Sleep Apnea and the Risks of Underlying Conditions

People with obstructive sleep apnea (OSA) often have more than one health condition simultaneously. When a person has more than one condition or disease at a time, it’s called comorbidity. Sleep apnea and certain comorbidities have amplifying effects on one another – the comorbidity can make a person’s sleep apnea worse and the sleep apnea can make their comorbidity worse. 

Failing to address an OSA diagnosis or comorbidity can increase the risk of severe health complications. Luckily, people with OSA can improve their overall health and daily life while living with sleep apnea by addressing their comorbidities, making lifestyle changes, and adhering to continuous positive airway pressure (CPAP) therapy. 

We’ll explore some common sleep apnea comorbidities and explain what kind of risks and impacts they can have. You’ll also learn how CPAP therapy may be able to help.

Cardiovascular Disease

• Risk: Cardiovascular disease is the leading cause of death worldwide. Many factors can cause people to develop the disease, including strain placed on the body’s heart and blood vessels. During apneic events when a person with OSA stops breathing, blood oxygen levels drop and put stress on the heart, which can lead to cardiovascular disease and heart attacks. 

• Impact: OSA may be a factor in as many as 38,000 cardiovascular-related deaths every year. People with sleep apnea who don’t use a CPAP as treatment are at an increased risk of heart failure, no matter their age. In fact, people with sleep apnea are 140% more likely to experience heart failure than those without OSA.

• CPAP Benefits: Treating sleep apnea may help lower cardiovascular disease risk by up to 64%. CPAP machines use pressurized air to help keep your breathing passages open, which can prevent your blood oxygen levels from dropping.

Hypertension (High Blood Pressure)

• Risk: High blood pressure and cardiovascular disease have many of the same contributing factors, including low blood oxygen levels. When people with sleep apnea stop breathing, their blood oxygen levels drop and their blood pressure can spike. Both during and after these episodes, their bodies also release stress hormones that increase blood pressure. Chronic sleep deprivation and low oxygen levels can contribute to consistently elevated blood pressure.

• Impact: Untreated hypertension can lead to heart attacks, heart failure, arrhythmias, kidney failure, and stroke. Untreated sleep apnea can worsen hypertension and vice-versa.

• CPAP Benefits: In clinical studies, researchers found that using a CPAP machine for at least 4 hours can reduce blood pressure, even in people with resistant hypertension.

Type 2 Diabetes

• Risk: Researchers believe that sleep apnea may cause insulin resistance and glucose intolerance, both of which can lead to type 2 diabetes. The sympathetic nervous system kicks into overdrive when a person stops breathing, which can affect how the body processes sugar.

• Impact: Uncontrolled type 2 diabetes can lead to death, kidney failure, blindness, cardiovascular disease, significant nerve damage, and limb amputation. Untreated sleep apnea can also make existing type 2 diabetes more severe. 

• CPAP Benefits: People who use their CPAP machine regularly and properly may see their body’s glucose control and insulin resistance improve. Studies have also found a link between CPAP adherence and improved heart function. 

Obesity

• Risk: Obesity and sleep apnea have an unfortunate relationship with one another – each condition makes the other worse. Obesity affects 30% of Americans and is the comorbidity that best predicts whether or not a person has sleep apnea. Among people with OSA, between 60 and 90% of them are obese, according to obesity markers defined by body mass index (BMI).

• Impact: Sleep apnea can make a person more likely to experience hormone and insulin imbalances that can worsen obesity and impact their overall health. Obese people are at increased risk of developing cardiovascular disease and diabetes, which can both be fatal.

• CPAP Benefits: Large neck circumference can contribute to sleep apnea. When a person has weight or pressure on their throat, it’s harder for their muscles to keep their breathing passages open. A CPAP machine can prevent their airway from collapsing by keeping it open with pressurized air. 

Stroke

• Risk: More than 80% of people who experience strokes also have sleep apnea. Sleep apnea and strokes share many common risk factors including high blood pressure, heart disease, diabetes, and obesity. The irregular breathing that sleep apnea causes can change blood flow and damage brain tissue, paving the way for strokes. 

• Impact: People with sleep apnea are at a 60% higher risk of having a stroke than those without OSA. Having a stroke can leave you permanently disabled, put you at higher risk for more strokes, and cause death.

• CPAP Benefits: People who have had strokes may be able to use a CPAP machine to help lower their blood pressure. Some researchers think that CPAP therapy may also help improve stroke victims’ moods and prevent strokes from recurring. 

Chronic Kidney Disease (CKD)

• Risk: Like many other comorbidities, sleep apnea and CKD negatively impact one another. Some studies suggest that people with CKD are 10 times more likely to have sleep apnea than people without the disease. Sleep apnea causes low oxygen levels that can worsen CKD, harm your kidneys, and impact renal function. 

• Impact: High blood pressure, heart disease, obesity, and diabetes can all be caused by sleep apnea and they can all, in turn, cause CKD. Sleep apnea puts people with CKD at higher risk of developing end-stage renal disease – a serious condition that can lead to dialysis, kidney transplant, or death.

• CPAP Benefits: In clinical studies, researchers found that kidney function can improve if people with sleep apnea use their CPAP machine correctly, even short term. 

Asthma and Chronic Obstructive Pulmonary Disease (COPD)

• Risk: COPD and asthma can both be aggravated by sleep apnea. People with asthma may have to use their inhaler more often because sleep apnea affects their respiratory system. The oxygen deprivation that accompanies sleep apnea can worsen COPD. 

• Impact: Having both sleep apnea and COPD at the same time is called overlap syndrome, and it can at the very least reduce quality of life. Overlap syndrome can contribute to hypertension and atrial fibrillation (Afib), and it also can be fatal. 

• CPAP Benefits: CPAP therapy has a proven track record of improving outcomes for people with overlap syndrome and it can even increase survival rates. People with respiratory illnesses like asthma and COPD can benefit from CPAP therapy’s increased oxygen levels.

Depression and Anxiety

• Risk: Because sleep apnea, depression, and anxiety share symptoms like irritability, exhaustion, and difficulty concentrating, it can be tricky for physicians to determine which condition is at fault. Regardless of whether sleep apnea or depression causes the symptoms, lack of restorative sleep can make them all worse.

• Impact: Depression and anxiety can contribute to daytime drowsiness that’s severe enough to cause traffic or workplace accidents. They can also make CPAP adherence harder, creating an exhaustion cycle that’s tough to break.

• CPAP Benefits: CPAP therapy can help people with OSA, people with major depressive disorder (MDD), and those with both. Getting restorative sleep can decrease depression symptoms and improve overall quality of life. 

Atrial Fibrillation (AFib) and Other Arrhythmias

• Risk: Changes in blood oxygen levels and the sympathetic nervous system can result in arrhythmias or irregular heart rhythms like AFib. People with OSA have a three times greater chance of developing Afib than the general population.

• Impact: AFib is a serious condition that can cause stroke, blood clots, and death. Sleep apnea can worsen many of AFib’s risk factors, including hypertension, diabetes, obesity, and CKD. 

• CPAP Benefits: Using a CPAP machine can reduce the risk of AFib by up to 42% and it may also prevent permanent AFib from developing. CPAPs help by increasing blood oxygen levels and lowering the risk that other comorbidities present. 

Liver Disease

• Risk: Sleep apnea’s breathing pauses can create insulin resistance and liver inflammation that has the potential to induce nonalcoholic fatty liver disease (NAFLD). NAFLD and sleep apnea also share other comorbidities like obesity, diabetes, and hypertension, putting people at a higher risk of developing more than one condition. 

• Impact: Unmanaged sleep apnea can lead to developing NAFLD for the first time and it can also make existing NAFLD worse. Minor liver disease symptoms can include exhaustion and weakness, while progressive liver disease can cause cirrhosis and death. 

• CPAP Benefits: While there aren’t any definitive studies that connect CPAP therapy with improved liver function, it can help treat some of the underlying conditions that often accompany liver disease. Obesity, diabetes, and hypertension can all be improved with strict adherence to CPAP therapy. 

You don’t have to navigate your sleep apnea alone. Our sleep care team works hard to get you the treatment you need to sleep better and live a longer, healthier life. If you have questions or need further help, call us at 1-844-757-9355 or email our team at [email protected].

About The Author

Diane Salazar

Respiratory Therapist

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Diane is a respiratory therapist with 27 years experience helping people get the treatment they need to improve their sleep quality and overall well-being.

• POSITION: Side Sleeper
• TEMPERATURE: Hot Sleeper
• CHRONOTYPE: Wolf

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