Written By Dr. Hugh B. McCormick Jr.

Constant fatigue and snoring may be signs of cardiac disease

You blame your daytime sleeping on hibernation in the cold winter, but the truth is that the problem has been steady for several months during the past few years, and is only getting worse. You experience fatigue particularly in the late afternoon or evening. Your spouse wants you to see a doctor because you snore a good part of the night, with pauses in your breathing that go on for minutes at a time. You are short of breath with less and less activity, but you take comfort because you don’t have any tightness or pain in your chest or left arm.

According to the Centers for Disease Control and Prevention, 785,000 Americans had new coronary attacks in 2011. There were 470,000 people with recurrent attacks, and 195,000 patients had “silent heart attacks.” While American men and women experienced a marked decrease in the death rate within the first 30 days of an acute heart attack between 1987 and 2010, long-term survival has only marginally improved. Causes of death from non-ST-segment myocardial infarction—smaller heart attacks, often “silent”—are now the most common type. Heart failure is the third leading cause of death for Americans behind coronary artery disease, which remains No. 1 on the all-time bad list of problem diseases.

You know the importance of risk factors such as a proper diet, exercise, blood pressure and weight control and cholesterol, and you’ve witnessed a heightened awareness of the “diabetes epidemic.” So why bring up sleeping habits like snoring, daytime sleepiness and daily fatigue? Sleep-related breathing disorders are highly prevalent in patients with cardiovascular disease, and it has been established that sleep disorders are associated with a high prevalence of cardiovascular disorders, such as coronary artery disease, stroke, hypertension and atrial fibrillation.

Obstructive sleep apnea (OSA) affects an estimated 15 million adult Americans and is present in a large proportion of patients with hypertension and in those with other cardiovascular disorders, including coronary artery disease, stroke and cardiac arrhythmias, such as bradycardia and ventricular ectopy. We do not know yet whether obstructive sleep apnea causes the development and progression of these cardiac diseases or is merely a consequence of them, but we know that the development of apnea is present many years before and goes largely unrecognized. While the milder forms of sleep disorders do not aggravate the cardiovascular problems listed in this discussion, the more severe forms of OSA are strongly connected.

Discuss your risk for cardiovascular disease with your physician, and if symptoms arise, seek an accurate assessment of sleep apnea. Don’t deny that you fatigue more easily, and get short of breath without much exertion. The proper testing for an accurate diagnosis is not risky or painful, and the rewards of discovery and treatment may lead to uncovering more serious cardiac disorders long before they overtly manifest. You may suddenly feel better than you have in years as you take a proactive preventive role in your own future health.