Dubai City, UAE -- (SBWire) -- 02/07/2021 --Sleep apnea is considered to be one of the secondary causes of resistant hypertension, but it is not routinely checked for in this patient population.
Cardiovascular disease and Sleep Apnea are intimately associated.
OSA increases the risk of morbidity and mortality from cardiovascular disease:
In some studies, nonfatal and fatal cardiovascular events were almost twice as common in people with Sleep Apnea compared to a population without Sleep Apnea.
Atherosclerosis has been shown to affect people with Sleep Apnea who have no other risk factors for the disease, and Sleep Apnea has been associated with an increased incidence of hypertension, arrhythmias, and heart failure.
No one knows for sure why Sleep Apnea can cause cardiovascular disease
The most likely reasons are increased sympathetic activity, oxidative stress (caused by reactive oxygen species generated by the decline in oxygen levels and subsequent re oxygenation, a similar process to the reperfusion injury process), and inflammation.
Sleep Apnea has been definitely linked with hypertension. Sleep Apnea can increase the 24 hour mean blood pressure by as much as 10 mm Hg, and this could – potentially – increase the risk of suffering a myocardial infarction by 20% and the risk of suffering a stroke by 40%.
In women, poor sleep quality was strongly related to anxiety and depression and resistant hypertension, but this was not the case for men.
This difference remained after accounting for other confounding factors.
In women, we found that poor sleep quality was associated with a fivefold increase in the probability of having resistant hypertension, even after adjustment.
Experimental evidence supports this view. It is known that interrupted sleep stimulates the sympathetic nervous system and increases cortisol levels, both of which cause an increase in blood pressure
Patients with Sleep Apnea are also at increased risk of developing pulmonary hypertension, coronary heart disease, and cerebrovascular accident
Severe untreated Sleep Apnea (AHI >30) has been linked to fatal and nonfatal cardiovascular events and all-cause mortality, although this association is less well documented in mild Sleep Apnea, the authors say. Recent studies suggest that untreated sleep apnea may promote left ventricular dysfunction, disease progression, and increased mortality in heart failure patients.
While there are "no doubts" that the complex link between Sleep Apnea, hypertension and cardiovascular risk deserves further study, the available evidence is "certainly sufficient" to recommend greater attention both to the identification and to treatment of the BP increase associated with Sleep Apnea as well as to the detection of sleep-related breathing disorders in patients with a diagnosis of hypertension.
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