Sleep apnea tricky to diagnose in patients with heart disease

most common initial treatment.

In severe sleep apnea, the oxygen level in the blood can be so low for so long that the heart and lungs can be damaged, eventually leading to a type of heart failure of the right side of the heart.

However, the situation is even more complex. People who have other kinds of heart failure, such as from repeated heart attacks, can develop the less common form of sleep apnea, central sleep apnea. Although this also may be treated by CPAP, it is critical to treat the underlying heart failure as well. Your doctor can tell you whether you have central or obstructive sleep apnea.

Spontaneous deep breaths and sighs are a part of normal human physiology. Sighs have several purposes, the most important being to help keep the lungs properly expanded. Sighs might be more common in people with heart failure, but I do not know of any correlation with sleep apnea.

Dear Dr. Roach: My question involves my dentist insisting on my taking four antibiotics before any procedure, even as minor as a cleaning. I have had a very successful knee replacement. Does this overuse of antibiotics contribute to the increase of “superbugs” that now appear to be very threatening? — S.D.

A: Four expert groups now recommend against the use of antibiotics before dental cleanings in people with prosthetic joints. Your dentist should know that the use of antibiotics does not reduce the risk of infection in the joint you had replaced. The downsides include not only the development of resistance, but also allergic reactions and a variety of other reactions. I can’t comment on your particular case; you might have a situation I don’t know about. However, most people are more likely to have harm than benefit from antibiotics before a dental cleaning, even if they have a joint replacement.