Heart Disease and Sleep Apnea

According to the American Heart Association (AHA), 40-80% of people with hypertension, heart
failure, coronary artery disease, pulmonary hypertension, atrial fibrillation, and stroke have sleep
apnea [1]. These and similar conditions — collectively referred to as heart disease — are the
leading causes of death worldwide [2].
Because sleep apnea is so common in heart disease patients, it has been studied as a possible
risk factor. That’s also why the AHA recommends screening for sleep apnea in patients with
certain heart conditions so they can get adequate treatment.

Here is more on how heart disease is linked to sleep apnea and why that matters.

Sleep Apnea and Heart Disease
Sleep apnea and heart disease are common health problems with a strong bidirectional link.
Decades of observational research suggest sleep apnea to be a risk factor for many heart
conditions, but the opposite may be true according to newer research [3].
Case in point: In the early 80s, doctors noted that following tracheostomy, many sleep apnea
sufferers showed a decrease in blood pressure and less severe arrhythmias [4]. Later research
found sleep apnea to be strongly linked to [3]:
● Hypertension
● Coronary artery disease
● Heart failure
● Arrhythmias
● Pulmonary hypertension
Furthermore, the National Commission on Sleep Disorders Research estimated that sleep
apnea is behind 38,000 deaths per year [4]. Obstructive sleep apnea is believed to increase the
risk of heart failure by 140%, of stroke by 60%, and of coronary heart disease by 30% [4].

How Sleep Apnea Affects Heart Health
The underlying mechanisms linking sleep apnea to heart disease are quite complex. The
frequent arousals from sleep, chronic sleep fragmentation, and low blood oxygen levels all lead
to several problems that put patients at risk of heart disease:
● Sympathetic overstimulation
● Hypercoagulation
● Endothelial dysfunction
● Reduced nitric oxide production
● Oxidative stress
● Vascular inflammation
● Arterial stiffness

Your sympathetic nervous system is responsible for your body’s “fight-or-flight” response. Sleep
apnea causes it to become overstimulated. This causes excessive constriction of blood vessels,
increasing blood pressure and heart rate. What’s more, sleep is also essential for normal
metabolic functioning. Sleep apnea disrupts normal metabolism, causing insulin resistance and
elevated blood lipids, which further damage the heart and blood vessels.

Lowering Your Risk of Heart Disease
Sleep apnea is one of many potential risk factors for heart disease. Because this sleep disorder
can significantly increase your risk of developing heart problems, it is important to get treatment
before any damage is done.
To diagnose sleep apnea, doctors check your symptoms, review your medical history, and order
a sleep study if your symptoms point to sleep apnea. If you end up being diagnosed with this
condition, the good news is that it is treatable. Treatment usually entails using a device that
helps you breathe at night called a CPAP machine.
However, many patients find CPAP machines to be cumbersome, while others have mild to
moderate OSA [1]. In these cases, the AHA recommends oral appliances as an alternative [1].

However, it is important to speak to your doctor first before considering oral appliances as an
alternative to CPAP machines.

1. References:
Yeghiazarians Y, Jneid H, Tietjens JR, Redline S, Brown DL, El-Sherif N, Mehra R,
Bozkurt B, Ndumele CE, Somers VK. Obstructive Sleep Apnea and Cardiovascular
Disease: A Scientific Statement From the American Heart Association. Circulation. 2021
Jul 20;144(3):e56-e67. doi: 10.1161/CIR.0000000000000988. Epub 2021 Jun 21.
Erratum in: Circulation. 2022 Mar 22;145(12):e775. PMID: 34148375.
2. Ritchie H, Spooner F, Roser M. Causes of Death. OurWorldInData.org. 2018. Available
at: https://ourworldindata.org/causes-of-death#citation
3. Peker Y, Akdeniz B, Altay S, Balcan B, Başaran Ö, Baysal E, Çelik A, Dursunoğlu D,
Dursunoğlu N, Fırat S, Gündüz Gürkan C, Öztürk Ö, Taşbakan MS, Aytekin V.
Obstructive Sleep Apnea and Cardiovascular Disease: Where Do We Stand? Anatol J
Cardiol. 2023 Jul 3;27(7):375-389. doi: 10.14744/AnatolJCardiol.2023.3307. Epub 2023
Jun 7. PMID: 37284828; PMCID: PMC10339137.

4. Jean-Louis G, Zizi F, Clark LT, Brown CD, McFarlane SI. Obstructive sleep apnea and
cardiovascular disease: role of the metabolic syndrome and its components. J Clin Sleep
Med. 2008 Jun 15;4(3):261-72. PMID: 18595441; PMCID: PMC2546461.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2546461/#:~:text=Obstructive%20sleep%
20apnea%20increases%20the,coronary%20heart%20disease%20by%2030%25.