The Relationship Between Sleep Apnea and High Blood Pressure

Sleep apnea may put people at risk for hypertension

sleep apnea and high blood pressure
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One of the most common and underrecognized causes of high blood pressure is sleep apnea. According to an article from the journal Hypertension, it is estimated that approximately 50 percent of those diagnosed with high blood pressure likely have obstructive sleep apnea (OSA). Clinically, I also find that OSA is an extremely common cause of high blood pressure in individuals that is difficult to control. Difficult to control blood pressure (also referred to as resistant hypertension) means that you need three or more blood pressure medications to treat your blood pressure.

Any disturbance in the quality or quantity of your sleep can increase your risk of developing high blood pressure. Sleep apnea is the most common undiagnosed medical condition that increases your risk of developing uncontrolled high blood pressure.

How Do You Know if You Have Sleep Apnea? 

Common symptoms include: 

  • Severe snoring when sleeping.
  • Apneic periods: You or your significant other notice that you may stop breathing for a second or two. This may happen many times during the night while you are sleeping.
  • Feeling extreme fatigue in the morning: This goes above and beyond just "feeling tired" in the morning. It is usually associated with extreme fatigue. Instead of feeling refreshed in the morning, you feel as if you could sleep for another eight hours. Another medical term to describe this is a "non-restorative sleep pattern."
  • A morning headache: Having a headache when you awaken can be a sign that you have sleep apnea. Sleep apnea is a state of oxygen deprivation at night which can contribute to a morning headache.
  • Many people with sleep apnea may not have any of the above-mentioned symptoms. As a clinician, when I suspect that someone has sleep apnea, even in the absence of symptoms, the majority of the time there was some degree of sleep apnea that required treatment to relieve this condition. 

Risk Factors for Obstructive Sleep Apnea

Risk factors for the development of sleep apnea include:

The Sleep Apnea/High Blood Pressure Link 

It is important to understand what should happen when someone goes to sleep. Normally when we sleep at night, our blood pressure should decrease compared to during the day. Our bodies should completely relax, and the blood pressure normally should decrease to a level of 125 mmHg or lower. When you have sleep apnea, your body at night does anything but relax. Think of sleep apnea as the equivalent of someone trying to choke you while you sleep. Your body does not get the oxygen that it so desperately craves while you are sleeping.

Recall that your blood pumps the blood (which carries oxygen) to the cells and tissues of your body. In response to this oxygen deprivation, your heart, lungs, and kidneys work harder. Picture this occurring every night for weeks to months to years. It is under-recognized because not many health professionals ask about it and not many patients think about it.

The Consequences of Untreated Sleep Apnea

Left undiagnosed and untreated, sleep apnea can cause:

  • Resistant hypertension
  • Pulmonary hypertension 
  • Swelling in the legs called edema
  • Heart Disease: Untreated OSA is considered to be a risk factor for the development of heart disease.
  • Kidney Disease: OSA is a risk factor for the development of kidney disease and proteinuria. 

How Is OSA Diagnosed?

While the above symptoms may suggest that sleep apnea is present, the gold standard for diagnosis is a sleep study or polysomnography. This is a test that can tell the doctor not only if sleep apnea is present but also the degree of OSA present (i.e., mild, moderate, or severe). It can also help tell the physician if other conditions are present, including restless legs syndrome or periodic limb movement syndrome, both of which commonly occur in patients with OSA.

How is OSA Treated?

  • Weight loss and avoidance of alcohol are important. Even a five-pound weight loss can improve symptoms of sleep apnea.
  • The use of a "sleep machine" called CPAP or continuous positive airway pressure is prescribed by a physician. A follow-up sleep study is often needed to be sure that the CPAP prescription is the right one for you.
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