Monthly Archives: February 2012

Even Sleep Apnea Patients Who Don’t Feel Drowsy in Daytime Are at Risk for Heart Disease – By Caroline Wilbert, WebMD Health News

Sleep apnea — even if it is so mild that people have no daytime drowsiness — may increase the risk of cardiovascular disease, a study shows.

The study, published in the American Journal of Respiratory and Critical Care Medicine, compared patients with mild sleep apnea to a comparison group that didn’t have sleep apnea. There were 64 participants with mild sleep apnea and 15 participants without sleep apnea.

To compare the risk for heart disease, researchers tested endothelial function, which is how well the cells in the lining of the blood vessels work, and artery stiffness. Endothelial dysfunction and arterial stiffness are involved in developing atherosclerosis, or hardening of the arteries. Moderate to severe sleep apnea has already been linked to increased artery stiffness, endothelial dysfunction, and high blood pressure.

Malcolm Kohler, MD, from the Oxford Centre for Respiratory Medicine in England, and colleagues found that patients with mild sleep apnea had worse endothelial function and greater arterial stiffness than the comparison group without sleep apnea.

Researchers also tested blood pressure, another way to gauge cardiovascular disease risk. The groups tested similarly on blood pressure.

The researchers write that “although this was not associated with significantly increased blood pressure, the findings of this study suggest that patients with minimally symptomatic OSA [obstructive sleep apnea] are at increased cardiovascular risk, as has been demonstrated in more severe disease.”

“It was previously known that people with OSA (obstructive sleep apnea) severe enough to affect their daytime alertness and manifest in other ways are at increased risk of cardiovascular disease, but this finding suggests that many more people — some of whom may be completely unaware that they even have OSA — are at risk than previously thought,” Kohler says in a news release.

In an accompanying editorial, Geraldo Lorenzi-Filho MD, PhD, points out that just one in five patients with sleep apnea complains of drowsiness during the day. “It is now recognized that OSA triggers a cascade of biological reactions, including increased sympathetic activity, systemic inflammation, oxidative stress, and metabolic alterations that are potentially harmful to the cardiovascular system,” he writes in the editorial.

Kohler and colleagues are now investigating the effects of continuous positive airway pressure (CPAP) therapy on arterial stiffness and endothelial function in patients with sleep apnea.

Having trouble staying asleep at night could spell trouble for your memory in old age, a new study suggests.

Research that will be presented in April at the annual meeting of the American Academy of Neurology shows that people who reported waking up more than five times in an hour also had an increased risk of having build up of amyloid plaques — which are linked with Alzheimer’s disease — in their brains.

“Further research is needed to determine why this is happening and whether sleep changes may predict cognitive decline,” study researcher Yo-El Ju, MD, of the Washington University School of Medicine in St. Louis, said in a statement.

Researchers examined the sleep patterns of 100 people ages 45 to 80 who didn’t have dementia by having them fill out sleep diaries and questionnaires, and placing a device on them as they slept for two weeks. Half of the study participants had a family history of Alzheimer’s disease.

The scientists found after the study that 25 percent of people had evidence of amyloid plaques in their brains. The average night’s sleep for the study participants was eight hours, and the average time actually spent sleeping (due to periods of wakefulness during the night) was 6.5 hours a night.

Researchers found that the more “efficient” sleepers — that is, the people who spent more than 85 percent of time in their beds actually sleeping — were less likely to have the amyloid plaques than the “inefficient” sleepers — defined as people who spent less than 85 percent of time in their beds actually sleeping.

Past studies have also shown that sleep has other beneficial impacts on the brain.

And just last year, researchers from Stanford University published a study in the journal Proceedings of the National Academy of Sciences that showed that having constantly interrupted sleep is linked with an impaired ability to learn new things, the Los Angeles Times reported. That study was conducted in mice.

By Julie Evans

Surprising reasons you’re tired all the time – Tampa

We all tend to blame fatigue on a too-busy lifestyle. And much of the time we’re right.

If you feel tired all the time, don’t blow it off. Give yourself about 2 to 3 weeks to make some lifestyle changes. Get more sleep, trim your social calendar, eat more wholesome foods, drink more fluids, take a multivitamin, and cut back on caffeine and alcohol.

“If you’re still feeling the symptoms of fatigue after those changes, then you need professional help,” says Sandra Adamson Fryhofer, MD, an internal medicine doctor in Atlanta. Excess exhaustion could be the sign of a more serious medical condition that can be treated. Here are the 6 most common problems to know about.

1. Anemia

This condition is more common in women with heavy periods or who don’t consume enough iron.

The fatigue caused by anemia is the result of a lack of red blood cells, which bring oxygen from your lungs to your tissues and cells. You may feel weak and short of breath. Anemia may be caused by an iron or vitamin deficiency, blood loss, internal bleeding, or a chronic disease such as rheumatoid arthritis, cancer, or kidney failure. Women of childbearing age are especially susceptible to iron-deficiency anemia because of blood loss during menstruation and the body’s need for extra iron during pregnancy and breastfeeding, explains Laurence Corash, MD, adjunct professor of laboratory medicine at the University of California, San Francisco.

The symptoms: Fatigue is a major one. Others include extreme weakness, difficulty sleeping, lack of concentration, rapid heartbeat, chest pains, and headache. Simple exercise, such as climbing the stairs or walking short distances, can cause fatigue.

The tests: A thorough evaluation for anemia includes a complete physical exam and blood tests, including a complete blood count (CBC), to check the levels of your red blood cells. It’s also standard to check the stool for blood loss.

2. Diabetes

More than a million people are diagnosed with type 2 diabetes every year, but many more may not even know they have it.

Sugar, also called glucose, is the fuel that keeps your body going. And that means trouble for people with type 2 diabetes who can’t use glucose properly, causing it to build up in the blood. Without enough energy to keep the body running smoothly, people with diabetes often notice fatigue as one of the first warning signs, says Christopher D. Saudek, MD, professor of medicine and program director for the General Clinical Research Center at the Johns Hopkins University School of Medicine.

The symptoms: Aside from exhaustion, other signs include excessive thirst, frequent urination, hunger, weight loss, irritability, vaginal yeast infections, and blurred vision.

The tests: There are two major tests for diabetes. The fasting plasma glucose test, which is more common, measures your blood glucose level after fasting for 8 hours, usually first thing in the morning. With the oral glucose tolerance test (OGTT), blood is drawn twice: just before drinking a glucose syrup, then 2 hours later.

3. Thyroid Disease

When your thyroid hormones are out of whack, even everyday activities will make you feel wiped out.

The thyroid gland, about the size of the knot on a man’s tie, is found in the front of the neck and produces hormones that control your metabolism. Too much thyroid hormone (hyperthyroidism), and metabolism speeds up. Too little (hypothyroidism), and metabolism slows down.

The symptoms: Hyperthyroidism causes muscle fatigue and weakness, which you may notice first in the thighs. Exercises such as riding a bike or climbing stairs become more difficult. Other symptoms include unexplained weight loss, feeling warm all the time, increased heart rate, shorter and less frequent menstrual flows, and increased thirst. Hyperthyroidism is most commonly diagnosed in women in their 20s and 30s, but it can occur in older women and men too, says Robert J. McConnell, MD, codirector of the New York Thyroid Center at Columbia University Medical Center in New York City.

Hypothyroidism causes fatigue, an inability to concentrate, and muscle soreness, even with minor activity. Other symptoms include weight gain due to water retention, feeling cold all the time (even in warmer weather), heavier and more frequent menstrual flows, and constipation. Hypothyroidism is most common in women over age 50. In fact, as many as 10% of women past 50 will have at least mild hypothyroidism, says McConnell.

The tests: Thyroid disease can be detected with a blood test. “Thyroid disorders are so treatable that a thyroid test should be done in all people who complain of fatigue and/or muscle weakness,” says McConnell.

4. Depression

More than “the blues,” depression is a major illness that affects the way we sleep, eat, and feel about ourselves and others.

Without treatment, the symptoms of depression may last for weeks, months, or even years. So it’s important to recognize the warning signs and get help.

The symptoms: We don’t all experience depression in the same way. But commonly, depression can cause decreased energy, changes in sleeping and eating patterns, problems with memory and concentration, and feelings of hopelessness, worthlessness, and negativity.

The tests: There’s no blood test for depression, but your doctor may be able to identify it by asking you a series of questions. If you experience five or more symptoms below for more than 2 weeks, or if they interfere with your life, see your doctor or mental health professional. Your doctor may also recommend a thorough physical exam to rule out other issues.
•Fatigue or loss of energy
•Sleeping too little or too much
•A persistent sad, anxious, or “empty” mood
•Reduced appetite and weight loss, or increased appetite and weight gain
•Loss of interest or pleasure in activities once enjoyed
•Restlessness or irritability
•Persistent physical symptoms that don’t respond to treatment, such as headaches, chronic pain, or constipation and other digestive disorders
•Difficulty concentrating, remembering, or making decisions
•Feeling guilty, hopeless, or worthless
•Thoughts of death or suicide

5. Rheumatoid Arthritis

This autoimmune disease is not always easy to diagnose early, but there are some subtle clues to look for.

RA happens when your immune system turns against itself and attacks healthy joint tissue, sometimes resulting in irreversible damage to bone and cartilage.

The symptoms: Many symptoms (such as fatigue, low energy, loss of appetite, and joint pain) are shared by other health conditions, including other forms of arthritis such as fibromyalgia and lupus. Also, anemia and thyroid disorders, which also cause fatigue, are even more common in people with RA, according to John Klippel, MD, president and CEO of the Atlanta-based Arthritis Foundation.

Rheumatologists look for at least four of the following criteria in diagnosing RA: morning stiffness in and around the joints lasting at least 1 hour before maximum improvement; at least three joint areas with simultaneous soft tissue swelling or fluid; at least one joint area swollen in a wrist, knuckle, or the middle joint of a finger; simultaneous involvement of the same joint areas on both sides of the body; lumps of tissue under the skin; and bone erosion in the wrist or hand joints, detected by x-ray.

The tests: A thorough physical exam by a rheumatologist can provide some of the most valuable evidence of the disease, but there is also a test for the presence of rheumatoid factor, an antibody found in the blood. About 80% of people with RA test positive for this antibody, but the test is not conclusive.

6. Sleep Apnea

You could have this sleep-disrupting problem if you wake up feeling tired no matter how much rest you think you got.

Sleep apnea is a disorder characterized by brief interruptions of breathing during sleep. In the most common type, obstructive sleep apnea, your upper airway actually closes or collapses for a few seconds, which, in turn, alerts your brain to wake you up to begin breathing again. Someone with obstructive sleep apnea may stop breathing dozens or even hundreds of times a night, says Roseanne S. Barker, MD, former medical director of the Baptist Sleep Institute in Knoxville, TN.

The symptoms: Sleep apnea is often signaled by snoring and is generally followed by tiredness the next day. Because sleep apnea can lead to heart disease, high blood pressure, and stroke, it’s important to be tested.

People who suffer from sleep disturbances are at major risk for obesity, diabetes, and coronary artery disease, according to new research from the Perelman School of Medicine at the University of Pennsylvania.

Shown for the first time in such a large and diverse sample, analyzing the data of over 130,000 people, the new research also indicates that general sleep disturbance (difficulty falling asleep, staying asleep, and/or sleeping too much) may play a role in the development of cardiovascular and metabolic disorders. The study is published online ahead of print in the Journal of Sleep Research.

“Previous studies have demonstrated that those who get less sleep are more likely to also be obese, have diabetes or cardiovascular disease, and are more likely to die sooner, but this new analysis has revealed that other sleep problems, such as difficulty falling asleep, staying asleep, or even too much sleep, are also associated with cardiovascular and metabolic health issues,” said Michael A. Grandner, PhD, research associate at the Center for Sleep and Circadian Neurobiology at Penn and lead author of the study.

The researchers examined associations between sleep disturbances and other health conditions, focusing on perceived sleep quality, rather than just sleep duration. After adjusting for demographic, socioeconomic, and health risk factors, patients with sleep disturbances at least 3 nights per week on average were 35% more likely to be obese, 54% more likely to have diabetes, 98% more likely to have coronary artery disease, 80% more likely to have had a heart attack, and 102% more likely to have had a stroke.

The researchers say that future studies are needed to show whether sleep problems actually predict the new onset of cardiovascular and metabolic disease, and whether treatment of sleep problems improves long-term health and longevity.