How undiagnosed sleep apnea affects the heart

Experts estimate that more than a quarter of the adult population suffers from sleep apnea, although it is rarely diagnosed (especially in women). In an Airway Focused Dentistry Mini-Residency session, Dr. Bertrand De Silva explained how misdiagnosis occurs, and the devastating impact on a patient’s health. The course was co-developed by Dana Point dentist, Dr. Mark A Cruz.

Dr. De Silva explained how apneic events overload the right ventricle with carbon dioxide, causing it to dilate and fail. Liver problems are often the first symptom, and the beginning of a long and dangerous series of misdiagnoses.

He described the potential chain of events, using a hypothetical patient:

• Liver problems are misdiagnosed as a nonalcoholic hepatitis, but does not improve with treatment.
• Next, patient develops peripheral edema (sweating in the legs).
• When testing does not reveal any blood clots, the patient is diagnosed with heart failure and given diuretics.
• The diuretic takes fluid off of the left side
  of the heart, not the afflicted right side. The physiological
  consequences actually exacerbate the problem.
• Over time, the effects of nightly apneic events lead to systemic hypertension (high blood pressure).
• Increased pressure causes tissues on both sides of the heart to stretch, eventually leading to overall enlargement of the heart.
• Medications such as blood thinners, digoxin,
  and beta blockers are prescribed. Additional medications are needed to
  treat side effects such as depression.
• Blood pressure medication dosage is increased
  to the point where the heart stops functioning normally, possible
  causing heart attacks.
• Eventually the person needs a pacemaker.
• By the time of death, the patient is taking nearly two dozen prescription medications, all of which are failing to help.

Dr. Cruz, Dr. De Silva, and other healthcare providers involved in the program are committed to improving sleep apnea diagnosis and treatment in the medical community.