Congenital Heart Disease and Sleep Apnea

Co-Authored By Tabitha Moe and Jeremy Feldman

Fatigued pulmonary hypertension patientAs of 2011, there are more adults than children with congenital heart disease.  Children with congenital heart disease who were born in the 1980’s and 1990’s were given exercise restrictions that were quite limiting.  This kept them from participating in competitive sports, recreational sports, or even playing in gym class at school.

The unfortunate outcome is that we now have an entire generation of adults who were born with congenital heart disease that are now accustomed to a very sedentary lifestyle.  Many of them feel as though they have always been told what they couldn’t do, and they have carried these outdated ideas into adulthood.  Unfortunately, when a sedentary lifestyle intersects with an American diet of fast food and take-out pizza there are many health consequences such as diabetes, high blood pressure, high cholesterol, and obesity.  Another important consequence is the development of Obstructive Sleep Apnea.

Obstructive Sleep Apnea (OSA) describes a problem whereby when you sleep your tongue slides backward in your throat and blocks your airway resulting in an inability to breath.  Gradually your oxygen saturation falls as you continue to be unable to breath.  Eventually your brain recognizes that you are not breathing and you awaken with a big gasp.  Your bed partner may hear this as choking sounds followed by a big loud breath.

The consequences of severe OSA may be quite profound.  Untreated sleep apnea increases your risk for high blood pressure, stroke, heart disease, pulmonary hypertension, traffic accidents, and reduced work productivity.  Patients with sleep apnea complain of fatigue, sleepiness, falling asleep at inappropriate times such as at work, in the doctor’s office, while talking, eating or driving.

Diagnosis of Sleep Apnea

A history of loud snoring, sleepiness during the day, waking up with headaches and witnessed choking episodes during sleep can suggest the diagnosis.  However, proving the diagnosis requires a Sleep Study (polysomnograph).  This test may be done either at a sleep laboratory where you spend 1-2 nights or at home.

Treatment of Sleep Apnea

An ounce of prevention is worth many pounds of cure.  To that end, the best strategy to prevent sleep apnea is to avoid being overweight.  As our weight increases, so does the risk of sleep apnea.  Weight loss leads to improvements in sleep apnea and in some patients may even lead to resolution of the problem.  The first line of treatment after weight loss is CPAP (continuous positive airway pressure).  This involves using a small air compressor connected to a facemask or nose-mask.  The air creates a pneumatic splint that keeps your airway open preventing you from choking yourself while you sleep.  Some patients are unable to tolerate CPAP and there are a variety of other options.  Oxygen alone is not adequate treatment of sleep apnea.

Ask your congenital heart disease cardiologist or pulmonary hypertension specialist if you should be evaluated for sleep apnea.