Sleep apnea is a condition where a person’s breathing repeatedly stops and starts during sleep. Pauses can last seconds to over a minute, occurring multiple times nightly. Hypertension, or high blood pressure, is elevated force of blood against artery walls. These two conditions are frequently linked and influence each other.
Understanding the Connection Between Sleep Apnea and Hypertension
Obstructive sleep apnea (OSA) is the main type of sleep apnea linked to high blood pressure. OSA occurs when the muscles in the back of the throat relax and collapse, blocking the airway during sleep. Central sleep apnea (CSA), a less common type, involves a lack of communication between the brain and breathing muscles.
Repeated breathing pauses in OSA lead to drops in blood oxygen levels, leading to hypoxia. These events trigger the body’s “fight or flight” response, activating the sympathetic nervous system. This activation causes blood vessels to constrict and heart rate to increase, leading to temporary spikes in blood pressure during sleep.
Over time, this chronic activation and stress on the cardiovascular system results in persistently high blood pressure, even during waking hours. Disrupted sleep from OSA symptoms also releases stress hormones like catecholamines (dopamine and epinephrine), further contributing to high blood pressure. OSA affects an estimated 30% to 40% of individuals with hypertension.
Recognizing and Diagnosing Sleep Apnea
Common signs of sleep apnea include loud snoring, gasping or choking during sleep, and excessive daytime sleepiness. Other indicators include morning headaches, difficulty with attention and memory, irritability, and a dry mouth upon waking.
Consult a healthcare provider if these symptoms are present, especially if already diagnosed with high blood pressure. A doctor will evaluate symptoms and medical history. Sleep apnea is primarily diagnosed through a sleep study, known as a polysomnogram (PSG), which can be performed either in a sleep laboratory or at home.
During a polysomnogram, sensors monitor heart rate, breathing, and blood oxygen levels. A diagnosis of sleep apnea is made if at least five breathing events per hour of sleep are recorded. The severity of sleep apnea is classified as mild (5-14 events/hour), moderate (15-30 events/hour), or severe (over 30 events/hour), which helps guide treatment decisions.
Managing Sleep Apnea to Improve Blood Pressure
Managing sleep apnea contributes to blood pressure control. Continuous Positive Airway Pressure (CPAP) therapy is an effective treatment for OSA. CPAP involves wearing a mask connected to a machine that delivers a continuous stream of air, keeping the airway open and preventing breathing pauses. This process reduces the stress on the cardiovascular system and helps lower blood pressure day and night.
Lifestyle modifications also play a role in reducing sleep apnea severity and improving blood pressure. These include weight loss and avoiding alcohol and sedatives before bedtime. Sleeping on one’s side, known as positional therapy, can help. Oral appliances, custom-fit dental devices that reposition the jaw to maintain an open airway, offer another treatment option.
In some cases, surgical procedures are considered to address anatomical obstructions contributing to sleep apnea. Effective sleep apnea treatment can reduce blood pressure, potentially decreasing the need for or dosage of antihypertensive medications. Studies indicate that even small decreases in blood pressure contribute to reducing cardiovascular risk.
Long-Term Health Implications
Untreated sleep apnea with hypertension carries long-term health risks. The constant strain on the cardiovascular system increases the likelihood of events such as heart attack and stroke. Heart failure and irregular heart rhythms, like atrial fibrillation, are also more common in people with untreated sleep apnea.
Managing both sleep apnea and hypertension is important for overall health and preventing these outcomes. Addressing sleep apnea is not just about improving sleep quality; it is a component of comprehensive hypertension management. Proper diagnosis and treatment of sleep apnea reduces long-term health risks and improve cardiovascular well-being.