Monday, January 23, 2012

Bra-size , Snoring , Diabetes and hypertension

 I saw an article the other day suggesting that larger Bra sizes increased the risk of developing diabetes. I immediately thought of news paper adds " Get your breast reduction TODAY and cure diabetes ". There may be more to this than meets the eye. We will just have to wait for more research to get the answer.

Snoring with intermittent lapses in breathing is no laughing matter . The National Commission on Sleep -
Disdisorder Research estimate that 7 to 18 million people in the United State have sleep disordered breathing .

Obstructive sleep apnea ( a condition in which the back of the throat collapses during sleep blocking the airway ) is the most common form of this condition. One study found , in a group of 379 women and 262 men between the ages 65 and 70 , that  57 %  had obstructive sleep apnea . This condition becomes more common as we age but is not limited to older people.

Sleep Apnea is associated with an increased risk of Metabolic syndrome , Hypertension , Heart disease and Diabetes. 

The symptoms of sleep apnea are often  common vague things that occur in our every day life such as snoring, insomnia , falling asleep reading the newspaper , tiredness , anxiety  and depression. 
Making a diagnosis first requires thinking about sleep apnea as a cause for a group of vague symptoms.

I will present a case that outlines the problems and delays in making a diagnosis.
   
    A 72 y/o male  with pre-diabetes ,hypertension and a stout build  ( 5ft 8 in and 186 # )developed vague symptoms of sudden strange nausea followed by mild forehead sweating and an intense desire to sit down.The symptoms lasted less than a minute and continued to occur in groups of 3 about once a month.  The symptoms occurred sitting standing or even lying down. Initially they were mild  and ignored until one day the symptoms occurred and he found himself on the ground. He saw his doctor and had an evaluation including blood test , chest X-ray and ECG.  His medications included glucaphage , amlodipine , a diuretic, L- Arginine and aspirin. There was no clear cause for the symptoms and glucophage,L-arginine and the diuretic were stopped. The symptoms were milder until one day he had the symptoms while driving and went off of the road. This episode  resulted in a cardiology visit and testing that revealed a mild transient electrical conduction problem during the episodes. A diagnosis of Vasovagal syndrome( basically fainting ) was made and amlodipine was discontinued. Exercises and better hydration was recommended and the symptoms improved but did not go away and his BP was staying elevated above 140 mmhg systolic.
     The concerns about driving persisted and prompted another visit with his doctor. The doctor ask about snoring, looked at his neck and throat , and suggested seeing a sleep specialist. A diagnosis of obstructive sleep apnea was made and CPAP  treatment was started resulting in completes resolution of all of the symptoms. His blood pressure is 123 -130 / 70 to 80 mmhg with no medications and his wife is now able to sleep through the night without the snoring serenade.

The time from the onset of symptoms and a diagnosis was about 18 months.


 Remember : 


Thinking of sleep apnea as a cause for your vague symptoms is the first step to making a diagnosis.


 AnotheHint , If your spouse can't sleep because of your snoring , think of sleep apnea.

     
 More on symptoms , screening test , effects on diabetes and blood pressure  . Stay tuned.  
    
   David Calder,MD



4 comments:

  1. Thanks for sharing. I find it very informative and relevant. Now I can see how these symptoms take place to the health of many.

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  2. Sleep apnea is a serious medical condition that may lead to death if not treated immediately. Thank you for sharing these medical studies. I'm sure more patients are becoming aware of their condition.

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  3. This is very great thing you have shared with us. Now I found enough resources by your tips about this issue, Thank you.

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  4. I feel strongly about it and love learning more on this topic. If possible, as you gain expertise, would you mind updating your blog with more information? It is extremely helpful for me.

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Your comments and questions are appreciated. David Calder,MD