There's an abundance of studies that suggest sleep apnea and high blood pressure are connected and dangerous together. Around 25 million individuals in the U.S. have sleep apnea, according to the American Academy of Sleep Medicine. Obstructive sleep apnea (OSA) occurs when your breathing is interrupted briefly and repeatedly while you sleep. It's been found to increase your risk for high blood pressure.
Chronic loud snoring is a telltale sign of OSA, combined with sounds of choking or gasping. Usually, the individual with OSA doesn’t even realize they’re snoring and it takes a bed partner or family member to point it out to them. Not all people with OSA snore though.
Daytime sleepiness is another main indicator of OSA.
Consequences and Effects of Untreated Sleep Apnea
Untreated sleep apnea and cause:
Pulmonary hypertension: Affects your lung arteries and the right side of your heart.
Resistant hypertension: Blood pressure that stays above goal regardless of coincident use of several antihypertensive agents, one being a diuretic.
Edema: Swelling in the legs
Heart disease: OSA is said to be a risk factor for heart disease development
The Causal Relationship Between Sleep Apnea and High Blood Pressure
The leading cause of death in the U.S. is heart disease, and high blood pressure is a huge risk factor for heart disease.
There's strong evidence for the cause and effect relationship between sleep apnea and hypertension, and the American Heart Association says people really should know this. OSA is also linked with obesity, which is a risk factor for stroke and heart disease.
Research shows high blood pressure, often called the "silent killer," may cause sleep apnea or worsen sleep apnea patient's breathing. Both high blood pressure and sleep apnea have been associated with a substantially increased risk of severe complications, like heart attack and stroke.
Studies found OSA might contribute to poor blood pressure control and that 70 percent of patients with resistant hypertension have OSA. One study found a strong link between untreated severe OSA and the risk of elevated blood pressure even when high blood pressure medications were taken.
The study involved individuals with established heart disease, cardiovascular risk factors and moderate to severe OSA. Resistant elevated blood pressure in people with severe sleep apnea taking a minimum of three antihypertensive medicines, including a diuretic was 58.3 percent more prevalent than the 28.6 percent of individuals with moderate sleep apnea also taking medications.
After analyzing even further, researchers found the chances of resistant elevated blood pressure were four-time greater in individuals with untreated severe OSA even after making adjustments for possible confounders like:
Body mass index
The findings of the study suggest severe OSA contributes to poor blood pressure even with the use of aggressive medication.
Cause and Effect Between Sleep Apnea and Hypertension
So, what is this cause-and-effect relationship between hypertension and sleep apnea?
When you're not breathing, your blood pressure rises and your body's oxygen level falls, signaling receptors that alert your brain. Your brain responds by sending signals through your nervous system basically telling your blood vessels to "tighten up" to increase the oxygen flow to your brain and heart since they have priority.
The issue is what goes on during the night often carries over in the day, even when you're awake. The low nighttime oxygen levels seem to trigger several processes that persist during the day, even when you're breathing normally.
Importance of Sleep Apnea Treatment
If you're having a problem managing high blood pressure, increasing your physical activity, changing your diet and taking hypertension medication can all help. But, if you have OSA, the best thing you can do for your hypertension is to treat your sleep apnea potentially with lifestyle changes, an oral appliance, or a CPAP/BiPAP device.
Contributors to the daytime hypertension patterns include alterations in vascular structure and function due to inflammation and oxidant stress and sympathetic nervous system overactivity. OSA treatment with continuous positive airway pressure (CPAP) eliminates apneas, thereby preventing surges in intermittent arterial pressure and restoring the "dipping" nocturnal pattern.
CPAP therapy also has moderate beneficial effects on daytime blood pressure. Since even a small reduction in arterial pressure may help to reduce cardiovascular risk, obtaining an OSA screening is an important component of evaluating individuals with hypertension.
CPAP vs MAD
While most studies usually focus on CPAP, in one study, researchers found that both continuous positive airway pressure (CPAP) and mandibular advancement devices (MADs) use led to blood pressure drops among patients. There wasn't any significant different in blood pressure drops between the use of CPAP versus a MAD.
A CPAP device increases air pressure to your throat to keep your airway from collapsing when you're inhaling. It promotes normal breathing while you’re sleeping. It helps decrease blood pressure levels and appears highly effective for individuals with resistant hypertension, making it serve as a possible treatment for patients at high risk.
A MAD brings your lower jaw forward while you're sleeping to open your airway. It fits inside your mouth similar to a mouth guard.
The study reinforces efficient treatment will move the cardiovascular parameters in a positive direction no matter which type of treatment is used — it simply improves cardiovascular health because it eliminates the sleep apnea.
Untreated Sleep Apnea Effects Beyond High Blood Pressure
The importance of sleep apnea and overall health should not be underestimated. While having high blood pressure is clearly an issue for developing heart disease or having a heart attack, living with untreated OSA can result in other problems besides high blood pressure.
It can also lead to poor work or school performance, fatigue and cause sleep issues for family members due to the snoring. Sleep apnea is also associated with an increased risk of insulin resistance, metabolic issues and obesity — which as you've learned contributes to high blood pressure.
If you snore loudly or feel tired during the day despite "getting a good night's sleep," it could be time for you to see your doctor for an OSA screening. The initial detection of OSA will depend on what you tell your doctor.
If you have resistant high blood pressure, a sleep study might be in order to rule out OSA. If you are diagnosed with sleep apnea, it's important to monitor your blood pressure while you treat the apnea with CPAP or oral appliance therapy.
Get Treated for High Blood Pressure and Sleep Apnea
If you would like an OSA treatment consultation with one of our dental sleep medicine experts, Steve Carstensen, DDS or Carrie Magnuson, DDS in the greater Seattle area, complete our simple form to schedule an appointment. Alternatively, you can contact us here at Premier Sleep Associates today by calling (425) 698-1732.
Here at Premier Sleep Associates, we offer FDA-approved snoring and sleep apnea oral appliances, and both Dr. Steve and Dr. Carrie are compassionate and highly experienced sleep dentists who treat patients with sleep-breathing disorders, such as sleep apnea.