Venous Insufficiency and Obstructive Sleep Apnea

For the most part, you’re a healthy person. You get your annual wellness exams and live a reasonably satisfactory lifestyle. You manage a career, along with family matters and extracurricular activities that are important to you.

Lately, you’re experiencing swelling or edema in your legs, feet, or ankles, which is usually caused by an increase in interstitial fluid volume. Being the health conscious person that you are, you follow-up with your physician and the diagnosis is venous insufficiency, a condition in which the veins have problems sending blood from the legs back to the heart.

Your physician proceeds to order a complete workup to rule out cardiovascular disease, peripheral vascular disease (PVD) known to be linked to diabetes, and peripheral arterial disease (PAD). This may include a venous Doppler ultrasound to evaluate blood flow through blood vessels in the legs, to rule out a blood clot in the vein and leaking around the valves of the veins.

Your physician may also order a sleep study to determine if you have sleep apnea. Sleep apnea occurs due to a blockage in the upper airway and can cause pulmonary hypertension, which is a common cause of leg edema. The most likely cause of leg edema in all patients over age 50 is venous insufficiency. It affects up to 30% of the population. Another type of edema, idiopathic edema, occurs in women under age 50, and is usually associated with the menstrual cycle and conditions related to obesity, depression, and diuretic abuse.

The volume of fluid available for movement from the legs increases with sitting and leg edema. Fluid volume that is displaced from the legs overnight is directly proportional to the time spent sitting during the day, not to physical activity.

Patients susceptible to fluid retention, may have fluid movement from the legs while asleep during the night, which may cause or worsen obstructive sleep apnea (OSA). The fluid increases in the neck and limits airflow in the airway during sleep contributing to cardiovascular disease and other medical conditions.

You may be advised to decrease your salt intake, limit sitting or standing for excessive periods of time, and to wear compression stockings to gently improve the circulation of blood in your legs, and reduce swelling. If you are found to be positive for sleep apnea, you may be advised to use Continuous Positive Airway Pressure (CPAP).

The takeaway…Get moving!