Sleep Apnea and High Blood Pressure
Extensive research has shown that people with sleep apnea have an increased risk of developing high blood pressure. In fact, The National Institutes for Health listed sleep apnea as an identifiable cause of high blood pressure.
Healthy sleep is essential for a healthy life because our quality of sleep affects our overall well-being. Normal sleep is generally composed of two main states: non-rapid eye movement (called non-REM) and rapid eye movement (called REM) sleep. Non-REM sleep makes up about 80% of our sleep and includes the occurrence of hormone release, which is very important to allow the body to function. REM sleep accounts for about 20% of the night and is the stage of “deep” sleep where dreams occur. Sleep apnea interrupts both non-REM and REM sleep. The interruption of both stages of sleep does not allow systems, like your heart, to rest and recover as they normally would.
During sleep, the upper airway collapses obstructing airflow from moving through the airway. Sleep apnea affects about 1 in 5 people. In the U.S. alone, sleep apnea affects 20 million adults and has also been closely linked to obesity, heart failure and diabetes. People with sleep apnea stop breathing while they’re asleep, sometimes hundreds of times a night. A bed partner may even witness these gasps that are followed by a coughing sound, which opens the airway again. Common symptoms of OSA include: snoring, constant tiredness, poor concentration, depression, lack of energy, weight gain or loss and high blood pressure.
Sleep Apnea and High Blood Pressure
Normally, blood pressure decreases during healthy sleep. However, people with sleep apnea tend to experience elevated blood pressure during sleep. This is due to the apneas (a pause in breathing for 10 or more seconds) and hypopneas (shallow breathing) associated with sleep apnea, which can lead to decreased amounts of oxygen and high levels of carbon dioxide in the blood. As these levels become more extreme, the body begins to struggle for air, which causes a brief awakening and the continuation of breathing. During each apnea, sympathetic nervous system activity increases, leading to irregular heart rate and increased blood pressure. Instead of getting a restful night’s sleep, people with sleep apnea experience severe stress on the heart, leading to increased blood pressure that affects the body both night and day. People with uncontrollable high blood pressure (those taking more than two drugs for their condition) are even more likely to have sleep apnea.
Treating Sleep Apnea
The good news is that sleep apnea is easily treatable without surgery or taking pills. The sleep disorder is commonly treated with continuous positive airway pressure (CPAP) therapy. A bedside device gently delivers pressurized air through a small nasal mask or pillows system. This pressure acts like an “air splint” to keep the upper airway open throughout the night. CPAP treatment for sleep apnea has been shown to significantly decrease blood pressure in sleep apnea patients, and these decreases can be seen during both sleep and wake time. Recent studies show that treating sleep apnea can decrease blood pressure and improve cardiovascular function. [1,2]
Conclusion
If you think you or your loved one may have sleep apnea, talk to your cardiologist or your family doctor about these symptoms to see if further evaluation is required. If your clinician finds that you have symptoms of sleep apnea, you will be sent to a sleep specialist for an overnight evaluation. If you test positive for sleep apnea, the sleep specialist will write you a prescription for CPAP therapy. This treatment is covered by most insurance.
[1] Gami et al. Association of atrial fibrillation and obstructive sleep apnea. Circulation 2004;110:364-367.
[2] Milleron et al. Benefits of obstructive sleep apnoea treatment in coronary artery disease: a long-term follow-up study. European Heart Journal2004;25:728-734.