Hi Greg,

As you know, sleep apnea is a relatively common condition typically associated with periodic obstruction of breathing by the tongue during sleep. Frequently it is suspected when someone is noted to be a loud snorer and has fatigue during the day due to ineffective rest at night. It is more common in individuals who are overweight–the condition can be improved by weight loss. It is often treated by having someone wear a special mask at night that provides continuous positive airway pressure (CPAP) to prevent or relieve the tendency to airway obstruction.

It has been increasingly recognized that untreated sleep apnea can exacerbate the findings of heart failure if someone is prone to the condition. Blood pressure is elevated during episodes of obstructive breathing at night. Other hormonal systems are activated as well that lead to the progression of heart failure. Ironically, heart failure itself can complicate things by making disordered breathing more likely. In general, if you have a suspicion for sleep apnea, it is best to be evaluated, especially if you have a history of heart failure. Whether sleep-apnea by itself can cause heart failure or cardiomyopathy without other risk factors is currently uncertain, but a topic of ongoing clinical research.