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Fri, Dec. 13

Treating sleep apnea helps control diabetes, hypertension

Dear Dr. Rosenberg,

I have high blood pressure and diabetes. My wife says I snore like a freight train. She told my doctor and he insists that I get a sleep study. Why?

A: The incidence of sleep apnea is very high in diabetes and hypertension. In fact, the American Academy of Sleep Medicine just came out with a recommendation that patients with either of these disorders get tested for sleep apnea. The good news is that if you have sleep apnea, diabetes and hypertension are much easier to control.

Dear Dr. Rosenberg,

I have had two stents placed in my coronary arteries for blockages. During a recent hospitalization, it was noted by nursing personnel that my oxygen levels dropped while asleep. As a result, my cardiologist wants me to get a sleep study. I have no symptoms of sleep apnea such as sleepiness or fatigue and I feel that my sleep is fine. What is the point?

A: The point is that many people without symptoms can have problems that lead to heart attacks and strokes. In a study published this month in the journal Chest, patients with sleep apnea and no symptoms were studied. Those patients showed significant problems with how their blood vessels responded to stresses such as low oxygen. The impaired ability to dilate and produce increased blood flow to organs such as the heart is called endothelial dysfunction. After six months of treatment of sleep apnea there was a marked improvement. Mind you, these patients were selected for the study because, like you, they had no symptoms of sleep apnea. I would listen to my cardiologist and if you have sleep apnea, send the nurses a thank you note. They may have prevented you from having more blockages.

Dear Dr. Rosenberg,

I have heard that sleep apnea can cause cardiac-related death in those who do not treat it. My husband has severe sleep apnea and refuses to treat it. Am I wrong about the cardiac-related death?

A: No, you are not. In fact, a recent study in the Journal of the American College of Cardiology pointed this out. They followed over 10,000 patients for five years. They found a very high incidence of sudden cardiac deaths in the group with untreated sleep apnea. Most of these deaths occurred between midnight and 6 a.m., a time when it is unusual for this to happen in those without sleep apnea. In that time, 142 patients experienced sudden cardiac death, with the most common predictors being a patient aged 60 years, having 20 apnea episodes per hour, and having a lowest oxygen saturation level of below 78 percent.

Dear Dr. Rosenberg,

I have sleep apnea and I can't wear the CPAP mask. I'm claustrophobic and whenever I try to wear it I get a panic attack. I'm considering one of those oral appliances. Can you tell me who is a good candidate for one of those?

A: Yes. First, if you have few or no teeth you are not a good candidate. The appliances seem to work best in patients with mild to moderate sleep apnea, and in patients whose sleep apnea occurs predominantly when lying on their back. Finally, they seem to be more effective in those who are not terribly overweight.

Dr. Robert Rosenberg, board-certified sleep medicine specialist, will answer readers' questions by incorporating them in future columns. Contact him through the form at or via mail at the Sleep Disorders Center of Prescott Valley, 3259 N. Windsong Drive, Prescott Valley, AZ 86314.

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