NATIONAL stop SNORING Week 19 - 24 APRIL. ZZzzzzzzzzz

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White's sleep ailment common
By SARAH LARSON
The Intelligencer


While the sports world still reeled Monday from the sudden death of football great Reggie White, a preliminary autopsy showed that he may have died from the combined effects of a respiratory and an inflammatory condition.

Local doctors who specialize in respiratory and sleep disorders say that sounds like apnea to them.

"As soon as I heard it was a respiratory illness that affected his sleep, I knew it was sleep apnea," said Dr. Les Szekely, who runs the University of Pennsylvania Sleep Center at Doylestown.

The severity of the condition varies from person to person, said Dr. Howard B. Koffler, a pulmonologist with Pulmonary and Allergy Associates, in Sellersville and Lansdale. Some people, for example, stop breathing eight times an hour, while others may have episodes as many as 60 times an hour, he said.

Cases that severe, Koffler said, are rare.

"Sudden death from stopping breathing is not that common," he said. "It happens, but not often."

There are two basic types of sleep apnea, Szekely said.

The first is called central sleep apnea, because the root cause lies with the central nervous system, he said. In this form, which mostly affects premature infants and some elderly people, the brain essentially forgets to breathe: it does not respond to the normal triggers that signal a person to breathe.

White most likely had the second type, called obstructive sleep apnea, in which the relaxation of sleep causes the soft palate and other tissues at the back of the throat to collapse.

"When the airway collapses, the patient has to wake himself up to open up the airway so they don't suffocate," Koffler said. "If it happens enough, say 20 to 30 times an hour, patients typically feel tired the next day, even though they only wake up for a few seconds. Classic symptoms are that they snore and they are very tired during the day."

Of the dozens of sleep disorders on the books, obstructive sleep apnea is one of the most common, Szekely said, affecting 4 percent of adult men and 2 percent of adult women in this country. That equals about 12 million people, according to the National Institutes of Health.

The doctors said sleep apnea also is associated with other serious conditions - coronary artery disease, irregular heart rhythms, hypertension, stroke and depression. Ongoing studies on sleep apnea hopefully will shed more light on the exact relationships, Koffler said.



"There is no question that sleep apnea and hypertension are associated," he said. "Studies are ongoing, and sleep apnea itself, above and beyond its relation to hypertension, is probably going to be shown to be associated with heart disease and stroke."

It may be too early to know if that is what killed Reggie White, but the theory is plausible, Koffler said.

"When people stop breathing, their oxygen drops, and that can cause a strain on the heart which can lead to heart failure," he said, adding that if White did, indeed, have sarcoidosis, that could have made matters worse. "If you start with a lower level of oxygen to begin with, and you have sleep apnea, you go from low levels of oxygen to very low levels very quickly. That can make you susceptible to problems such as cardiac arrhythmia."

Though White's family's initial statement referred to sleep apnea, it is still not clear whether he was being treated for the disease.

Szekely said treatments range from weight loss, for those who are obese, to surgery to an "oral appliance" that moves the jaw forward. The most common, though, is CPAP, or continuous positive airway pressure, in which a tightly fitted mask hooks to a machine that pressurizes air to keep the back of the throat open.

"It eliminates snoring almost always, and eliminates apnea almost always," Szekely said. "Of my patients who use it, 75 to 80 percent get used to it, love it, and don't leave home without it."

Regardless of whatever killed him, White's death leaves quite a hole for fans.

"He was great," Koffler said, adding that he had Eagles season tickets when White was on the team. "He was fun to watch."

The Associated Press contributed to this report.

Sarah Larson can be reached at (215) 957-8167 or slarson@phillyBurbs.com.

December 28, 2004 5:25 AM