CleveMed Blogs

We spend a third of our lives asleep –that can be a long time of fitful rest for someone who experiences sleep problems. Disruptions in this state of rest can lead to a decline in one’s overall quality of life. Most patients with sleep problems first seek medical help from their primary care physician.

Sleep in the Primary Care Setting:

Poor quality of sleep tends to accompany common illnesses, and life stressors (including family and social structure changes); thus, patients tend to visit their primary care physician who has a complete knowledge of the factors that are related with their sleep problems. Obstructive Sleep Apnea occurs at a high frequency in the primary care practice setting. An estimated 18 million Americans suffer from OSA; yet, despite the volume of sleep complaints to the primary care physicians, they often go unaddressed.

Common OSA facts and its associated health risks

• OSA is more common in men, and those over the age of 40.
• Snoring (Sleep Disordered Breathing) can be a sign of sleep apnea.
• Adult OSA has a long-standing and unambiguous correlation with obesity and daytime sleepiness. The National Sleep Foundation Sleep in America poll found that 77% of obese adults report having sleep problems. ¹ Sleep specialists say that weight gain, especially in the trunk and neck area, increases the risk of sleep-disordered breathing due to compromised respiratory function.¹ Research shows that sleep problems, like sleep apnea, also result in weight gain which can lead to additional health problems.¹
• Epidemiologic studies have linked sleep apnea with potential, long-term cardiovascular risk.
• Other studies have noted the consistent and strong association between OSA and hypertension.

Diagnosis and Management of OSA

Patients normally go to a sleep lab for OSA diagnosis & evaluation. Often, this causes the primary care physician to loose direct view of his/her patient’s sleep condition. An alternative to sending patients to a sleep lab test is to begin the diagnosis and management process within the primary care setting, by utilizing newer technology that makes sleep diagnosis portable and more readily accessible. Today, diagnosis and therapy of OSA should be considered as part of the health plan to manage diabetes, hypertension, and congestive heart failure — which are all core aspects of primary care medicine.

In conclusion, with training in sleep and an understanding of appropriate testing procedures, primary care physicians can use current evidence based information in the field to provide high-quality sleep medicine in the primary care setting.

This week the CleveMed Sleep Disorders Division traveled to Orlando, FL to attend the American Cardiologist Convention. If you wondered what brings a sleep division to a cardiology conference, this article presents educational tools just for you. For an interactive presentation to learn about sleep apnea and the cardiovascular system go to: www.clevemed.com/cardiology. Request a free information package at SaveAHeart@CleveMed.com

Screenshot of CleveMed's educational interactive presentation about Sleep Apnea and Cardiology. Save a heart, Identify Symptoms of Sleep Apnea

Sleep apnea is a serious chronic disorder affecting more than 15 million Americans. Patients with sleep apnea stop breathing numerous times during the night, which fragments their sleep and stresses the cardiopulmonary system during what is supposed to be a restful and regenerative period. The result is worsening of many heart and lung diseases that often coexist with sleep apnea. Sleep apnea has many forms, like Obstructive (OSA), Central (CSA), and Complex (CompSA). OSA is the only form with an effective treatment - forcing air into the patient’s upper airways via a mask to keep the pharynx open (Continuous Positive Airway Pressure – CPAP). Central or Complex apnea events often coexist with OSA. CSA and CompSA, are strongly linked to serious heart and lung diseases.

Here are just a few interesting numbers:

• 71% of all patients diagnosed with cardiovascular disease have sleep apnea³
• OSA patients have diminished heart rate variability and increased BP variability¹
• Treatment of coexisting OSA by CPAP can eliminate recurrent hypoxia and reduce nocturnal BP and heart rate¹
• OSA treated by CPAP resulted in a 58% reduction in the frequency of ventricular premature complexes during sleep¹

CleveMed’s educational interactive presentation at www.clevemed.com/cardiology:

• Find more stats & facts from documented studies on sleep apnea and the cardiovascular system
• Engage in the events of a case study and meet the physician who treated the case
• View a video on sleep disorders diagnostic devices
• Request a free information package on sleep apnea and the cardiovascular system by emailing SaveAHeart@CleveMed.com

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 Scientific 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.

This post also draws on the experience of several experts at CleveMed.

Sleep disordered breathing includes a group of disorders, such as obstructive and central sleep apnea, that are characterized by repeated arousals from sleep as a result of a cessation in breathing, causing highly fragmented and poor quality sleep. Many studies point to a strong link between sleep disordered breathing (SDB) and a number of disorders, particularly cardiovascular disease. Several other studies are finding that adverse surgical outcomes are more frequent in patients with sleep apnea, as both anesthesia and surgery exacerbate airway instability and affect homeostasis in that patient population.

Dr. Nancy Foldvary from Cleveland Clinic Foundation suggests that patients with sleep apnea may be at increased risk for postoperative complications with a greater need for intensive monitoring. Since SDB is a complicating factor in many surgeries, the ability to conveniently conduct a sleep study in those settings can improve the peri-operative management of care, particularly for bariatric and cardiac surgery patients who have high prevalence of obstructive sleep apnea (OSA) (Another potential application for wireless PSG is to diagnose those inpatients with cardiovascular disease who are also suspected of having OSA).

Dr. Nancy Collop with John Hopkins University summarizes that there is an urgent need to improve the diagnosis of sleep disordered breathing in surgical patients in order to avoid complications intraoperatively and postoperatively.

This post draws from the opinions of experts featured in the following news article: CleveMed receives $2.3 million in NIH funding for inpatient diagnosis of sleep disorders in cardiovascular surgery patients