Snoring May Cause Strokes

We’ve always known that that heavy snorers are at increased risk for stroke. But a recent study from Australia showed that carotid artery narrowing in the worst snorers was 10 times higher than those who snore the least. In typical scientific journal fashion, a much larger sample size was said to be needed to establish a casual relationship. You can read a layman’s summary here from the New York Times. The authors proposed that perhaps vibrations themselves can damage the thin inner wall lining, leading to plaque buildup and eventual narrowing.
There are many more published articles that associate snoring with stroke. We know that a significant percentage of people who snore will have obstructive sleep apnea, and sleep apnea is strongly linked to stroke. The frustrating thing is that despite regular reports like this that warn of the the dangers of snoring, people continue to equate snoring as something to be laughed at and doctors continue to treat the end effects of obstructive sleep apnea (such as hypertension, diabetes, depression, anxiety, heart disease, heart attack and stroke). At least once per week, I see a younger snoring patient that tells me that his (or her) father snored heavily and suffered a stroke or a heart attack in their 40s or 50s. The frightening thing is that we know now that you don’t even have to snore to have obstructive sleep apnea.

Do you have a parent that snores heavily, and if so, did they suffer from a stroke or a heart attack at a relatively young age?

Can Obstructive Sleep Apnea Lead to Alzheimer's?

Sleep apnea and Alzheimer's are not commonly known to be associated, but a recent study in the Journal of Clinical Sleep Medicine reported that the greater the severity of one's sleep apnea, the greater the chance that you'll have what are called lacunar infarcts in your brain on an MRI study. Lacunar strokes (or infarcts) occur when small vessels supplying a specific part of the brain gets blocked and can show up on an a CAT scan or MRI as multiple small lesions. These areas correlate with small areas of dead brain tissue in the distribution of small arteries. In the study, 54% of people with severe OSA, and 12% with mild OSA, were found to have lacunar infarcts. All these people were asymptomatic neurologically at the time of testing. Their conclusion was was people with severe OSA have a higher incidence of silent cerebrovascular lesions than their counterparts with less severe OSA.

An interesting finding, in light of the fact that Alzheimer's is now thought to be a disease of small vessels in the brain. There's still a lot of controversy about the clinical significance of incidental lacunar infarcts on an imaging study, but I think you would agree with me that having dozens or hundreds of these small areas of dead brain tissue is not good for your memory. Add to this all the research studies that show that people with OSA are more likely to clot due to increased inflammation in general. Others studies have shown that people with lacunar infarcts have a higher incidence of heart disease. Over 80% of people with OSA are not diagnosed in this country. OSA is known to be strongly linked to heart disease. The links go on and on.

Do you think this is a valid association that's worth further research, or am I taking the sleep-breathing paradigm a little too far?

Migraines Linked to Stroke and Heart Attacks in Women

An interesting study in the January 2008 issue of Cephalagia revealed that women who had migraines more than once per week had nearly three times higher risk of ischemic stroke and 1.5 times more risk of heart attack as compared to women without migraines. Even having migraines once per month or less was associated with a 1.5 times increased risk of stroke or heart attack. The authors state that further research is needed to determine if migraine prevention reduces the risk of cardiovascular diseases. 

My feeling is that even if migraines were controlled with aggressive dietary modifications and pharmacologic agents, there will be minimal to no improvement in the incidence of the risk of heart attack or stroke. My logic is as follows: Migraine is a common feature in people with sleep-breathing disorders. It's especially more common in women (and men) who have upper airway resistance syndrome (UARS), which is a variation/precursor of obstructive sleep apnea (OSA). Obstructive sleep apnea is known to be linked to high blood pressure, heart disease and stroke. In my experience, allowing people to sleep better (by breathing better at night) usually improves migraines, as well as the effects of OSA. So covering up a migraine headache with medications will not address the cause, which is inefficient sleep due to breathing problems at night. I discuss the reasons for this in detail in my forthcoming book, Sleep, Interrupted.