Who Needs AcuSleep?
. Sleeper with Snorer
. Medical Problems
AcuSleep Testing in Persons with Medical Problems
ADHD (attention deficit/hyperactivity disorder)
Inattention and hyperactivity are generally accepted as
important consequences of sleep-disordered
Some sleep experts
have made strong recommendations, such as:
"An assessment of sleep patterns and
possible sleep problems should be part of
the evaluation of every child presenting
with behavioral and/or academic problems,
especially Attention Deficit/Hyperactivity Disorder
We more fully discuss the relationship between sleep breathing and childhood ADHD
on another page.
Less is known about the relationship between sleep breathing and adult ADHD,
but it would not be surprising if sleep played a role there as well.
See Coronary artery disease.
85% of asthma patients complain about being awakened from time to time by their
There is a clear and common tendency for asthma attacks to be more frequent at
This raises the question, is it asthma or is it a sleep breathing disorder?
Recently, sleep studies were performed on 22 patients with severe, difficult to control
Surprisingly, 21 of them (95%) turned out to have obstructive sleep apnea. And it wasn't
mild sleep apnea -- the average number of apneas and near-apneas was 17.5/hour.
There is suggestive, but not conclusive, evidence that obstructive sleep apnea (OSA)
influences atrial fibrillation. A recent
of OSA's role in cardiovascular disease noted:
Persons with atrial fibrillation are far more likely to have symptoms of OSA than
are persons without
Finally, in men, the larger the neck, the more likely atrial fibrillation is to
(Neck size is a classic risk factor for OSA as well.)
- In patients with heart failure, atrial fibrillation is more common in those with OSA than in those without OSA.
- After coronary artery surgery, atrial fibrillation is more common in those with OSA than in those without OSA.
- After electric-shock treatment for atrial fibrillation, atrial fibrillation is more likely to recur in those with OSA than in those without OSA.
See Coronary artery disease and Stroke.
Chronic fatigue syndrome
According to the International Chronic Fatigue Syndrome Study
"Diagnosis of the chronic fatigue syndrome can be made only after alternative medical and
psychiatric causes of chronic fatiguing illness have been
The CFS Study Group lists sleep apnea as a condition that explains chronic
"Sleep deprivation or experimental disruption of sleep is known to produce many of the features of CFS, including fatigue, impaired cognition, and even joint pain and
The reported prevalence of undiagnosed primary sleep disorders (sleep apnea, narcolepsy, and
restless leg syndrome/periodic limb movements in sleep) varies from 0% to 50% of CFS
As in fibromyalgia, the distinction between sleep apnea and a lesser difficulty
of sleep breathing called "upper airway resistance syndrome," may be important.
Congestive heart failure
Between 10% and 40% of persons with congestive heart failure have
obstructive sleep apnea (OSA).
OSA is unquestionably bad for people with congestive heart failure.
The deep breaths repeatedly attempted by a person with OSA puts an extra
strain on the heart. The release of stress hormones during every
apnea and near-apnea also puts an extra strain on the heart.
found that treatment of OSA, if it exists in a person
with congestive heart failure, improves the efficiency of the heart.
A relationship between congestive heart failure and central sleep apnea has been known
since 1818, lately under the name "Cheyne-Stokes
Coronary artery disease
Obstructive sleep apnea (OSA) is an established cause of nighttime chest pains
in persons with coronary artery disease (CAD).
In persons with CAD, untreated OSA is associated with a higher rate of
death from cardiovascular
causes, compared to persons with CAD and no
A recent review concluded that this
"argues for the recognition and treatment of any sleep apnea in these patients"
(i.e. patients with coronary artery
Does OSA make it more likely that coronary artery disease will develop?
Viewed alone, OSA is associated with a greatly increased risk of
having CAD. How much risk OSA adds to
blood pressure and
is unknown, because those factors are themselves
affected by OSA.
Poor sensitivity to the hormone insulin is the root problem in many persons with diabetes,
particularly obese persons.
Weight loss generally improves insulin sensitivity.
Now, however, there is increasing evidence that treating sleep apnea can improve the body's
insulin, independent of any change in
Because diabetes and sleep apnea often occur together,
this discovery has major implications. It suggests
"the presence of a potentially treatable risk factor for cardiovascular disease in the diabetic
A recent review
of obstructive sleep apnea in epilepsy concluded:
Obstructive sleep apnea can affect an individual with epilepsy profoundly.
These relatively common disorders can coexist and potentially exacerbate each other.
The identification and appropriate treatment of OSA may have far-reaching consequences
in improving a patient's quality of life and recurrence of seizures.
also noted that a reduction in seizures has been seen in both adults and children
with epilepsy who have had their OSA treated.
found that 27 of 28 women with fibromyalgia had
limitations on airflow during sleep breathing.
Only one of these women had obstructive sleep apnea.
The others had a related condition called
upper airway resistance
Eighteen of the 28
women snored at least occasionally.
Gastro-esopheageal reflux (also known as "GERD")
Gastro-esopheageal reflux (GERD) is commonly found in persons who snore or have obstructive sleep apnea (OSA).
A recent study found that 73% of such persons had symptoms of GERD,
with no significant difference between persons with OSA and those with
Treating OSA has been shown to reduce the severity of GERD
See Gastro-esopheageal reflux.
Before a heart attack, coronary artery disease is the major concern.
After a heart attack, congestive heart failure is the major concern.
See Congestive heart failure.
High blood pressure
Hypertension (also known as "high blood pressure")
It is widely agreed that sleep apnea causes at least some cases of
This discovery has been called
In 2003, the foremost panel of hypertension experts in the United States did two remarkable things:
These experts did not dictate how the evaluation should be performed because this is not presently known.
A few studies have shown that treatment of OSA can lower blood pressure,
particularly when OSA is more
Ultimately, you and your doctor (and perhaps your insurance company) will decide how a sleep apnea evaluation will be done.
Information about your snoring can influence this decision.
- They put sleep apnea at the top of the list of identifiable causes of hypertension, and
- They specified that
the evaluation of all persons with hypertension should consider the possibility of sleep
A person with classic sleep apnea is sleepy during the day and falls asleep very quickly upon going to bed.
But not every person with sleep apnea has a classic case. A recent study showed that half of sleep apnea patients
have significant insomnia
The American Academy of Sleep Medicine recommends testing for a sleep-breathing disorder
when treatment of insomnia
Multiple studies show that snoring is associated with a higher risk of
Four studies have found that 60% to 80% of stroke survivors have sleep
No doubt some strokes specifically affect the muscles keeping the
airway open during sleep breathing.
One would expect a very high percentage of survivors of such strokes
to have obstructive sleep apnea (OSA).
Thus, snoring that newly appears after a stroke is of particular concern,
as it may signal the appearance of OSA.
The cause of some strokes is unknown (these are "cryptogenic strokes").
Occult right-to-left shunting is sometimes posited in such cases.
Of note, apneic episodes in OSA can provoke right-to-left shunting through a
foramen ovale that does not normally permit
One authority summarizes: "Regardless of whether OSA precedes or follows a
stroke, it is associated with unfavorable clinical outcomes after stroke,
including early neurologic worsening, delirium, depressed mood, poor
functional status, and impaired
References and Notes