Save A Heart . Identify Symptoms of Sleep Apnea

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Facts about Sleep Apnea

• 50% of Obstructive Sleep Apnea (OSA) patients are hypertensive¹
• Estimated 30% of hypertensive patients also have OSA¹
• OSA patients have diminished heart rate variability and increased BP variability¹
• 71% of all patients diagnosed with cardiovascular disease have sleep apnea³
• Nocturnal arrhythmias have been shown to occur in up to 50% of OSA patients¹
• Sleep@CleveMed.com Email us to request a free info packet created for Cardiologists. (Please include your name and valid postal mailing address)
• View video about CleveMed Division of Sleep Disorders

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Case Report

by Joseph Golish, MD

Patient Information

Gender: Male
Age: 55
Height: 5'10"
Weight: 309 lbs

Disruptive Snoring, Sleepiness

Disruptive snoring witnessed apnea marked sleepiness. He underwent a polysomnogram.

Polysomnogram

Doctor's Diagnosis:

Severe Obstructive Sleep Apnea (OSA) controlled on 7 cm of CPAP

Treatment & Results:

He used the device faithfully and embarked upon a weight reduction diet and exercise program. His weight decreased to 176 pounds, and he abandoned his CPAP therapy since he felt he no longer needed it.

Exertional chest pressure

However, his weight gradually increased to 236 pounds, and he was noted to have high blood pressure (HPT), diabetes, and hypercholesterolemia, requiring a number of medications, including injectable insulin. He also experienced exertional chest pressure.

Urgent coronary arteriogram

Doctor's Diagnosis:

An urgent coronary arteriogram demonstrated severe coronary disease, but without evidence of myocardial dysfunction.

Coronary artery bypass graft

He underwent and recovered uneventfully from his coronary artery bypass graft

Post-discharge patient review

After discharge, because of postoperative nocturnal desaturations and his various comorbidities, his physician recommended evaluation for OSA.

Home Sleep Test

Doctor's Diagnosis:

The patient refused an in-lab study, having had "enough of hospitals," but did consent to a home test. He underwent a type III monitoring home sleep test with SleepScout (CleveMed)

Night 1

Monitoring results showed severe OSA with marked desaturation into the 70% range and apnea-related, multiple premature ventricular contractions (PVCs).

Night 2

On the second night, he was monitored in his home utilizing Auto-PAP set in the automatic mode at a range of 5 cm to 15 cm, in tandem with the same SleepScout monitor. Downloaded data from the Auto-PAP recommended a pressure of 7 cm. However, the portable monitor indicated that although his overt apneas had been corrected, there were still five hypopneas per hour with desaturations to 80% along with PVCs.

Night 3

The patient was put on a fixed CPAP pressure and studied again using SleepScout. The pressure was increased to 10 cm in an attempt to resolve the hypopneas, desaturations and PVC events. This third night study demonstrated complete control of his hypopneas, desaturation, and arrhythmias.

Results: Stabilization of heart rate variability and correction of desaturation and ventricular arrhythmias

Joseph Golish, MD, is a board-certified specialist in sleep medicine and author of more than 300 publications on sleep. He is a member of the Sleep Steering Committee for the ACCP. After 35 years as a professor at Cleveland Clinic and head of sleep medicine, he has left academic medicine to advance a new paradigm in sleep medicine, focusing on accessibility and affordability. His goals are the proper use of HST and fostering continuity of care, in an efficient and cost-effective manner, while preserving high quality. He is currently the Medical Director of Cleveland Medical Devices (CleveMed) and the Director of Sleep Center, North Coast Clinical Trials, in Cleveland, Ohio.
Adapted from Portable Monitoring Pathways by Joseph Golish, MD.

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Citations

1. V. K. Somers, D. P. White, R. Amin, W. T. Abraham, F. Costa, A. Culebras, S. Daniels, J. S. Floras, C. E. Hunt, L. J. Olson, et al.Sleep Apnea and Cardiovascular Disease: An American Heart Association/ American College of Cardiology Foundation Scientifi c Statement From the American Heart Association Council for High Blood Pressure Research Professional Education Committee, Council on Clinical Cardiology, Stroke Council, and Council on Cardiovascular Nursing In Collaboration With the National Heart, Lung, and Blood Institute National Center on Sleep Disorders Research (National Institutes of Health) Circulation, September 2, 2008; 118(10): 1080 - 1111.

2. Bradley TD, Floras JS. Sleep apnea and heart failure. Part I: obstructive sleep apnea. Circulation (2003) 107:1671–1678.

3. Floras JS, “Sleep Apnea in Heart Failure: Implications of Sympathetic Nervous System Activation for Disease Progression and Treatment.” Current Heart Fail Reports 2005;2(4) :212-217