Did you know that obstructive sleep apnea (OSA) affects up to 70 percent of patients with heart failure? Untreated OSA may significantly increase the risk of cardiovascular disease, as well as a variety of other chronic diseases. On top of that, of the estimated one billion people worldwide with OSA, nearly 80 percent of them are undiagnosed. This means that millions of people are living with the consequences of sleep apnea—like interrupted sleep, exhaustion, and trouble concentrating—and they may have another serious condition without even realizing it.

Few people realize the extent that obstructive sleep apnea can have on their health. Besides affecting the quality of an individual’s sleep, many people with the disorder also have another health concern, such as hypertension, obesity, diabetes, cardiovascular disease, and migraine headaches. Let’s dive into three of the most common comorbidities associated with OSA, why those with the sleep disorder may be more likely to struggle with them, and why this matters.

Hypertension

Hypertension, also known as high blood pressure, involves the pumping of blood through vessels at a higher force than normal. High blood pressure is a common health issue that regularly affects those with OSA. While OSA is estimated to affect about 7 percent of the population, it affects up to 40 percent of people with hypertension. Similarly, about half of those who are diagnosed with OSA also have high blood pressure. 

So, why do so many people have both hypertension and OSA? First of all, sleep apnea is shown to cause an activation of the sympathetic nervous system, which activates a series of physical reactions to a stressful situation, including faster heart rate and higher blood pressure. While these reactions keep us alive in a life-or-death situation, an overstimulation or constant reaction can lead to chronic high blood pressure. 

When individuals wake from sleep due to difficulty breathing, the sympathetic nervous system activates to help them get the air they need. Often, this leads to higher blood pressure throughout the daytime, not only at night. 

Cardiovascular Disease

On top of being connected to a higher risk of hypertension, obstructive sleep apnea may also increase the risk of heart attacks, stroke, and abnormal heart rhythms. Patients who report to cardiology clinics have a high prevalence of sleep apnea, mostly due to the fact that insufficient sleep can negatively affect heart health. While sleep usually allows the body to recuperate after a long day, not getting enough sleep means that the heart does not get the recovery time that it needs. And when that sleep deprivation becomes chronic, the risk of developing heart disease increases dramatically. 

OSA is associated with a higher risk of other forms of cardiovascular disease for reasons similar to hypertension. As the sympathetic nervous system activates in response to the need for more air, the heart must work harder to support the rest of the body and becomes worn from the continuous effort. Additionally, many of the common risk factors associated with obstructive sleep apnea also affect cardiovascular disease, like smoking, excessive alcohol consumption, and obesity. Those who are obese, smoke, or drink excessively not only increase their risk of developing heart disease, but they also become more likely to develop OSA.

Diabetes

According to the American Diabetes Association, over 30 million Americans have diabetes, and it is the seventh leading cause of death in the United States. Type 2 diabetes in particular is often associated with obesity, high blood pressure, and heart disease. It is also linked to sleep apnea. Research suggests that nearly 71 percent of people with diabetes may have sleep apnea. 

Like with heart disease and hypertension, those who have been diagnosed with sleep apnea are more likely to have diabetes, and those diagnosed with diabetes are more likely to have sleep apnea. While it may be unclear whether either of them cause the other, it is clear there is a strong correlation between them. Some studies suggest that OSA may also contribute to other problems associated with diabetes, including insulin resistance and glucose intolerance

Why It Matters

The high comorbidity associated with obstructive sleep apnea is important for several reasons. First, high comorbidity makes treatment much more difficult and worsens prognosis. Second, a better characterization and knowledge of patients with comorbidities can help healthcare providers give their patients the individualized care they need to live a happier life.

Not only can treating a chronic condition improve the symptoms of OSA, but treating sleep apnea may similarly show improvements in its comorbidities. By treating sleep apnea, not only can you get the sleep you need to function,  but you can also see improvements in almost every area of your life. 

Obstructive sleep apnea is not only highly prevalent, but it is also associated with other chronic conditions, including hypertension, heart disease, and diabetes. On top of these concerns, OSA is increasingly tied to other comorbidities such as asthma, anxiety, depression, and cancer.