A potentially fatal condition that could cause heart failure while you are asleep (From Durham Times)
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A potentially fatal condition that could cause heart failure while you are asleep
7:40am Friday 29th June 2012 in Features
SLEEPING next to a snorer is a nightly endurance test for thousands of spouses, but the loud snorts and snuffles may be a symptom of something much more sinister.
Those who have Obstructive Sleep Apnoea (OSA) are not usually the ones to notice it.
It is their partners who tolerate persistent snoring and the irregular breathing emanating from their loved ones that first raise the alarm.
The patient may be aware of the disease if they experience excessive tiredness or chronic fatigue, at which point they are urged to turn to people like Dr Mohammad Fayaz for help.
Dr Fayaz has been a Consultant Respiratory Physiologist at University Hospital of North Durham for four years, in which time he has seen hundreds of patients be diagnosed with, and fully treated for, OSA.
It is only in recent years that awareness about the condition has grown.
According to studies in the 1970s and 80s, about four per cent of people had the condition.
Today Dr Fayaz believes up to 20 per cent of people could have it, a sharp rise due in no small part to the increase in obesity.
It is most common in people aged between 30 and 65, and is found in more men than women.
The problem is caused by the muscles at the back of the throat, that keep the airway open, collapsing meaning the airway closes and the person stops breathing.
This results in less oxygen getting into the blood stream triggering a message to the brain waking the person up, at which point they start breathing normally again. Dr Fayaz said it can happen hundreds of times during the night and the result is a feeling of excessive tiredness and fatigue as the sleep cycle is permanently disrupted.
The temporary loss of breath also triggers the release of a catecholamine hormone, also known as the fight or flight response, which increases the blood pressure and heart rate in preparation for a perceived battle or need for escape.
These hormones, such as adrenaline, put a great strain on the system and in rare cases, can cause the heart to fail, meaning death during the night.
But Dr Fayaz said that is an extreme response, although the regular nature of OSA means sufferers are much more at risk of developing heart conditions or stroke disease.
He said: ‘‘So it is a very serious condition and can severely impact someone’s quality of life, but it is cheap and easy to treat and I have heard many people say ‘why did I not get this seen to sooner’.’’ Dr Fayaz moved to allay fears that diagnosis would mean nights in a hospital being watched while you sleep. He said: ‘‘In the most severe cases patients are admitted, but our outpatients system works in the vast majority of cases and involves small monitors, which track heart rates, oxygen levels and blood pressure, being worn during the night in the comfort of people’s own homes.’’ THERE are three levels of the condition, mild, moderate and severe, which can be treated either through lifestyle modification (people lose weight, reduce their body mass index and become fitter), medically (through the use of a Continuous Positive Airway Pressure (Cpap) mask) or surgery.
The latter option is rarer and is usually used if there is a physiological anomaly that is causing the condition, such as an oversized tongue, small chin or swollen tonsils and adenoids.
Dr Fayaz said some people who developed the condition due to their obesity have effectively cured themselves of it by losing weight and becoming fitter.
And while smoking and regularly drinking excessive amounts of alcohol do not cause the condition, they can make it inexorably worse.
But even for those who will never be cured, treatment can ensure a much happier and fulfilling lifestyle, the Dr said.
He said: ‘‘Like diabetes for example, people may have it for the rest of the lives but if its diagnosed and controlled then people’s quality of life can be significantly improved.’’ About 20 per cent of serious car accidents are caused by driver tiredness, and of those many could be caused by driver’s suffering from OSA.
But Dr Fayaz said the loss of concentration and risk of dozing off during the day because of OSA is all but wiped out by the condition being treated.
One method of treatment (such as in Mr Cheesmond’s case) is the use of a Cpap mask, worn for between four and six hours every night which blows air through the airways keeping them open and clear during the night.
MR Fayaz said: ‘‘Most people are fine with the mask and become accustomed to it, others who may have claustrophobia do not like to use it so we have to look at other methods.
‘‘But it is like getting a pair of glasses, at first you do not like them because they are new, but you soon become accustomed and start to wonder how you managed so long without it.’’ Getting the condition treated will mean a more useful and restful night’s sleep – as well as far fewer whacks on the arm from your snore-frazzled spouse.