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Ask Dr. K: Preventing sleep apnea will also help your heart



DEAR DOCTOR K: At my last checkup, my doctor asked if I snore. When I told the doctor that my husband says I snore a lot, the doctor said snoring can be a sign of heart disease, particularly in postmenopausal women. What does snoring have to do with heart disease?

DEAR READER: Snoring is not a sign of heart disease, but it can be a sign of sleep apnea. And people with sleep apnea are at greater risk for heart disease.

Sleep apnea is a condition that causes brief, repeated pauses in breathing throughout the night. A woman’s risk of sleep apnea rises after menopause. That’s when levels of the hormone progesterone (which increases the number of breaths per minute) decline. In addition to affecting your slumber, sleep apnea can threaten your heart health.

My colleague Dr. Lawrence Epstein is associate medical director for the Sleep Clinic at Harvard-affiliated Brigham and Women’s Hospital. He explains that sleep apnea is a risk factor for high blood pressure, which raises the risk of both heart attacks and strokes. Sleep apnea also is more common in people who are obese. And obesity is itself a risk factor for heart disease.

So that’s why your doctor asked about snoring. If you have sleep apnea, you may be at higher risk for heart disease.

Snoring is just one sign of sleep apnea. Other signs include daytime drowsiness, morning headaches or mood changes.

If your doctor suspects sleep apnea, he or she may refer you for a sleep study. This test can confirm or rule it out.

The gold standard treatment for sleep apnea is continuous positive airway pressure (CPAP). CPAP blows air into the airways to keep them open at night. It is nearly 100 percent effective at treating sleep apnea, and it improves blood pressure in people with sleep apnea who have heart disease.

But here’s the catch with CPAP: You have to use it. Some people find CPAP uncomfortable at night and don’t use it as prescribed.

There are other options. For example, an oral appliance, which looks like a mouth guard or retainer, can help prevent your tongue from falling back and blocking the airway while you sleep. For many people who find CPAP uncomfortable, this is a pretty good option.

If you do have sleep apnea, try some lifestyle changes. They may reduce your apnea episodes enough to avoid the need for treatment.

— TURN OVER. In some people, apnea occurs only when they’re on their back. If that’s true for you, buy a body pillow to keep you on your side.

— AVOID ALCOHOL. Alcohol is a muscle relaxant. It can slacken the tissues of your throat while you sleep.

— STOP SMOKING. Cigarette smoking causes the upper airway to swell.

— LOSE WEIGHT. One of the best ways to prevent — or eliminate — sleep apnea is to shed extra pounds.

These changes not only can improve your sleep apnea, they also may reduce your risk of heart trouble and strokes.

Dr. Komaroff is a physician and professor at Harvard Medical School. To send questions, go to AskDoctorK.com, or write: Ask Doctor K, 10 Shattuck St., Second Floor, Boston, MA 02115.



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