Introduction

Sleep apnea is a condition characterised by your breathing stopping and starting repeatedly throughout the night while sleeping. This occurs as a result of the pharynx (throat) being completely or partially blocked, preventing the body from receiving enough oxygen. There are three types of sleep apnea: obstructive, central, and treatment-emergent central.¹ There are similar symptoms they all share, such as snoring, gasping for air during sleep, dry mouth, and poor sleep quality that causes a feeling of tiredness during the day.² A healthcare professional should be consulted if you experience any of these symptoms, as research has demonstrated a link between sleep apnea and cardiovascular disease, including heart enlargement (cardiomegaly). There are several treatments available to manage sleep apnea, which also improves heart enlargement in patients. Therefore, this article will explore the effects of sleep apnea treatments on the enlargement of the heart.³

Understanding the link between sleep apnea and heart enlargement

According to the National Heart Lung and Blood Institute (NHLBI) Sleep Heart Health Study, sleep apnea increases cardiovascular disease risk such as heart failure, strokes, and coronary heart disease. Each of these conditions put the heart at risk for enlargement. Due to sleep apnea, oxygen levels are reduced, causing a rise in blood pressure, resulting in thickened and dilated heart chambers. Leaving sleep apnea untreated can result in heart enlargement.³

Common treatments for sleep apnea

There are a variety of treatment options available for sleep apnea, including lifestyle changes, breathing devices, oral devices, and surgical procedures.¹ To avoid sleep apnea symptoms, these treatments will ensure that the airways remain open/clear, allowing oxygen levels to be provided throughout the body to maintain normal breathing. Heart enlargement can be prevented with the help of these treatments as it can be beneficial for improving cardiovascular health.²

Lifestyle modifications

The following lifestyle changes would be recommended by a healthcare professional for individuals with less severe sleep apnea:

• Change of diet and exercising for weight loss
• Reducing alcohol and caffeine intake
• Quitting smoking 
• Change position of sleeping from on the back to the side to keep airways open^1,2

Heart enlargement can be reduced by making these lifestyle modifications. A healthy diet and regular exercise can help prevent the development of other conditions such as high blood pressure, high cholesterol, and type 2 diabetes, which can strain your heart and cause enlargement. Smoking cigarettes can lower oxygen levels in the blood, making the heart work harder, resulting in higher blood pressure and enlarging the heart, which should also be avoided.⁴

If these changes do not work and your sleep apnea is more moderate or severe, then several other treatment options are available.²

Continuous positive airway pressure (CPAP) Therapy

In most cases of moderate or severe sleep apnea, CPAP therapy is the preferred treatment. Whilst sleeping, this machine provides a constant flow of air at the same pressure through your upper airways, allowing you to breathe normally.

By placing a mask over the nose or over both the nose and mouth, the device can be used. This treatment can prevent common sleep apnea symptoms, especially snoring, and can improve your quality of sleep. However, it can cause some side effects, such as dry mouth or nose, nosebleeds and a runny nose.^1,2

Heart enlargement can be prevented by using CPAP as it increases oxygenation to the body, resulting in lower blood pressure. In this way, a patient with sleep apnea can reduce their risk of developing cardiovascular conditions as well as heart enlargement. Studies have shown that CPAP is able to improve the heart's structure by preventing chamber dilation alongside reducing left ventricular hypertrophy.⁵

Bilevel positive airway pressure (BiPAP) Therapy

BiPAP machines are an alternative to CPAP machines for those individuals who find them uncomfortable to use. It is also used for cases of moderate or severe sleep apnea. When you inhale, it provides a higher pressure known as inhalation positive airway pressure (IPAP) and when you exhale, it provides a lower pressure known as exhalation positive airway pressure (EPAP). The varying pressure setting helps keep your airways open so that your body can receive more oxygen. A mask can be placed over the face for its use, rather than just on the nose or mouth. The effects of this treatment are similar to those of CPAP in terms of heart enlargement. As it allows oxygen levels to increase, much less strain is placed on the heart, thereby preventing heart enlargement that is caused by other cardiovascular conditions.^6,7

Oral devices

Oral devices are another form of treatment for sleep apnea, which is recommended for those who cannot tolerate the mask-worn machines. The dentist can provide different oral devices which can prevent blocked airways while sleeping, by the placement of them in the mouth.²

Examples of oral devices include:

• Mandibular repositioning mouthpiece:  It covers the upper and lower teeth that hold the jaw in place so that it does not slide backwards and block the upper airway
• Tongue retaining device: It is a mouthpiece that holds the tongue in a forward position to prevent it from blocking the upper airway¹

People with sleep apnea may find oral devices less effective than CPAP, but they are easier to use and more comfortable. The treatment reduces the severity of sleep apnea in a similar way to CPAP, which can help prevent heart enlargement. A few studies indicate that blood pressure and sleep quality may improve, also reducing a strain on the heart from these devices.⁸

Surgical Interventions

Surgery is taken into consideration as a last resort for sleep apnea when all other treatments have failed or in emergency cases, such as:

• Surgical device implantation - Involves placing a surgical device in the mouth and upper chest region that opens the airways by stimulating particular nerves in the throat
• Uvulopalatopharyngoplasty (UPPP) - To enlarge the upper airways, tissue in the mouth and throat can be surgically removed
• Tissue shrinkage - Similar to tissue removal, radiofrequency ablation is used to shrink tissue in the mouth or at the back of the throat
• Jaw repositioning - By surgically moving the upper and lower jaw forward, upper/lower jaw advancement can also enlarge the upper airway
• Tracheostomy - An opening in the neck is made to allow insertion of a metal or plastic tube for breathing, creating a new airway. It is covered during the day and left open at night to allow air to flow and avoid obstructing the throat's airway (for life threatening sleep apnea)
• Adenotonsillectomy - Removal of enlarged tonsils or adenoids^9,10

Following surgery, the effects of these procedures on heart enlargement may help to raise oxygen levels, which will result in having the same effect as the other treatments.

Conclusion

In summary, a person with sleep apnea can experience irregular breathing while they are asleep. Understanding this condition is crucial because it affects both the cardiovascular and respiratory systems. Over time, studies have found connections between sleep apnea and cardiovascular diseases, including the widely discussed condition of heart enlargement. Therefore, to ensure effective management of sleep apnea, it is best to consult a healthcare professional as soon as possible. Treatment for sleep apnea will not only overcome its sleep related symptoms, but it will also enhance cardiovascular health from which the risk of heart enlargement will lower.