Sleep Apnea and Cardiac Arrest

[shambharwani]

I am looking for information about the possibility of a person who has undiagnosed Sleep Apnea suffering a cardiac arrest.

A relative of mine - 75 year old - (btw also a retired cardiologist) had a cardiac arrest recently. He was lucky, being a cardiologist himself realised something was wrong and rushed to the hospital's emergency room and while he was there being checked upon went into cardiac arrest. He was revived, hospitalized for around 2 weeks during which an angiography was done. The doctors were not able to find anything wrong during the angio and several other tests conducted. He was also diagnosed as having mild untreated sleep apnea. Since the heart seemed to have no major problems the doctors put it as a one off case and said it was probably sleep apnea related. He left the hospital equipped with a Bipap.

Three days later the events repeated themselves. This time too he reached the hospital but was outside the emergency room when it happened. He is still in hospital and MRI reveals there is some brain damage and his speech / memory are affected. Still the doctors do not know why it happened and how to treat him. They have decided to put a pacemaker on him once he is sufficiently stabilized. The sleep doctor now says sleep apnea does exhibit such symptoms and has a mild case of sleep apnea. So we are still in the dark about the cause, how to treat it and eventually prevent a occurrence.

BTW the patient has been previously treated for High BP, was under medication but had missed taking his tablets for a month.

Can anyone suggest what the doctors may be missing out in their diagnosis, whether any other tests / examinations could reveal the cause of his problem.

Thanks,
Sham

[rested gal]

He was also diagnosed as having mild untreated sleep apnea. Since the heart seemed to have no major problems the doctors put it as a one off case and said it was probably sleep apnea related. He left the hospital equipped with a Bipap.

Sham, what type of test did they do when they diagnosed him with mild sleep apnea? Was it a full, attended overnight PSG? If so..was it a split night study, or was it one full night for baseline diagnosis and a second full night for bilevel titration?

The BiPAP they put him on... plain bilevel machine? Or an S/T (spontaneous/timed) model with a timed backup rate set for "breaths per minute?"

Depending on what happened during the sleep test (if a full PSG) and how well it was evaluated, I'd wonder if he might be a candidate for an ASV type of machine. But that's just a really wild guess on my part and may not apply to him at all, in any way.

What you said here is troubling, considering he is a retired cardiologist and presumably knows better:

BTW the patient has been previously treated for High BP, was under medication but had missed taking his tablets for a month.

Sure hope everything works out well for him.

[Julie]

His problem may be related to atrial fibrillation, which means electrical impulses that regulate heart rhythm become irregular, but as there isn't a specific 'lesion' to see, it can be frustrating to track it. It is also common in OSA. You might want to ask his MD about the possibility of his using a pacemaker.

[LSAT]

His problem may be related to atrial fibrillation, which means electrical impulses that regulate heart rhythm become irregular, but as there isn't a specific 'lesion' to see, it can be frustrating to track it. It is also common in OSA. You might want to ask his MD about the possibility of his using a pacemaker.

Julie......Sham said..."They have decided to put a pacemaker on him once he is sufficiently stabilized. "

[Julie]

Oops! Must have missed that .

[Slinky]

Yup, no BP med for a month?????????? My first thought, of course, as the cause. And - my second thought A fib.

[HoseCrusher]

Let's see... Sleep apnea involves an obstruction to breathing. When the obstruction is severe, oxygen saturation drops. When oxygen saturation drops, the heart speeds up in an effort to pump more oxygen and chemicals are released in an effort to wake you up.

All of this adds stress to the heart.

In addition, mild apnea events can cause arousals that set the same thing into action, but at a smaller scale.

My cardiologist insisted that I have a sleep study done and use xPAP treatment as a proactive measure for heart health. He mentioned that studies have shown a correlation between obstructive sleep apnea and heart disease. I am under the impression that this is like "death from a thousand cuts." Each cut (or obstructive event) is not enough to kill you, but they add up in the end.

In addition, by age 75 most people have a reduced stomach acid production. This results in fewer nutriants being absorbed from diet, and this can lead to an electrolyte imbalance. Most people are dehydrated and are deficient in magnesium. This directly relates to the heart electrical system. Afib by itself is not a concern for cardiac arrest, but it can cause blood clots that can cause problems. The problem is that afib can transform into SVT and other issues that are life threatening. Since a pacemaker is being considered, the assumption is that there are some irregularities with the heart rhythm.

Here is one discussion that indicates that there is a 25% risk of cardiac failure in people with obstructive sleep apnea.

http://www.rjmatthewsmd.com/Definitions ... ea%202.htm

If you do a search using "cardiac arrest sleep apnea" you will find several other articles on this.

[JohnBFisher]

... I am looking for information about the possibility of a person who has undiagnosed Sleep Apnea suffering a cardiac arrest. ...

If you don't mind, let me tackle this one.

All too often sleep apnea is ignored or undiagnosed. Either the patient or the doctor ignores the symptoms.

But can it lead to Cardiac Arrest? Absolutely. Many years ago, before sleep apnea was understood or a therapy was available, my grandfather simply died in his sleep. He had cardiac problems for year. However, when I remember his snoring / gasping at night, I am CERTAIN he had undiagnosed, severe obstructive sleep apnea. And I am also certain the unmanaged sleep apnea led to unmanageable blood pressure issues and cardiac problems.

And such things do run in families. When I hit my teens, my sister started to complain that I snored "just like Grand Dad". It took me another 20 years before it started to severely impact my life. I was diagnosed at about age 34.

But yes, it definitely can contribute to cardiac arrest.