the greater are the risks of breathing problems during sleep, a new study
shows. However, this effect was not seen among women.
Sleep-disordered breathing has been associated with high blood pressure and blood vessel
disease, and many studies have found that drinking alcohol before going to sleep increases the
likelihood of abnormally shallow breathing or even episodes in which breathing stops, Dr. Paul E.
Peppard and colleagues from the University of Wisconsin-Madison report.
However, whether or not light-to-moderate drinking, at any time of the day, affects breathing during
sleep has not been clear, they report in the Journal of Clinical Sleep Medicine.
To investigate, the researchers looked at 775 men and 645 women participating in a sleep study.
Two hundred eighty-one men (36 percent) and 332 women (51 percent) did not drink. The majority
of the rest (42 percent of men and 41 percent of women) reported, on average, having less than
one drink per day.
The subjects consumed two or fewer drinks in the afternoon of the days that the evaluation was
done. All of the subjects had been reporting their drinking habits for five years before their
breathing was evaluated, and
After the researchers accounted for the effects of body size, smoking and medications that can
cause breathing problems, they found that for every additional drink a man habitually took per day,
his risk of sleep-disordered breathing increased by 25 percent.
No such relationship was seen among women, which could have been because only 10 percent of
the women reported having an average of more than one drink per day, the researchers note.
There is also evidence that women may be less vulnerable to the effects of alcohol on breathing.
Men who were moderate drinkers were more likely to have five or more episodes of interrupted
breathing per hour during sleep than men who didn't drink at all.
This level of sleep-disordered breathing is seen in one of every four men in the United States, the
researchers note, and "this 'mild' degree of sleep-disordered breathing is associated with
cardiovascular and behavioral outcomes."
The investigators conclude that "men with sleep-disordered breathing and those at risk for
sleep-disordered breathing (are) advised to minimize alcohol consumption regardless of proximity
to bedtime."
SOURCE: Journal of Clinical Sleep Medicine, April 15, 2007.

The breathing disorder often goes undetected, study finds.

MONDAY, March 12 2007
(HealthDay News) -- Two out of three people given pacemakers for heart problems were found to
have sleep apnea, which could worsen their cardiac disease, French researchers report.
"There have been previous studies that showed a lower prevalence [of sleep apnea] but the
sensitivity of the methods used in those studies was insufficient to detect all cases," said lead
researcher Dr. Patrick Levy, a professor of physiology at Grenoble University.
In fact, 21 of the 98 pacemaker users who were tested in the study were found to have severe
sleep apnea, meaning their breathing was interrupted at least 30 times each hour. That percentage
equals that seen in the general population, the researchers said. Their report appears in the March
13 issue of Circulation.
But another 36 of the study participants had more subtle forms of sleep apnea. These conditions
were only detected by laboratory monitoring that used polysomnography, a device that records
breathing and sleep.
"This is an important clinical finding," Levy said. "They were not as symptomatic as the usual sleep
apnea patients. In usual sleep apnea, we are looking for snoring and sleepiness. Most of these
patients were not presenting with sleepiness."
In the trial, sleep apnea was defined as abnormally slowed breathing occurring 10 times or more an
hour.
A number of studies have linked sleep apnea with a higher risk of cardiovascular conditions such
as heart attacks and stroke. For example, one study found that sleep apnea doubled stroke risk.
The new findings didn't surprise one U.S. expert.
"This study basically makes the point that patients who have electrical disease of the heart have a
high incidence of sleep apnea," said Dr. Kenneth Ellenbogen, director of the electrophysiology and
pacing laboratory at Virginia Commonwealth University and a spokesman for the American Heart
Association.
"You shouldn't think that once you put the pacemaker in, you're done," he said. "There are a whole
series of things we should be thinking about."
Specifically, doctors should be thinking about testing people who get pacemakers for sleep apnea,
Ellenbogen said.
But Levy said his team is "not advocating testing every single pacemaker patient. That is not
realistic. We need some simplified way of diagnosis, and the challenge is to provide the medical
community with such a tool."
The study could not determine whether sleep apnea was present before the pacemakers were put
in or whether it developed afterward, Levy said.
It is possible that treating sleep apnea by such measures as weight loss, cessation of smoking and
a technique called continuous positive air pressure (CPAP) could help restore normal heart rhythm
for some people, he said. "If you successfully treat the sleep apnea, some patients may not need
the pacemaker," he said.
But more studies are needed to determine the best treatment strategy for people who need
pacemakers and have sleep apnea, Levy added.