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  • Sleep apnea/AFIB

    I think a while back I had seen a few posts regarding sleep apnea. My doctor is aware that I have mild sleep apnea and have questioned if it had any relation to the AFIB but he doesn't seem to think so. I'm wondering if I should have another sleep study done and wear a CPAP (did at first several years ago when I had my first test done)..I just could not get used to the uncomfortable mask.
    \"It is not length of life, but depth of life.\"

    Ralph Waldo Emerson

  • #2
    Re: Sleep apnea/AFIB

    Cynthia:

    My wife and I both had sleep studies done; it turns our I snore like crazy but didn't technically have sleep apnea; my wife doesn't snore but did have sleep apnea.

    We both ended up getting CPAP machines (insurance paid most of it for both of us) but when I woke up, I felt no benefit and just couldn't get used to the mask, so I quit using it. My wife, meanwhile, can now get a good night's sleep when she couldn't before by using hers.

    My Dr pushed me to get it because it might help me get enough oxygen in the night, putting less stress on my HCM heart to beat harder. It's a stretch, and who knows what my oxygen is doing when I snore at home (levels in the test were OK), but the bottom line is that I felt no benefit and a lot of awkwardness.

    I do think, if your insurance covers it and you have a reputable supplier, that you have another sleep study done. Always good to get the data. What you do with it is up to you and your Dr.

    Frank S.
    Father had "IHSS"
    "Exercise induced asthma" since age 40
    Diagnosed with HCM age 44 (2004)
    Myectomy and L Ant Artery unbridging Stanford Dr. Mallidi 3/17/2011

    Comment


    • #3
      Re: Sleep apnea/AFIB

      Sleep apnea is something that you should not neglect, if you have heart issues. The lack of oxygen puts extra strain on the already weakened heart. I would not, and have not gone without my C/PAP machine for more than one night, in the last 10 years. A few years ago, I went to my camp, in the North woods (75 miles away), and forgot the power cord to run the C/PAP with a 12 volt converter. The next day, after not using the C/PAP, was absolutely rotten. If you have sleep apnea, you should definitely be using a machine. They have made a lot of advances, in the last 10 years. The machines are smaller, and the masks are much more comfortable. It does take getting used to, but the results are well worth it. Not sure about the AFIB, but am sure that the lack of oxygen to the heart muscle is not good for anyone, say nothing about people with HCM. I would definitely ask your PCP for another sleep study. Good luck.

      Comment


      • #4
        Re: Sleep apnea/AFIB

        Get another test( sleep study) ASAP and learn to adjust to the mask and keep trying different ones until you get a good fit and comfort.

        Chest. 2010 May;137(5):1078-84. Epub 2010 Feb 12.
        Obstructive sleep apnea is common and independently associated with atrial fibrillation in patients with hypertrophic cardiomyopathy.
        Pedrosa RP, Drager LF, Genta PR, Amaro AC, Antunes MO, Matsumoto AY, Arteaga E, Mady C, Lorenzi-Filho G.

        Sleep Laboratory, Pulmonary Division, Heart Institute (InCor), Av. Enéas Carvalho de Aguiar, 44, São Paulo, Brazil.
        Abstract
        BACKGROUND: Hypertrophic cardiomyopathy (HCM) is associated with arrhythmias and cardiovascular death. Left atrial enlargement and atrial fibrillation (AF) are considered markers for death due to heart failure in patients with HCM. Obstructive sleep apnea (OSA) is independently associated with heart remodeling and arrhythmias in other populations. We hypothesized that OSA is common and is associated with heart remodeling and AF in patients with HCM.

        METHODS: We evaluated 80 consecutive stable patients with a confirmed diagnosis of HCM by sleep questionnaire, blood tests, echocardiography, and sleep study (overnight respiratory monitoring).

        RESULTS: OSA (apnea-hypopnea index [AHI] > 15 events/h) was present in 32 patients (40%). Patients with OSA were significantly older (56 [41-64] vs 38.5 [30-53] years, P < .001) and presented higher BMI (28.2 +/- 3.5 vs 25.2 +/- 5.2 kg/m(2), P < .01) and increased left atrial diameter (45 [42-52.8] vs 41 [39-47] mm, P = .01) and aorta diameter (34 [30-37] vs 29 [28-32] mm, P < .001), compared with patients without OSA. Stepwise multiple linear regression showed that the AHI (P = .05) and BMI (P = .06) were associated with left atrial diameter. The AHI was the only variable associated with aorta diameter (P = .01). AF was present in 31% vs 6% of patients with and without OSA, respectively (P < .01). OSA (P = .03) and left atrial diameter (P = .03) were the only factors independently associated with AF.

        CONCLUSIONS: OSA is highly prevalent in patients with HCM and it is associated with left atrial and aortic enlargement. OSA is independently associated with AF, a risk factor for cardiovascular death in this population.

        http://onlinelibrary.wiley.com/doi/1...10.00196.x/pdf

        http://www.4hcm.org/forums/showthread.php?t=17229

        http://www.4hcm.org/forums/showthread.php?t=13209

        http://www.4hcm.org/forums/showthread.php?t=11069

        http://content.karger.com/produktedb...asp?doi=321718


        High prevalence of abnormal nocturnal oximetry in patients with hypertrophic cardiomyopathy.
        Eleid MF, Konecny T, Orban M, Sengupta PP, Somers VK, Parish JM, Mookadam F, Brady PA, Sullivan BL, Khandheria BK, Ommen SR, Tajik AJ.

        Divisions of Cardiovascular and Pulmonary Diseases, Department of Internal Medicine, Mayo Clinic College of Medicine, Scottsdale, Arizona.
        Comment on:

        J Am Coll Cardiol. 2009 Nov 3;54(19):1810-2.
        Abstract
        OBJECTIVES: We sought to determine the prevalence of nocturnal oxygen desaturation and obstructive sleep apnea (OSA) in a population of patients with hypertrophic cardiomyopathy (HCM).

        BACKGROUND: The coexistence of sleep apnea and HCM, 2 common cardiovascular conditions, has been largely unrecognized in the treatment of patients with HCM. The nocturnal hypoxia-induced hyperadrenergic state in OSA is expected to worsen hemodynamics and outcomes in HCM.

        METHODS: One hundred subjects with HCM between June 1, 2006, and July 14, 2008, were screened with nocturnal oximetry. Clinical variables were collected for statistical analysis. Oximetry was classified abnormal (suspicion of sleep-disordered breathing) in the presence of repetitive desaturation (> or =5 events/h) followed by a rapid return to baseline oxygen saturation (SaO(2)) level with a decrease of > or =4% and threshold of 90%.

        RESULTS: Seventy-one (71%) patients with HCM had abnormal nocturnal oximetry (71 +/- 9%, 95% confidence interval: 62% to 80%). Subjects with abnormal oximetry were older (age 59.5 +/- 15.3 years) and more were hypertensive (n = 39 [55%]) than those with normal oximetry (age 45.8 +/- 18.5 years, n = 9 [31%], p < 0.001, p = 0.03). Patients with HCM were more symptomatic in the presence of abnormal oximetry (New York Heart Association functional class II to III) (62% vs. 83%, p = 0.023). HCM patients had a higher prevalence of abnormal nocturnal oximetry (n = 71, 71%) compared with a control group of similar age and sex distribution (n = 49, 49%) (p = 0.001).

        CONCLUSIONS: Abnormal nocturnal oximetry is common in patients with HCM, suggesting that OSA is prevalent. OSA may impact hemodynamics and symptoms in HCM. Further studies are needed to determine the long-term benefit of OSA treatment on hemodynamics and disease progression in HCM.

        PMID: 19874995 [PubMed - indexed for MEDLINE]

        Publication Types, MeSH Terms
        LinkOut - more resources
        Dx @ 47 with HOCM & HF:11/00
        Guidant ICD:Mar.01, Recalled/replaced:6/05 w/ Medtronic device
        Lead failure,replaced 12/06.
        SF lead recall:07,extracted leads and new device 2012
        [email protected] Tufts, Boston:10/5/03; age 50. ( [email protected] 240 mmHg ++)
        Paroxysmal A-Fib: 06-07,2010 controlled w/sotalol dosing
        Genetic mutation 4/09, mother(d), brother, son, gene+
        Mother of 3, grandma of 3:Tim,27,Sarah,33w/6 y/o old Sophia, 5 y/o Jack, Laura 34, w/ 5 y/o old Benjamin

        Comment


        • #5
          Re: Sleep apnea/AFIB

          How do people w/ sleep apnea feel or I guess I am asking what are the symptoms. Like if you have the cpap machine and you don't wear it, how do you feel the next day? Just wondering. I know I snore and have wondered for years if I have it. They did a preliminary apnea test on me at Mayo a few years ago and watched my o2 levels throughout the night and the dr said they didn't dip or go low enough to have further testing..........
          Heather, 43, non-obstructive HCM, dx'd at age 14, AICD implanted 11-02, PVAI ablation done for a-fib and a-flutter 5-2010. 2nd PVAI done for a-flutter and a-tach 3-2014. 3rd PVAI for a-flutter June 2015, dr forgot to reset ICD settings and I went into vt and almost died, July 2015, July 2015-started tx work up, October 2015, put on list in Dallas and tx'd on November 14, 2015.

          Comment


          • #6
            Re: Sleep apnea/AFIB

            For me I really can not sleep if I do not wear it..I have Bi-Pap- which just adds a pause for me to exhale. When I have surgery for any reason it is the first thing I have to have. I have anxiety feelings building to overwhelm because I stop breathing so frequently without it. It's just an awful feeling they actually put me on Bi-pap when I have surgery because I de-sat so much even just on oxygen, I de-sat. Even though one of my prior doctors told me I could not possibly know if I had sleep apnea because the patient cannot monitor their own apnea and know they are snoring ... he was wrong. I would constantly wake up and could catch myself snoring and I would feel my breathing diminish and the stops were what made me anxious as the oxygen levels fell. So I was right, I did know and my stops or apnea episodes were as many as 70 an hour. This is a severe example as I have severe sleep apnea. When i worked before my HCM diagnosis and before my sleep apnea diagnosis, I fell asleep at the wheel while driving several times and also fell asleep while still talking to someone sitting at work. They told me my eyes were open the whole time and I was talking and half snoring! I feel that I was very lucky to finally get treatment. My brother w/ HCM also has it but uses C-pap.
            Decreased O2 levels would be a strong indicator as well as day time excess sleepiness and to be honest I never felt like I got any rest in the years before the diagnosis and treatment. I do feel rested now, and it has been 11 years of treatment. Also I would startle frequently and my heart would pound. I also had lots of chest pain much of the time.

            My pulmonary MD uses the Epworth Sleepiness scale, here is a link:

            http://www.stanford.edu/~dement/epworth.html
            Dx @ 47 with HOCM & HF:11/00
            Guidant ICD:Mar.01, Recalled/replaced:6/05 w/ Medtronic device
            Lead failure,replaced 12/06.
            SF lead recall:07,extracted leads and new device 2012
            [email protected] Tufts, Boston:10/5/03; age 50. ( [email protected] 240 mmHg ++)
            Paroxysmal A-Fib: 06-07,2010 controlled w/sotalol dosing
            Genetic mutation 4/09, mother(d), brother, son, gene+
            Mother of 3, grandma of 3:Tim,27,Sarah,33w/6 y/o old Sophia, 5 y/o Jack, Laura 34, w/ 5 y/o old Benjamin

            Comment


            • #7
              Re: Sleep apnea/AFIB

              My sleep apnea was making me stop breathing 19 times an hour on the average. This resulted in my body pumping adrenaline into my heart to try to save me. I have had symptoms of sleep apnea way back into my early teens. Doing the math I figure I've had 2 million + hits of adrenaline over the years. I truly believe this is what along with having HOCM anyway caused my heart muscle to grow as arge as it did and cause the huge obstruction that they found.

              I had been falling asleep at the wheel constantly my entire life; multiple times a day. I'd do everything to try and stop it but nothing worked even completely caffined up with espresso. Since going on the CPAP machine 18 months ago I have only fallen asleep once at the wheel and that was about 3 weeks ago on the way to CCF no less. My cell phone rung and woke me up just as I was nodding off. It was my wife and I acted angry that she had woke me up. Boy did I get a scolding.

              I just talked to my banker a couple of days ago he he said he felt like crap because he had fallen asleep on the couch and had not therefore used his CPAP machine. We all know the feeling. Yes, get the sleep study done. It improves the quality of life a lot.

              Toodle pip... Moosedreams
              Diagnosed HCM Nov 2009
              100 mg Atenolol; Baby asprin
              First Trip to CCF June 2010
              HCM Specialist at CCF... Dr. Harry Lever
              Septal Myectomy at CCF... August 9th 2010: Dr. Nicholas Smidera
              AICD w/pacer at CCF... December 20th 2010

              Once you choose hope, anything's possible. ~ Christopher Reeve

              Since we can not run in the park, we can be the ones to take a stroll, look around and enjoy the simple things in life. ~ Rosemaire1125

              www.TheRhubarbChronicles.com

              Comment


              • #8
                Re: Sleep apnea/AFIB

                Wow Pam! According to that scale I am an 11 and anything over 9 was considered to need to be looked into! Maybe I'll add that to my to do list this summer! I am wondering if it may be why I am so tired, foggy headed, and sometimes dizzy! They can't seem to find anything else......so that's is the only thing left to rule out!
                Heather, 43, non-obstructive HCM, dx'd at age 14, AICD implanted 11-02, PVAI ablation done for a-fib and a-flutter 5-2010. 2nd PVAI done for a-flutter and a-tach 3-2014. 3rd PVAI for a-flutter June 2015, dr forgot to reset ICD settings and I went into vt and almost died, July 2015, July 2015-started tx work up, October 2015, put on list in Dallas and tx'd on November 14, 2015.

                Comment


                • #9
                  Re: Sleep apnea/AFIB

                  Hmm. That scale suggests that I get enough sleep. I'd have said that I certainly don't. I'm guessing that there's "getting enough sleep to be functional," which I probably do, and "getting as much as I should," which I don't.

                  Anyway, it's nice to know that at least according to this, I'm ok . . .

                  Gordon
                  Myectomy on Feb. 5, 2007.

                  Comment


                  • #10
                    Re: Sleep apnea/AFIB

                    Yeah, my local cardio did that survey which is what prompted the one from the PCP but since my 02 levels were fine for that night Well care will not cover a full study. I was an 11.

                    Mary

                    Comment


                    • #11
                      Re: Sleep apnea/AFIB

                      Thank you so much for bringing this up because the additional info and links are a real help to me... I had my sleep study about a month ago and I'm going for my results and what we're going to do about it next week.

                      I have a feeling CPAP is in my future, but that Bi-Pap sure sounds a lot more pleasant... I want to exhale too! That pause sounds like a great idea to me. Besides if I don't get a chance to exhale, won't I just start swallowing oxygen and having a bloated tummy? Don't need that!

                      Anyway - I have been pretty concerned about how much noise do those machines make? And how uncomfortable are the masks, and how many different styles of mask do they even make and are they actually even designed for women? And has anyone confirmed with their dentist that it hasn't changed their teeth or jaws after long term use? Just tons of questions for my Respirologist I guess but anyone can chime in.

                      I need to probably concentrate on how important it is for the HCM heart to get proper oxygen tho, that'll hopefully help me accept the inevitable.
                      »-(¯`·.·´¯)-> HCMA LOVES YOUR HEART <-(¯`·.·´¯)-«
                      Murmur detected in childhood (3rd gen, 3 clear siblings)
                      Chronic dyspnea, dizziness & palpitations (21+)
                      Echocardiogram showing 3X thicknesses 2000
                      Cardiac CT 2009 no significant obstruction or plaque (Yay!)
                      Cardiac MRI 2010 showing septal scarring (Boo!)
                      Verapamil 280mg a day (metoprolol starved extremities)
                      ICD MAR 2010 - Canadian Trials St. Jude FORTIFY

                      Comment


                      • #12
                        Re: Sleep apnea/AFIB

                        The hospital ones sound loud, mine (Respironics) is very quiet once the mask seal is complete. I actually have a widow fan on the floor running all the while I sleep as it creates a white, (sort of) noise to lull me to sleep. This is my machine:

                        http://www.cpapsupplyusa.com/Respiro...er-DS600H.aspx

                        I also tried several masks and found that the phantom worked best for me and coincidentally my brother uses the same and we never even talked about it when I went on mine.

                        This is my mask by sleep net it formerly was blue and now clear,( there are quite a variety of different masks and they try them all on..) I believe the phantom is no longer offered by respironics but they get it for me and my brother as a special order.

                        http://www.softgelmask.com/sleepnet_...mshowcase.html

                        Insurance pays for all of it and the needed new equipment every few months.

                        Been wearing same for 10 plus years and no problems with jaw/ teeth. The right fit actually forces you to close your mouth while you sleep. It can be a learning curve and adjustment all the way around, but I do love my Bi-pap and what it has done for me. I have mild COPD and therefore the pause to exhale. My brother does not need the pause and his lungs are strong enough to exhale against the settings. No I do not believe you swallow the air... when they test you they can tell if you are exhaling efficiently and ones pulmonary function tests before this also contribute to the findings and decision.
                        Dx @ 47 with HOCM & HF:11/00
                        Guidant ICD:Mar.01, Recalled/replaced:6/05 w/ Medtronic device
                        Lead failure,replaced 12/06.
                        SF lead recall:07,extracted leads and new device 2012
                        [email protected] Tufts, Boston:10/5/03; age 50. ( [email protected] 240 mmHg ++)
                        Paroxysmal A-Fib: 06-07,2010 controlled w/sotalol dosing
                        Genetic mutation 4/09, mother(d), brother, son, gene+
                        Mother of 3, grandma of 3:Tim,27,Sarah,33w/6 y/o old Sophia, 5 y/o Jack, Laura 34, w/ 5 y/o old Benjamin

                        Comment


                        • #13
                          Re: Sleep apnea/AFIB

                          My husband's cpap looks a lot like Pam's bipap. He doesn't have problem exhaling and his is set at a moderately high setting - #12. His mask is a small gel mask. Here's a link:http://www.amazon.com/Respironic-Com.../dp/B002C634EY
                          Attached Files
                          Reenie

                          ****************
                          Husband has HCM.
                          3 kids - ages 23, 21, & 19. All presently clear of HCM.

                          Comment


                          • #14
                            Re: Sleep apnea/AFIB

                            My insurance won't cover a sleep study, but I have been told by many (well not that many) people that I often stop breathing during the night for extended periods and it scares the crap out of them. I'm hoping that it is related to being overweight and that it will improve as I get back to my ideal weight, but I understand that this is not always the case. Is there an established connection between HCM and sleep apnea? I'd be interested in learning more about this.
                            "Some days you're the dog... some days you're the hydrant."

                            Comment


                            • #15
                              Re: Sleep apnea/AFIB

                              I think in my first response I gave some research and findings.. It seems it may be connected according to those findings.
                              Dx @ 47 with HOCM & HF:11/00
                              Guidant ICD:Mar.01, Recalled/replaced:6/05 w/ Medtronic device
                              Lead failure,replaced 12/06.
                              SF lead recall:07,extracted leads and new device 2012
                              [email protected] Tufts, Boston:10/5/03; age 50. ( [email protected] 240 mmHg ++)
                              Paroxysmal A-Fib: 06-07,2010 controlled w/sotalol dosing
                              Genetic mutation 4/09, mother(d), brother, son, gene+
                              Mother of 3, grandma of 3:Tim,27,Sarah,33w/6 y/o old Sophia, 5 y/o Jack, Laura 34, w/ 5 y/o old Benjamin

                              Comment

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