Category Archives: Sleep Apnea

Sleep Apnea May Raise Your Cancer Risk

Several recent studies have demonstrated an increased risk of premature death in those with sleep apnea, implicating several different possible reasons. Cancer and cardiovascular effects have been among the leading candidates.

In this month’s issue of the Journal of Clinical Sleep Medicine, another paper once again points out this relationship. The report is a 20-year follow-up of all causes of mortality in 400 residents in the Western Australian town of Busselton, making it part of the Busselton Health Study Cohort done at the University of Sydney.

The researchers found that moderate and severe sleep apnea (meaning more than 15 respiratory obstructions per hour) was associated with a higher incidence of cancer and cancer-related deaths. In fact, people with moderate or severe sleep apnea were 2.5 times as likely to get cancer, and 3.4 times as likely to die from cancer. Mild sleep apnea did not impact cancer risk.

Two other recent studies have related cancer incidence and death to sleep apnea. In one, researchers found the growth rate of melanoma cells was accelerated by sleep apnea. Another found that mild sleep apnea resulted in a 10 percent increased risk of death, and that moderate and severe sleep apnea led to a two-fold and five-fold increased death risk, respectively.

We estimate that 18 million Americans have sleep apnea. Of those, only about 20 percent have been diagnosed and treated. As a result, sleep apnea is of major public health significance. There have been a few encouraging studies demonstrating that with treatment, the risk of cancer decreases. In one, effective treatment was associated with positive changes in cancer-related genetic pathways, according to a white blood cell analysis.

We have begun to realize which specific sleep apnea factors may encourage tumor growth. The most likely factor is the low oxygen that results from repeated respiratory obstructions. We believe this encourages new blood vessel growth (neovascularization), which ends up feeding the tumor cells and promoting their growth. Genetic changes that result from sleep apnea may also be to blame.

We need to take this disorder very seriously. The incidence of sleep apnea is increasing, in great part due to our love of fast food, sugary drinks, and the resulting epidemic of obesity, which predisposes many of us to the disorder. Therefore, as if we did not already have enough reasons to treat sleep apnea, we can now add cancer. Here are easy signs of sleep apnea to look out for: loud snoring, daytime fatigue, interrupted breathing, or large neck (men 17” and women 16”). If you or a loved one has any of these, get it checked out. I think that before long we will be adding “check for sleep apnea” to such things as a colonoscopy and breast or prostate exams.

Ten Things You Need To Know About Sleep Apnea

Sleep apnea occurs when you go to sleep. The muscles of the throat collapse and the movement of air is obstructed. If this lasts for ten or more seconds and occurs more than five times an hour, it is sleep apnea. Estimates are that over 18 million Americans have this disease. Unfortunately, only 20% have been diagnosed and treated.

Ten things to know:

1. Sleep apnea significantly increases your risk of stroke. 50% of all stroke victims have sleep apnea.

2. If you have or have had atrial fibrillation, there is a 40% likelihood that you have sleep apnea. Untreated, your chances of it recurring are double that of someone without sleep apnea.

3. Sleep apnea causes insulin resistance and as a result may cause or worsen diabetes.

4. If you have PCOS (Polycystic Ovary Syndrome) your chances of having sleep apnea is greater than 50%.

5. If you have a child with Down syndrome, the odds of that child having sleep apnea is close to 60%.

6. If you have frequent unexplained nighttime urination or early morning headaches, there is a very high probability that you have sleep apnea.

7. If you are on three or more blood pressure medications and your doctor is still having trouble controlling your pressure, your chance of having sleep apnea is 60%.

8. If you have insomnia with frequent awakenings, it may be due to sleep apnea.

9. You don’t have to be an obese man to have sleep apnea. 30% of people with sleep apnea are not obese, and after menopause, women’s rates of sleep apnea approximate men’s.

10. You don’t have to be sleepy to have sleep apnea. Many people, especially with underlying heart disease, are not. Female patients often present with symptoms of anxiety, depression, and fatigue, as opposed to sleepiness.

It is important to realize that sleep apnea can present in numerous ways. In fact, some studies show that over 25% of patients did not even snore. Therefore, if you or a loved one has any of the above symptoms or risk factors, get it checked out. It could save your life. Sleep apnea is easily diagnosed and treated.

Sleep Apnea and Diabetes

diabetes testA study presented at the 2013 American Thoracic Society International Conference demonstrated that in people with prediabetes, treatment of associated sleep apnea improved blood sugar control.  Two weeks of treatment with continuous positive airway pressure (CPAP) resulted in a significant lowering of blood sugar.

We have known for several years that there is a link between diabetes and sleep apnea.  Sleep apnea is a stress-producing condition occurring while you are asleep.  It results in high levels of cortisol and activation of the sympathetic nervous system.  This can result in significant elevations in blood sugar.  At the same time, it is also wreaking havoc with your oxygen levels.  This causes the release of substances called inflammatory mediators, which inhibit the ability of insulin to get into the cells.  This is referred to as insulin resistance.  In response, the pancreas, where insulin is produced, attempts to put out more and more insulin.  However, there comes a time when it can no longer do this and then we go from prediabetes to diabetes.

We know that the incidence of sleep apnea in diabetics is high.  Previously it was felt that obesity, which is common to both conditions, was the link.  However, now it is becoming increasingly clear that sleep apnea may be the cause of diabetes in those who suffer from this breathing disorder.

So what are the implications?  First, weight loss is extremely important and can improve both diabetes and sleep apnea.  However, if you have been diagnosed with early diabetes and snore loudly or are constantly sleepy or fatigued, you may have sleep apnea.  In this case bringing it to the attention of your health care provider could result not only in an improvement in how you feel but also in your blood sugar control.