Sleep Apnea, Overall Wellness and Heart Health - How Are They All Related
Sleep apnea is a common disorder but many people go undiagnosed. Dr. Vidya Pai and Dr. John Osborne discuss sleep apnea and how it relates to heart health.
Featuring:
Dr. Pai is a board-certified, Harvard-trained sleep doctor and Head of Sleep Medicine at the Low T Center. She completed her internship at Drexel University and her residency at Michigan State University. She then completed a fellowship in Sleep Medicine at the prestigious Harvard University in Boston, MA. She is board-certified in sleep medicine and a member of the American Academy of Sleep Medicine. She has a special interest in diagnosing and treating complex sleep disorders and truly understands how sleep apnea, narcolepsy, restless legs and parasomnias disrupt lives of patients and their families. Prior to working at Low T Center as the National Sleep Director, Dr. Pai was the Sleep Medicine Director at Providence Health Center, RI and at North Texas Medical Center, TX.
John Osborne, MD | Vidya Pai, MD
Dr. Osborne obtained his Bachelor of Science with Honors from Penn State University, his M.D., magna cum laude, from Jefferson Medical College and his Ph.D. in cardiovascular physiology from Thomas Jefferson University. After graduation, he continued his post-doctoral work at Harvard Medical School and Brigham and Women's Hospital in Boston, Massachusetts, where he completed his internship, residency, and research residency in Internal Medicine and a Fellowship in Cardiovascular Disease. While at Harvard, Dr. Osborne published many articles on atheriosclerosis, vascular biology, and molecular genetics. His clinical training focused on non-invasive techniques, and he is the only physician board certified in Cardiology and Internal Medicine, Lipidology, Clinical Hypertension, Cardiac CT Angiography, Echocardiography and Nuclear Cardiology. His clinical interests include preventive cardiology, metabolic syndrome, hypertension, congestive heart failure, cholesterol disorders, and cardiovascular genetics. He was recently named as one of only ten Fellow's of the National Lipid Association in 2019 and is currently pursuing his MSc in Cardiovascular Management, Outcomes, and Economics at the London School of Economics and Policy.Dr. Pai is a board-certified, Harvard-trained sleep doctor and Head of Sleep Medicine at the Low T Center. She completed her internship at Drexel University and her residency at Michigan State University. She then completed a fellowship in Sleep Medicine at the prestigious Harvard University in Boston, MA. She is board-certified in sleep medicine and a member of the American Academy of Sleep Medicine. She has a special interest in diagnosing and treating complex sleep disorders and truly understands how sleep apnea, narcolepsy, restless legs and parasomnias disrupt lives of patients and their families. Prior to working at Low T Center as the National Sleep Director, Dr. Pai was the Sleep Medicine Director at Providence Health Center, RI and at North Texas Medical Center, TX.
Transcription:
Scott Webb: I used to find it funny when my grandpa would wake himself up from snoring, but the truth is he probably had sleep apnea and it really is no laughing matter. My guest today are Dr. Vidya Pai, a board-certified, Harvard-trained sleep doctor and Head of Sleep Medicine for the Low T Center and Dr. John Osborne, a podcasting veteran and Head of Cardiology for the Low T Center. This is Age is Just a Number by the Low T Center. I'm Scott Webb. Doctors, thanks for joining me today, Dr. Pai, what is sleep apnea and why is it so important that people are diagnosed and treated for it?
Dr. Pai: Obstructive sleep apnea is a fairly common sleep disorder. It's been estimated that approximately like 20 million adults in the US suffer from the disorder. And while sleep apnea is so common, most people actually goes undiagnosed. In fact, it's estimated that almost 80% of patients with sleep apnea don't even get diagnosed. Sleep apnea is a potentially serious sleep disorder where patients experience short periods of time during the night where they stop breathing. Now, these episodes could last anywhere from a couple of seconds to more than a minute. And patients with sleep apnea often feel tired. They nod off in the daytime and even after a full night of sleep they wake up unrefreshed, these episodes of periodic breathing that happens over the night and feels not a normal sleep patterns, most patients snore very loudly during the night. And there are two kinds of sleep apnea that patients have. One is the obstructive kind where, when a patient falls asleep at night, the throat muscles actually close up. And that's what causes pauses in breathing. The second kind of sleep apnea, which is called central sleep apnea, which occurs in your brain, actually does not send proper signal to control your breathing. And then there are a certain group of patients that have the mixed apnea where they have both obstructive and central apnea.
Host: I'm just kind of processing this. There's two different kinds. People can have one kind or the other or some may have both. And definitely, you know, not something to ignore. And so about snoring, is that a cue for people? Should people immediately become alarmed if they or their partner is snoring a lot? Does that necessarily mean they have sleep apnea?
Dr. Pai: So although chronic snoring is a strong indicator that you might have sleep apnea and you should be evaluated by a health professional if you are a chronic snorer, not everyone who snores has sleep apnea. So snoring is typically caused by a narrowing of your upper airways. So what happens is that when you lay down to relax and fall asleep, the tissues in the back of your throat kind of block your passageway. So air from your breathing rattles these tissues and creates that distinctive noise of snoring, but simple snoring can cause some sleep apnea, because individuals with sleep apnea actually experienced short periods of time at night where they stopped breathing. These periods of stopping to breathe can last for a couple of seconds to even more than a minute, And associated with snoring, patients with sleep apnea have fatigue in the daytime. They wake up in the morning feeling unrefreshed and tired, and also the partner who sleeps with them in bed notices that they stop breathing. They're gasping or snorting at night. So simple snoring differs from sleep apnea. So if you notice that you know, you're snoring and you also have an excessive daytime fatigue, or you're tired, you're unrefreshed. That's when you should alert yourself and probably meet with a healthcare provider to get a sleep study. And although according to the American Sleep Apnea Association, some ninety million Americans snore at night. So if you snore, you're probably in good company. But not everyone who's snores has sleep apnea.
Host: Yeah, I definitely don't have sleep apnea, but I am a serial snorer as my wife can attest to, and she's tried many different ways over the years to prevent me from snoring. And pretty much now she just punches me or kicks me, definitely stops me from snoring. So Dr. Osborne, great to have you back on again. Let's talk about sleep apnea and its relationship to the heart. What are the effects that sleep apnea or undiagnosed or untreated sleep apnea can have on the human heart?
Dr. Osborne: Sleep apnea has a variety of bad effects on the heart. In fact, as an example, it's estimated that about 80% of people with high blood pressure have sleep apnea. So there's a very strong interrelationship between sleep apnea and hypertension. And the other big factor that we've begun to appreciate in the last several years is the relationship between sleep apnea and the most common heart rhythm disorder in the U S and really globally as well, which is atrial fibrillation, which is an irregular rhythm of the heart that increases the risk of stroke as well as mortality. But stroke by about five fold and mortality by about twofold. So these conditions, particularly high blood pressure, hypertension, and atrial fibrillation are both extremely common and very much bidirectionally related to sleep apnea.
Host: That's good to know. So let's just say you mentioned high blood pressure. Let's just say I have high blood pressure. Does that automatically mean Dr. Pai, that I should get a sleep study?
Dr. Pai: So while high blood pressure is a strong indicator that you might also have sleep apnea, there are several indicators to get a sleep study. One would be snoring, fatigue in the daytime, generally just not feeling good and not feeling like yourself. But high blood pressure is one important indicator that needs to be evaluated. So if you do have high blood pressure, it would be a good idea to speak with your healthcare provider to get a sleep study.
Host: Okay, so it may not necessarily mean that you need a sleep study, but speaking to your provider, going to the Low T Center, seeing folks like yourselves would definitely help. Dr. Osborne, does treating sleep apnea provide heart and blood vessel benefits? I think I know the answer to that, but let's go through that a little bit. Like why is it such a great idea for people to be diagnosed and be treated for their sleep apnea?
Dr. Osborne: When we look at atrial fibrillation that we spoke of a moment ago, this irregular heart rhythm that significantly increases the risk of stroke. We know that in patients who have atrial fibrillation and sleep apnea who are treated with C-PAP and divide those patients into two groups, those that are successfully treated, that is usually C-PAP, which is the typical treatment strategy for sleep apnea. When that is used, and successfully used, and we can literally monitor and measure how many hours per night you use it. If you look at people who Institute C-PAP, who have evidence of recurrent atrial fibrillation, those that don't use C-PAP effectively have about an 82% instance of recurrence of atrial fibrillation, which is about half that in those patients who have sleep apnea where it is successfully treated. Just to give you one example of some of the benefits, at least for the heart of treating sleep apnea with appropriate therapies such as C-PAP.
Dr. Pai: Right, because it has been found the treatment of the C-PAP for just 12 weeks, reduced like the 24 anean diastolic and systolic blood pressures in several patients. There've been several studies where treatment of sleep apnea has helped patients go down on the medication or the number of medication they use to treat their high blood pressure. And so treatment of also definitely contributes to reduction in blood pressure and overall improvement in heart health.
Host: We've traveled, you know, as a big family a couple of times, Mexico, Florida and my brother-in-law has sleep apnea and he brings his C-PAP with him. It kind of looks like a Darth Vader a little bit, but it also seems maybe a little scary for people, especially if they have to take it on vacation and lug that thing around. So maybe you could just take people through the reasons why it's not scary, that it will probably save their lives if they're willing to use it and be treated and take it with them, you know, when they go on vacation?
Dr. Pai: Sleep apnea is a potentially life threatening condition. And until patients know that, they usually don't take the sleep apnea very seriously, very soon after using C-PAP, patients notice that they wake up more fresh, they are less groggy during the day, they’re less tired and they start feeling more like themselves. So that's a huge motivating factor for them to use their CPAP. So untreated C-PAP, untreated sleep apnea causes excessive daytime sleepiness, impaired judgment, and slows reaction time. The other factor we need to consider is the patient's bed partner. You know, so it's not just the patient who's losing sleep, it's even the partner because they are kind of tossing and turning, listening to snoring all night. And a lot of times the partner suffers from anxiety, you know, wondering if their partner is going to be okay, like watching them pausing to breathe at night. So, you know, it also creates an anxiety in the partner. So, you know, actually educating patients and telling them about the whole slew of effects on their blood pressure or their heart, every single aspect of their life. So actually educating patients really helps.
Host: Well, and hopefully this podcast has done that, really want to educate people about how important it is that they, that they be diagnosed if they think they might have sleep apnea, that they are treated for it. And then Dr. Osborne give you the final word today. Overall heart health, overall wellness, how is that impacted by treating sleep apnea?
Dr. Osborne: All I can say is the better you sleep, the better your heart health.
Host: Sometimes you're a man of few words. I appreciate that. Anything else we need to tell folks about sleep apnea, about how the Low T Center can help them both diagnose and treat this very treatable thing?
Dr. Pai: At the Low T Center, we know that sleep apnea is , you know, it's scary to think that, oh man, I could be on a C-PAP machine for the rest of my life. So we've made the process pretty simple. They meet with the provider first who actually goes over, you know, their symptoms and signs and educates them on what sleep apnea is all about, after which we provide them with a home sleep test. So they actually have the test in their own bedroom. It's not going to be in a sleep lab where they tend to not fall asleep. So it's in their own bedroom, where they get a home sleep test. After which, if they are diagnosed with sleep apnea, we have a very friendly team who helps the, fits them with the right mask and then is with them all along the way, helping them get successful on their CPAP. We have a very strong program and are very proud of it. So I think anyone who walks into the door feels comfortable that they've been diagnosed with apnea but that we’re there holding their hand along the way.
Dr. Osborne: Tell them about this new home sleep technology that we're just rolling out right now, it's really cutting edge.
Dr. Pai: It's called a WatchPAT device. All it has is a finger probe and you almost wear like a device that looks like a watch. So we actually measure your peripheral arterial tone and so that's how we can sense if you have sleep apnea and the device is remarkably simple and easy to use. So patients love it. So we've just introduced that at the Low T Center last few weeks and have got rave reviews on it. So our patients are loving it and we now are be able to diagnose them much more simpler and all they need to do is put on the watch device and sleep through the night, and we have the results ready for them in the morning.
Host: That is really cool. I was thinking, you know, the old days of having to go someplace for a sleep study for like this and being able to wear this device, wear it in your home, and have the results the next morning. I mean, as always, the Low T Center is on the cutting edge. Call (866) 806-8235 or go to LowTCenter.com for more information, to book an appointment, or to purchase a home sleep test. Thanks for listening to Age is Just a Number by the Low T Center. If you found this podcast helpful, please share it on your social channels and be sure to check out our entire podcast library for topics of interest to you. I'm Scott Webb and we'll talk again soon.
Scott Webb: I used to find it funny when my grandpa would wake himself up from snoring, but the truth is he probably had sleep apnea and it really is no laughing matter. My guest today are Dr. Vidya Pai, a board-certified, Harvard-trained sleep doctor and Head of Sleep Medicine for the Low T Center and Dr. John Osborne, a podcasting veteran and Head of Cardiology for the Low T Center. This is Age is Just a Number by the Low T Center. I'm Scott Webb. Doctors, thanks for joining me today, Dr. Pai, what is sleep apnea and why is it so important that people are diagnosed and treated for it?
Dr. Pai: Obstructive sleep apnea is a fairly common sleep disorder. It's been estimated that approximately like 20 million adults in the US suffer from the disorder. And while sleep apnea is so common, most people actually goes undiagnosed. In fact, it's estimated that almost 80% of patients with sleep apnea don't even get diagnosed. Sleep apnea is a potentially serious sleep disorder where patients experience short periods of time during the night where they stop breathing. Now, these episodes could last anywhere from a couple of seconds to more than a minute. And patients with sleep apnea often feel tired. They nod off in the daytime and even after a full night of sleep they wake up unrefreshed, these episodes of periodic breathing that happens over the night and feels not a normal sleep patterns, most patients snore very loudly during the night. And there are two kinds of sleep apnea that patients have. One is the obstructive kind where, when a patient falls asleep at night, the throat muscles actually close up. And that's what causes pauses in breathing. The second kind of sleep apnea, which is called central sleep apnea, which occurs in your brain, actually does not send proper signal to control your breathing. And then there are a certain group of patients that have the mixed apnea where they have both obstructive and central apnea.
Host: I'm just kind of processing this. There's two different kinds. People can have one kind or the other or some may have both. And definitely, you know, not something to ignore. And so about snoring, is that a cue for people? Should people immediately become alarmed if they or their partner is snoring a lot? Does that necessarily mean they have sleep apnea?
Dr. Pai: So although chronic snoring is a strong indicator that you might have sleep apnea and you should be evaluated by a health professional if you are a chronic snorer, not everyone who snores has sleep apnea. So snoring is typically caused by a narrowing of your upper airways. So what happens is that when you lay down to relax and fall asleep, the tissues in the back of your throat kind of block your passageway. So air from your breathing rattles these tissues and creates that distinctive noise of snoring, but simple snoring can cause some sleep apnea, because individuals with sleep apnea actually experienced short periods of time at night where they stopped breathing. These periods of stopping to breathe can last for a couple of seconds to even more than a minute, And associated with snoring, patients with sleep apnea have fatigue in the daytime. They wake up in the morning feeling unrefreshed and tired, and also the partner who sleeps with them in bed notices that they stop breathing. They're gasping or snorting at night. So simple snoring differs from sleep apnea. So if you notice that you know, you're snoring and you also have an excessive daytime fatigue, or you're tired, you're unrefreshed. That's when you should alert yourself and probably meet with a healthcare provider to get a sleep study. And although according to the American Sleep Apnea Association, some ninety million Americans snore at night. So if you snore, you're probably in good company. But not everyone who's snores has sleep apnea.
Host: Yeah, I definitely don't have sleep apnea, but I am a serial snorer as my wife can attest to, and she's tried many different ways over the years to prevent me from snoring. And pretty much now she just punches me or kicks me, definitely stops me from snoring. So Dr. Osborne, great to have you back on again. Let's talk about sleep apnea and its relationship to the heart. What are the effects that sleep apnea or undiagnosed or untreated sleep apnea can have on the human heart?
Dr. Osborne: Sleep apnea has a variety of bad effects on the heart. In fact, as an example, it's estimated that about 80% of people with high blood pressure have sleep apnea. So there's a very strong interrelationship between sleep apnea and hypertension. And the other big factor that we've begun to appreciate in the last several years is the relationship between sleep apnea and the most common heart rhythm disorder in the U S and really globally as well, which is atrial fibrillation, which is an irregular rhythm of the heart that increases the risk of stroke as well as mortality. But stroke by about five fold and mortality by about twofold. So these conditions, particularly high blood pressure, hypertension, and atrial fibrillation are both extremely common and very much bidirectionally related to sleep apnea.
Host: That's good to know. So let's just say you mentioned high blood pressure. Let's just say I have high blood pressure. Does that automatically mean Dr. Pai, that I should get a sleep study?
Dr. Pai: So while high blood pressure is a strong indicator that you might also have sleep apnea, there are several indicators to get a sleep study. One would be snoring, fatigue in the daytime, generally just not feeling good and not feeling like yourself. But high blood pressure is one important indicator that needs to be evaluated. So if you do have high blood pressure, it would be a good idea to speak with your healthcare provider to get a sleep study.
Host: Okay, so it may not necessarily mean that you need a sleep study, but speaking to your provider, going to the Low T Center, seeing folks like yourselves would definitely help. Dr. Osborne, does treating sleep apnea provide heart and blood vessel benefits? I think I know the answer to that, but let's go through that a little bit. Like why is it such a great idea for people to be diagnosed and be treated for their sleep apnea?
Dr. Osborne: When we look at atrial fibrillation that we spoke of a moment ago, this irregular heart rhythm that significantly increases the risk of stroke. We know that in patients who have atrial fibrillation and sleep apnea who are treated with C-PAP and divide those patients into two groups, those that are successfully treated, that is usually C-PAP, which is the typical treatment strategy for sleep apnea. When that is used, and successfully used, and we can literally monitor and measure how many hours per night you use it. If you look at people who Institute C-PAP, who have evidence of recurrent atrial fibrillation, those that don't use C-PAP effectively have about an 82% instance of recurrence of atrial fibrillation, which is about half that in those patients who have sleep apnea where it is successfully treated. Just to give you one example of some of the benefits, at least for the heart of treating sleep apnea with appropriate therapies such as C-PAP.
Dr. Pai: Right, because it has been found the treatment of the C-PAP for just 12 weeks, reduced like the 24 anean diastolic and systolic blood pressures in several patients. There've been several studies where treatment of sleep apnea has helped patients go down on the medication or the number of medication they use to treat their high blood pressure. And so treatment of also definitely contributes to reduction in blood pressure and overall improvement in heart health.
Host: We've traveled, you know, as a big family a couple of times, Mexico, Florida and my brother-in-law has sleep apnea and he brings his C-PAP with him. It kind of looks like a Darth Vader a little bit, but it also seems maybe a little scary for people, especially if they have to take it on vacation and lug that thing around. So maybe you could just take people through the reasons why it's not scary, that it will probably save their lives if they're willing to use it and be treated and take it with them, you know, when they go on vacation?
Dr. Pai: Sleep apnea is a potentially life threatening condition. And until patients know that, they usually don't take the sleep apnea very seriously, very soon after using C-PAP, patients notice that they wake up more fresh, they are less groggy during the day, they’re less tired and they start feeling more like themselves. So that's a huge motivating factor for them to use their CPAP. So untreated C-PAP, untreated sleep apnea causes excessive daytime sleepiness, impaired judgment, and slows reaction time. The other factor we need to consider is the patient's bed partner. You know, so it's not just the patient who's losing sleep, it's even the partner because they are kind of tossing and turning, listening to snoring all night. And a lot of times the partner suffers from anxiety, you know, wondering if their partner is going to be okay, like watching them pausing to breathe at night. So, you know, it also creates an anxiety in the partner. So, you know, actually educating patients and telling them about the whole slew of effects on their blood pressure or their heart, every single aspect of their life. So actually educating patients really helps.
Host: Well, and hopefully this podcast has done that, really want to educate people about how important it is that they, that they be diagnosed if they think they might have sleep apnea, that they are treated for it. And then Dr. Osborne give you the final word today. Overall heart health, overall wellness, how is that impacted by treating sleep apnea?
Dr. Osborne: All I can say is the better you sleep, the better your heart health.
Host: Sometimes you're a man of few words. I appreciate that. Anything else we need to tell folks about sleep apnea, about how the Low T Center can help them both diagnose and treat this very treatable thing?
Dr. Pai: At the Low T Center, we know that sleep apnea is , you know, it's scary to think that, oh man, I could be on a C-PAP machine for the rest of my life. So we've made the process pretty simple. They meet with the provider first who actually goes over, you know, their symptoms and signs and educates them on what sleep apnea is all about, after which we provide them with a home sleep test. So they actually have the test in their own bedroom. It's not going to be in a sleep lab where they tend to not fall asleep. So it's in their own bedroom, where they get a home sleep test. After which, if they are diagnosed with sleep apnea, we have a very friendly team who helps the, fits them with the right mask and then is with them all along the way, helping them get successful on their CPAP. We have a very strong program and are very proud of it. So I think anyone who walks into the door feels comfortable that they've been diagnosed with apnea but that we’re there holding their hand along the way.
Dr. Osborne: Tell them about this new home sleep technology that we're just rolling out right now, it's really cutting edge.
Dr. Pai: It's called a WatchPAT device. All it has is a finger probe and you almost wear like a device that looks like a watch. So we actually measure your peripheral arterial tone and so that's how we can sense if you have sleep apnea and the device is remarkably simple and easy to use. So patients love it. So we've just introduced that at the Low T Center last few weeks and have got rave reviews on it. So our patients are loving it and we now are be able to diagnose them much more simpler and all they need to do is put on the watch device and sleep through the night, and we have the results ready for them in the morning.
Host: That is really cool. I was thinking, you know, the old days of having to go someplace for a sleep study for like this and being able to wear this device, wear it in your home, and have the results the next morning. I mean, as always, the Low T Center is on the cutting edge. Call (866) 806-8235 or go to LowTCenter.com for more information, to book an appointment, or to purchase a home sleep test. Thanks for listening to Age is Just a Number by the Low T Center. If you found this podcast helpful, please share it on your social channels and be sure to check out our entire podcast library for topics of interest to you. I'm Scott Webb and we'll talk again soon.