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What Do I Need To Know About Sleep Apnea after AVR?
Two months after AVR, my cardiologist's nurse tole me my Dr. accidentally ran onto sleep apnea, while going somewhere else entirely. This ball is out of left field, and I'm finding the posts a little confusing. An answer to any of these questions, even one, will help me know what to ask when I see him next week.
1. Everyone assures me it must be obstructive, thinking maybe of my age or weight (64, not obese but overweight). I'm not so sure, as my son had central sleep apnea in infancy and, in retrospect, I have had these very mild symptoms, off and on, for quite a few years. What will he want to know, and what tests will he do to find out which it is? I only THINK I might have had it a long time, it has not been suspected or diagnosed and it has never bothered me.
2. I was slightly short of breath, almost not noticeable, for a few months before AVR. However, a couple of weeks before surgery, I started struggling to breathe--associated at first with starting a beta blocker, but not quitting afterward--and I have been very short of breath ever since surgery. SOB does not wake me, though--nothing does! (Although everyone except my kids, who have seen me sleep, swears that the apnea must wake me, but I just don't know it at the time.) Does anyone know of a link between shortness of breath and the onset of apnea?
3. Is it possible this sleep apnea messed up my (bicuspid aortic) valve, or the valve/valve surgery caused the sleep apnea? Is it a common occurrence with this surgery?
4. The sleep apnea seems quite mild now; is this a progressive condition, and how fast does it change? What other symptoms will arise?
Thank you. I want to have as much background as you can give me, so I don't waste my appointment by not knowing the right questions.
1. Everyone assures me it must be obstructive, thinking maybe of my age or weight (64, not obese but overweight). I'm not so sure, as my son had central sleep apnea in infancy and, in retrospect, I have had these very mild symptoms, off and on, for quite a few years. What will he want to know, and what tests will he do to find out which it is? I only THINK I might have had it a long time, it has not been suspected or diagnosed and it has never bothered me.
2. I was slightly short of breath, almost not noticeable, for a few months before AVR. However, a couple of weeks before surgery, I started struggling to breathe--associated at first with starting a beta blocker, but not quitting afterward--and I have been very short of breath ever since surgery. SOB does not wake me, though--nothing does! (Although everyone except my kids, who have seen me sleep, swears that the apnea must wake me, but I just don't know it at the time.) Does anyone know of a link between shortness of breath and the onset of apnea?
3. Is it possible this sleep apnea messed up my (bicuspid aortic) valve, or the valve/valve surgery caused the sleep apnea? Is it a common occurrence with this surgery?
4. The sleep apnea seems quite mild now; is this a progressive condition, and how fast does it change? What other symptoms will arise?
Thank you. I want to have as much background as you can give me, so I don't waste my appointment by not knowing the right questions.
Thanks for the response, and the message about the apnea resource.
I haven't seen my cardiologist about this yet; his assistant said since I had an appointment soon, and it wasn't serious enough to be an emergency, he'd tell me all about it then. This about doubles the usual list of questions I take to an appointment--good thing he's a long-time professor and used to explaining things.
I think probably the oxygen monitor is the thing that got me into this fix. X-P The equipment people gave me a pulse oximeter with a recorder attached to see whether I qualified for my insurance carrier to give me a personal oximeter--and the results indicated sleep apnea, a surprise.
My daughter had two sleep studies when she was quite young, as a volunteer subject for a research project in the nursing school. They came to the house and wired her up, which was no problem for her going to sleep, but I was glad I wasn't trying to do that. This week, another cardiac patient told me they don't do that for patients, I'll almost certainly need to go to a sleep center--she told me it took her 45 minutes to go to sleep. Hah! I'm guessing 4 or 5 hours for me!
But, as you say, it'll be interesting to see what happens. :-)
I haven't seen my cardiologist about this yet; his assistant said since I had an appointment soon, and it wasn't serious enough to be an emergency, he'd tell me all about it then. This about doubles the usual list of questions I take to an appointment--good thing he's a long-time professor and used to explaining things.
I think probably the oxygen monitor is the thing that got me into this fix. X-P The equipment people gave me a pulse oximeter with a recorder attached to see whether I qualified for my insurance carrier to give me a personal oximeter--and the results indicated sleep apnea, a surprise.
My daughter had two sleep studies when she was quite young, as a volunteer subject for a research project in the nursing school. They came to the house and wired her up, which was no problem for her going to sleep, but I was glad I wasn't trying to do that. This week, another cardiac patient told me they don't do that for patients, I'll almost certainly need to go to a sleep center--she told me it took her 45 minutes to go to sleep. Hah! I'm guessing 4 or 5 hours for me!
But, as you say, it'll be interesting to see what happens. :-)
I'm not real up on central apnea. I think a degree of it is considered normal. Whether awake or asleep, it's something about the brain reading C02 levels to know when we need to inhale. It's a natural tendency for many to hold their breath when doing something. When doing physical therapy, my PT kept telling me to breathe.
You are one who thrives on information and understanding what is going on with you. I think you would be fascinated by getting a sleep study then getting a detailed copy of it and deciphering it.
My sleep was restless more due to limb movement issues. Before that, I slept soundly except for occassionally waking up to coughing and a racing heart, which I found out later was the apnea. I have read that central sleep apnea tends to cause more complete awakenings than obstructive, which many people are not awakened enough to remember, but enough to disrupt their sleep stages.
As a spot check, a doctor could order you to wear a recording oxygen monitor for a night or two at home and see if you are registering any fluctuations of concern. That would be an easy place to start. Keep us posted as you go along.
You are one who thrives on information and understanding what is going on with you. I think you would be fascinated by getting a sleep study then getting a detailed copy of it and deciphering it.
My sleep was restless more due to limb movement issues. Before that, I slept soundly except for occassionally waking up to coughing and a racing heart, which I found out later was the apnea. I have read that central sleep apnea tends to cause more complete awakenings than obstructive, which many people are not awakened enough to remember, but enough to disrupt their sleep stages.
As a spot check, a doctor could order you to wear a recording oxygen monitor for a night or two at home and see if you are registering any fluctuations of concern. That would be an easy place to start. Keep us posted as you go along.
Your post is very helpful, gives me more information that I was really wanting about what is involved in the sleep study; information is my friend.
I have been tired as long as I can remember, but I've had procedures or Dx in the past that were supposed to increase my energy (AVR, for example!) and don't.
I am particularly interested in your statement that you stop breathing while awake, and have to remind yourself. I have had that happen for many years, maybe always, that I've known of. I did it after surgery in March while a nurse was taking data, and my O2 did drop to 91 briefly, and she reminded me to breathe--I hadn't really thought of it yet, but when she said it, I realized I hadn't been.
On another occasion, maybe 15 years ago, I was in the ER in a room, but triaged not serious and they were busy (here in Tucson, maybe everywhere, on Friday and Saturday nights, all night, they are crowded with gunshot and knifing victims as well as auto accidents--not to mention sometimes dealing with the other guy from the fight). I was relaxed, the pain had let up some and I was tired. I kept hearing this alarm go off, really every few seconds some of the time, and finally realized it was happening when I didn't breathe. Nobody there was concerned about it, but then, I wasn't bleeding on the clean floor, Anyway, I'm pretty sure it was the same thing I experience now.
Do you sleep soundly, or do you feel that your sleep is disrupted?
I almost never wake up in the night, kids say I don't snore or anything, but I would think I have gaps in breathing if I have them in the daytime. Also, there's this thing where they say, you can be waking up but no one around you knows you're waking up?
Anyway, I sleep like a brick once I get to sleep, my family mostly does--sometimes we say we "die" until morning. My vital signs get pretty low, not low enough to worry me but low enough that when I wake in the morning, I'm limp until bp and HR pick up a little; it's been interesting to watch the numbers, and try to relate them to how I feel. It will seem very odd, though, if they discover (as, I guess, they will) that my sleep is disrupted, since it's always seemed so total.
Thanks for your response. I hope you have a moment to look at the questions here.
I have been tired as long as I can remember, but I've had procedures or Dx in the past that were supposed to increase my energy (AVR, for example!) and don't.
I am particularly interested in your statement that you stop breathing while awake, and have to remind yourself. I have had that happen for many years, maybe always, that I've known of. I did it after surgery in March while a nurse was taking data, and my O2 did drop to 91 briefly, and she reminded me to breathe--I hadn't really thought of it yet, but when she said it, I realized I hadn't been.
On another occasion, maybe 15 years ago, I was in the ER in a room, but triaged not serious and they were busy (here in Tucson, maybe everywhere, on Friday and Saturday nights, all night, they are crowded with gunshot and knifing victims as well as auto accidents--not to mention sometimes dealing with the other guy from the fight). I was relaxed, the pain had let up some and I was tired. I kept hearing this alarm go off, really every few seconds some of the time, and finally realized it was happening when I didn't breathe. Nobody there was concerned about it, but then, I wasn't bleeding on the clean floor, Anyway, I'm pretty sure it was the same thing I experience now.
Do you sleep soundly, or do you feel that your sleep is disrupted?
I almost never wake up in the night, kids say I don't snore or anything, but I would think I have gaps in breathing if I have them in the daytime. Also, there's this thing where they say, you can be waking up but no one around you knows you're waking up?
Anyway, I sleep like a brick once I get to sleep, my family mostly does--sometimes we say we "die" until morning. My vital signs get pretty low, not low enough to worry me but low enough that when I wake in the morning, I'm limp until bp and HR pick up a little; it's been interesting to watch the numbers, and try to relate them to how I feel. It will seem very odd, though, if they discover (as, I guess, they will) that my sleep is disrupted, since it's always seemed so total.
Thanks for your response. I hope you have a moment to look at the questions here.
I certainly understand that taking on treatment of another problem so soon is not something one would wish to do.
I tend to not breath for long periods when awake and have to remind myself sometimes to breathe, but when I had the sleep studies no central apnea showed up.
The sleep study will tell you so much more than the oximeter alone. There are several aspects of sleep apnea factored in the diagnosis... type, number and length of apneas, oxygen level, and how the events affect your sleep stages. It monitors your brain waves and your heart. If someone for example only had 10 events per hour, but their oxygen dropped real low, that could be as medically serious as someone with 30 brief events per hour. And if one's sleep architecture is repeatedly disrupted, sleep deprivation brings on a host of other health issues.
I have been on cpap for a few years now, and in the beginning it was awful for me and I quit. I paid the price with my health, and was more than glad to go back on cpap and be compliant. Now it is second nature, and my sleep is so much better, I wouldn't think of sleeping without it. You have to believe you need it, and the details of a sleep study will convince you one way or another. Good luck on working thru this.
I tend to not breath for long periods when awake and have to remind myself sometimes to breathe, but when I had the sleep studies no central apnea showed up.
The sleep study will tell you so much more than the oximeter alone. There are several aspects of sleep apnea factored in the diagnosis... type, number and length of apneas, oxygen level, and how the events affect your sleep stages. It monitors your brain waves and your heart. If someone for example only had 10 events per hour, but their oxygen dropped real low, that could be as medically serious as someone with 30 brief events per hour. And if one's sleep architecture is repeatedly disrupted, sleep deprivation brings on a host of other health issues.
I have been on cpap for a few years now, and in the beginning it was awful for me and I quit. I paid the price with my health, and was more than glad to go back on cpap and be compliant. Now it is second nature, and my sleep is so much better, I wouldn't think of sleeping without it. You have to believe you need it, and the details of a sleep study will convince you one way or another. Good luck on working thru this.
Thanks very much for your reply.
My O2 always measured 98% +. At and after surgery (maybe before a while) it varied quite a lot, going as low as 91% for short times. I asked my cardiologist to prescribe an oximeter so I could keep track, as the reasonably good ones are quite expensive and I'd lost my cheap one. It turned out the requests are referred to an equipment guy who does an overnight O2 test--which I was sure would be high, probably too high to get the oximeter. On the contrary, it indicated sleep apnea, and now I have to have a sleep study. I should have just bought another cheap oximeter!
For an AVR patient, I take very little medication. Prior to surgery, I briefly took metoprolol, 100mg/day, which caused orthostatic hypotension and SOB and was discontinued. The only heart meds I take now are 25mg Atenolol per day (starting after SOB began) and 81mg aspirin per day. I am also taking ferrous sulfate for anemia, but not much longer as my hematocrit is back to normal (which I hoped would stop the SOB but didn't).
I'm not at all sure the apnea hasn't been with me for a while. I have gaps in breathing while awake, although I have no common nighttime symptoms like snoring or waking (according to my kids). I haven't seen my dr. yet and don't know how many times an hour I stop breathing. My son had sleep apnea as an infant, which would have been central.
It's kind of academic now, whether the valve was affected by apnea or not, since it's been replaced, although I suppose the same affect could happen to the new valve, a xenograft.
Since my life has been so changed by Dx and surgery for AVR in the past couple of months, I seem to have a great resistance to dealing with another issue. It wasn't observed until this oximeter test, and now I wish I hadn't done it--I hate to open the door to another big medical mess. And I wish I knew more about it now--I always want to know what to ask my Dr. to find out what I want to know; they don't always volunteer the kind of information that's important.
If I understand it, I guess it's a matter of how often breathing stops or hesitates each hour that determines the seriousness, isn't it? I think my dr. has the data to tell me how often. Do you know what the parameters are, the difference between mild. moderate, severe, whatever the levels are called?
Thanks for answer. I'll check back, or send a private message if you want.
My O2 always measured 98% +. At and after surgery (maybe before a while) it varied quite a lot, going as low as 91% for short times. I asked my cardiologist to prescribe an oximeter so I could keep track, as the reasonably good ones are quite expensive and I'd lost my cheap one. It turned out the requests are referred to an equipment guy who does an overnight O2 test--which I was sure would be high, probably too high to get the oximeter. On the contrary, it indicated sleep apnea, and now I have to have a sleep study. I should have just bought another cheap oximeter!
For an AVR patient, I take very little medication. Prior to surgery, I briefly took metoprolol, 100mg/day, which caused orthostatic hypotension and SOB and was discontinued. The only heart meds I take now are 25mg Atenolol per day (starting after SOB began) and 81mg aspirin per day. I am also taking ferrous sulfate for anemia, but not much longer as my hematocrit is back to normal (which I hoped would stop the SOB but didn't).
I'm not at all sure the apnea hasn't been with me for a while. I have gaps in breathing while awake, although I have no common nighttime symptoms like snoring or waking (according to my kids). I haven't seen my dr. yet and don't know how many times an hour I stop breathing. My son had sleep apnea as an infant, which would have been central.
It's kind of academic now, whether the valve was affected by apnea or not, since it's been replaced, although I suppose the same affect could happen to the new valve, a xenograft.
Since my life has been so changed by Dx and surgery for AVR in the past couple of months, I seem to have a great resistance to dealing with another issue. It wasn't observed until this oximeter test, and now I wish I hadn't done it--I hate to open the door to another big medical mess. And I wish I knew more about it now--I always want to know what to ask my Dr. to find out what I want to know; they don't always volunteer the kind of information that's important.
If I understand it, I guess it's a matter of how often breathing stops or hesitates each hour that determines the seriousness, isn't it? I think my dr. has the data to tell me how often. Do you know what the parameters are, the difference between mild. moderate, severe, whatever the levels are called?
Thanks for answer. I'll check back, or send a private message if you want.
Meant to ask if you were on any meds known to be risky for causing heart valve issues?
Maybe when you had your procedure some oxygen ratings showed up that cued your doc in. An overnight sleep study will answer a lot of your questions. It will record whether your events are central, obstructive, or both. The type of apnea you have will make a difference which type of machine will work best for you. The study will determine if it is mild, moderate or severe, as like you said, you're asleep so you really can't tell. A diagnosis of mild does not mean you don't have to treat it. Any diagnosis means treatment is needed, as the ratings already allow a certain number of events that are considered acceptable. Sleep apnea does increase cardiac risk, but I haven't read anything about your particular heart problem. Good thing to ask the doc. I doubt your daytime SOB is sleep apnea related - probably different things going on with you. Without sleep study results, everything is a maybe. Hope you get that scheduled soon.
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