How sleep apnea causes heart attacks – and how Israeli tech helps

Itamar Medical, one of the first companies in the world to embrace the idea of a link between heart disease and sleep apnea, is now the only company in the world offering cardiologists a platform to track, treat, and manage apnea in their patients.

The cardiologists are embracing it, according to CEO Gilad Glick.

“After years of standing by the theory of a direct connection between heart disease and sleep issues, the medical establishment has endorsed our ideas, and our international symposium here in Tel Aviv on the subject was enthusiastically attended and embraced by cardiologists visiting from around the world,” said Glick. “With our Total Sleep Solution, cardiologists and other doctors for the first time have an easy way to take care of dealing with an important but difficult-to-implement care solution for heart patients.”

Glick was speaking on the sidelines of the 13th International Dead Sea Symposium on Innovations in Technology, Treatment & Prevention of Cardiac Arrhythmias, held in Tel Aviv last week. During the event, Itamar held its own mini-symposium on “Sleep Apnea and Arrhythmias,” reviewing the recent research highlighting the strong connection between sleep issues and heart problems and presenting ways for cardiologists to integrate sleep management into their treatment plans.

That research, which started in dribbles and drabs about a decade ago, has turned into a tsunami of data over the past five years showing how sleep apnea is not only associated with heart attacks, but is actually a cause of heart attacks.

“There is today no question about it,” said Glick. “The research we presented at our mini-symposium showed very clearly that apnea is a cause and modulator of cardiac disease – the more apnea, the more heart disease, and the less apnea, the less heart disease.”

Sleep apnea is a condition in which an individual has trouble breathing while asleep, with patients suffering from conditions ranging from short, shallow breathing to gasping and wheezing during sleep, to going for long seconds or even minutes without drawing a breath. The body needs oxygen 24 hours a day, and the body’s autonomic nervous system generally takes care of breathing while an individual is asleep. When the body is denied a sufficient measure of oxygen, the results can include daytime fatigue, heavy snoring, and liver and heart problems.

The most common form of the disease is called Obstructive Sleep Apnea (OSA), in which individuals with low muscle tone – usually those middle-aged and older (most often men), but including overweight or out-of-shape younger people – develop a narrower breathing tube that restricts the flow of air into the body.

Choking from a lack of air isn’t the most dangerous part of OSA; if a person can’t breathe, he or she is likely to wake up right away. The greater danger is heart attack or stroke; as less oxygen gets into the bloodstream, the body works harder to pump in more blood so all organs and systems get the oxygen they need. As the heart pumps harder, OSA sufferers are at greater risk for a cardiovascular incident.

It is estimated that as many as one in 15 Americans age 50 and over suffer from some form of OSA, with many of that group at much higher risk for heart attacks when they hit age 65. Untreated sleep apnea doubles the risk of stroke and the risk of sudden death from heart attacks, and increases the risk for death from cardiovascular issues by 500%, the research shows.

To help detect OSA, Itamar Medical several years ago developed a device that measures the flow of blood in the arteries to determine how hard the heart is working during sleep. The technology, called PAT – Peripheral Arterial Tone – measures arterial function and the speed and health of blood flow, and the device, called the WatchPAT, sets off an alarm when blood flow increases to a level that indicates that the heart is overworking as an individual sleeps, indicating the presence and degree of sleep apnea based on algorithms developed by the company.

Itamar Medical’s WatchPAT (Courtesy)

While PAT technology by itself can help cardiologists determine if their patients are suffering from OSA, the question of how to deal with apnea is another matter altogether.

“Traditional apnea management is a nightmare – it’s very invasive, requires tubes, sensors, and other equipment,” said Glick. “Cardiologists are just not equipped to deal with treating OSA, nor do they have the time or inclination to integrate it into their practices. And the outcome from traditional treatments is moderate at best, meaning that only about half the cases of OSA are treated successfully. But our platform, the Total Sleep Solution, provides cardiologists with a turnkey platform that allows them to integrate OSA treatment.”

Based on WatchPAT, a wearable monitor developed by Itamar, the system reads data, uploads it to a cloud server, and analyzes the wearer’s vital heart and OSA signs. If there is a problem, the appropriate care provider is alerted, and intervention plans can be made to prevent the further development of OSA.

So far, the system has been adopted by 60 hospitals around the world. In addition, there are hundreds of cardiologists and other medical practitioners who have adopted the system, said Glick.

“We developed this system after extensive research and consultation with cardiologists, and we train doctors in how to use the system,” said Glick. “For them, it is a win-win, because they have a service they can offer their patients, they can help alleviate a major medical issue that aggravates problems in their cardiac patients, and they don’t have to invest time and effort in learning to deal with a new care component. We do all the work for them – from diagnosis to helping design a treatment protocol, to ensuring patient compliance.”

“Three and a half million Americans suffer from sleep apnea,” said Glick. “The numbers show that most of them are going to end up with a catheter in the heart, or open heart surgery. As long as the apnea remains untreated, their chances of survival are at best 60%, the statistics show. But heart patients who are treated for apnea have more like an 80% success rate, meaning they survived at least a year. There are tens of millions of heart patients in the US alone – and who knows how many of them were apnea sufferers first, with doctors failing to make the connection between that condition and their heart problems. Clearly the world needs this system, and it’s no wonder cardiologists are very interested in what we are doing.”