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Does Sleep Apnea Cause High Blood Pressure

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Sleep Apnea And Blood Pressure: The Whole Story

HBP 020- How is snoring and sleep apnea linked to High Blood Pressure

Are sleep apnea and high blood pressure related? Can obstructive sleep apnea cause hypertension? Do people with sleep apnea have improvement in their blood if they use continuous positive airway pressure ? Read on to find the answers to these questions and more.

In order to explain the high blood pressure and sleep apnea connection, let’s first define a few key concepts.

Home Remedies For Sleep Apnea

Sleep apnea treatment can start at home before taking it to doctors if it is not that severe. Few home remedies to deal with sleep apnea are:

  • Trying yoga: Yogas varied breathing exercises might help you increase your oxygen levels. As a result, yoga can help you sleep better by reducing the number of times you wake up.
  • Changing sleeping position: studies have shown changes in sleeping positions did work for improved sleeping patterns and sleep apnea.
  • Avoid alcohol and smoking: Changes in your lifestyle can help you sleep better and enhance your health. To avoid sleep apnea issues, consider stopping smoking and minimising your alcohol intake.
  • Use oral appliances: using oral appliances while sleeping can keep your air pathways open.

What Does This Mean For My Disability Claim

If you are seeking VA benefits for high blood pressure and sleep apnea, you need to file a claim for secondary service connection to receive compensation for both of these conditions. Secondary service connection is when a service-connected condition or injury causes a new condition or aggravates a non-service connected disability. In this case, if a veteran is already service-connected for obstructive sleep apnea and later develops hypertension because of their obstructive sleep apnea, they can file a claim for hypertension secondary to obstructive sleep apnea. To receive compensation for this secondary condition, you need a current diagnosis of hypertension.

For VA purposes, elevated blood pressure, or hypertension, is considered a systolic blood pressure reading of 160 or more and a diastolic pressure reading of 100 or more, i.e. 160/100 mm Hg. Hypertension must be confirmed by blood pressure readings taken two or more times on at least three different days. If secondary service connection is granted for your hypertension disability, blood pressure readings help determine both the severity of your hypertension and the rating percentage that the VA could potentially assign to your claim.

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How Much Does Sleep Apnea Raise Blood Pressure

Its important to understand how big of a problem sleep apnea is in causing high blood pressure.

A population-based study found that :

Mean blood pressures were significantly higher among participants with sleep apnea compared with those without .

Whether asleep or awake, those with sleep apnea have an average blood pressure about 10% higher than those without sleep apnea.

And while 10% doesnt seem a lot by itself, its enough to push a lot of people over the threshold where blood pressure becomes dangerous.

The NIH defines a normal blood pressure as :

  • Systolic under 120
  • Diastolic under 80

A significant number of people will go from a healthy blood pressure to a high blood pressure with a 10% increase in either number.

High blood pressure leads to damage in arteries, which can then cause damage to the heart, brain, kidneys, eyes, and more.

Sleep Apnea And High Blood Pressure A Dangerous Pair

Sleep Apnea and High Blood Pressure Are Linked

Many people think sleep apnea is as simple as loud snoring, but its much more than that. Sleep apnea affects many systems in the body and is associated with several serious conditions like high blood pressure.

High blood pressure puts a daily strain on the cardiovascular system which may lead to stroke, heart disease, and other serious conditions. Fortunately, managing high blood pressure with medication and lifestyle changes can reduce your risk for harmful health effects.

Its important to understand the relationship between sleep apnea and high blood pressure because these two conditions affect one another, and treatment for sleep apnea can lower blood pressure in people who have both.

Sleep Apnea, like high blood pressure, isnt normally something people usually detect on their own. If you have sleep apnea, you likely dont know about it unless youre keeping your bed partner up at night by snoring or that you are gasping in your sleep.

Obstructive sleep apnea occurs when the muscles that support the soft tissues in your throat, such as your tongue and soft palate, temporarily relax. When these muscles relax, your airway is narrowed or closed, and breathing is momentarily cut off. Individuals with sleep apnea stop breathing for short periods of time when sleeping. Pauses in breathing can last just a few seconds to a few minutes and occur as little as 5 to as many as 30 times per hour.

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What Happens When You Stop Breathing

When you stop breathing, your heart rate also tends to drop the longer your body is deprived of oxygen. Then, your involuntary reflexes cause you to startle awake at the end of that period of not breathing. When this occurs, your heart rate tends to accelerate quickly and your blood pressure rises.

These are changes that take place acutely when you stop breathing. However, your body starts to experience chronic effects if you experience frequent apnea. Data suggests increased risk, particularly when you stop breathing roughly 30 times or more per hour. But there is likely a risk at even lower frequency rates.

For example, your blood pressure tends to go up, your heart walls thicken due to increased workload and the structure of your heart changes. It tends to become stiffer and less flexible because there are more fibrous cells growing in between the muscle cells.

All of those things increase the risk that you can have either atrial or ventricular arrhythmias. They also tend to reduce the function of the heart so that its less efficient at pumping blood.

Diagnostic Evaluation Of Osa

Several reviews43,44 have been published about the diagnosis and physical examination of patients with OSA. The common physical findings in OSA are listed in Table 3.43,44 Because many patients with OSA have an upper airway abnormality, an ear, nose and throat evaluation is essential in the diagnostic workup.

Common Physical Findings in OSA


Primarily central obesity as assessed by an increased waist-to-hip ratio

Short neck and increased neck circumference

On oral examination

No clear abnormalities present in some cases

Crowded mouth with low-extending soft palate sometimes present

Large uvula

Generalized erythema and swelling of all tissues including the pharyngeal pillars

Large tonsils and adenoids may be present, especially in children

Large tongue

High, arched and narrow hard palate

Overbite of upper teeth

Information from references43 and44.

Common Physical Findings in OSA


Primarily central obesity as assessed by an increased waist-to-hip ratio

Short neck and increased neck circumference

On oral examination

No clear abnormalities present in some cases

Crowded mouth with low-extending soft palate sometimes present

Large uvula

Generalized erythema and swelling of all tissues including the pharyngeal pillars

Large tonsils and adenoids may be present, especially in children

Large tongue

High, arched and narrow hard palate

Overbite of upper teeth

Information from references43 and44.

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What Is The Relationship Between Sleep Apnea And Blood Pressure

Of the two types of sleep apnea, only OSA is linked to high blood pressure. CSA isnt a known cause of hypertension, but it develops in 30 to 50% of people with heart failure.

The prevalence of OSA is estimated to be between 4 and 7% of the general population, but it affects 30 to 40% of people with hypertension. Of people diagnosed with OSA, it is estimated that around half also have high blood pressure.

In healthy individuals, blood pressure naturally lowers by between 10 and 20% at night, a phenomenon that is sometimes referred to as blood pressure dipping. People with severe OSA experience blood pressure dips of less than 10%, which indicates a nondipping blood pressure pattern.

People who have nondipping blood pressure at night face an increased risk for cardiovascular issues. Additionally, many patients with OSA experience a sudden and pronounced elevation of their blood pressure when they wake up in the morning. This morning surge is another factor that may increase risk for cardiovascular disease. Moderate to severe OSA increases all-cause and cardiovascular mortality.

OSA doesnt only affect blood pressure at night. Studies show that daytime blood pressure levels also increase with sleep apnea severity.

What Is High Blood Pressure

Waking up with headaches? Sleep Apnea and Hypertension related…

Blood pressure is the measure of the amount of pressure your pumping blood is placing on the walls of your blood vessels. When the force applied to your blood vessels is too great, you have what is called hypertension.

Hypertension is the relationship between the systolic blood pressure and the diastolic blood pressure . According to the American College of Cardiology, patients are classified as hypertensive when their systolic/diastolic is greater than 130+/80+.

Hypertension is a concern because it is a precursor for heart disease and heart failure. As many as 50% of patients with hypertension also suffer from Obstructive Sleep Apnea.

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Treating Obstructive Sleep Apnea Improves Essential Hypertension And Quality Of Life

DONALD S. SILVERBERG, M.D., ADRIAN IAINA, M.D., Tel Aviv Medical Center, Tel Aviv, Israel

ARIE OKSENBERG, PH.D., Loewenstein Hospital Rehabilitation Center, Raanana, Israel

Am Fam Physician. 2002 Jan 15 65:229-237.

Obstructive sleep apnea , defined as an average of at least 10 apneic and hypopneic episodes per sleep hour, is a common sleep-related breathing disorder that leads to excessive daytime sleepiness because of marked fragmentation of sleep. Patients are frequently not diagnosed despite years of being symptomatic , because physicians do not routinely look for the disorder. Additionally, the role of OSA in the production of essential hypertension is frequently not appreciated.14 The purpose of this article is to demonstrate how commonly OSA occurs, how the quality of patients’ lives can improve with successful treatment, and how the disorder is related to EH.

OSA is characterized by a repetitive partial or complete closing of, apneas or hypopneas that last a minimum of 10 seconds are considered clinically significant, although they usually last from 20 to 30 seconds and can last more than one minute. Most of these episodes end when the patient wakes up slightly, almost always without being aware of it. This arousal response causes the airway to reopen. In severe cases, the cycle of opening and closing of the pharynx can recur 400 to 600 times a night.

Effects Of Lifestyle Changes And Weight Loss On Osas

Obesity is the single most important cause of OSAS and BP elevation. It is thus expected that weight loss will reduce the severity of OSAS and reduce BP levels. Indeed, in subjects who achieve significant reductions in body weight either through dietary, pharmacological or surgical measures, considerable reductions have been reported for various indices of OSA severity and for BP levels. In particular, bariatric surgery has been shown to be a highly effective measure to achieve OSAS improvement and BP control, as supported by a large meta-analysis of 136 randomized controlled trials. Of note, reductions in BP levels were mainly related to weight loss . However, despite its efficacy, bariatric surgery is reserved for selected patient groups and moderately obese patients who are inadequately controlling their body weights by conventional medical and behavioral therapies).

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Does High Or Low Blood Pressure Cause Sleep Apnea

According to the American Academy of Sleep Medicine, approximately 25 million adults in the United States have sleep apnea. In this disorder, an individual frequently stops breathing while they are sleeping. Sleep apnea has a significant impact on both high and low blood pressure. Lets take a closer look at why this is.

Sleep Apnea and High Blood Pressure

When an individual has sleep apnea, they face breathing pauses while they are sleeping. When this happens, their blood oxygen levels decrease and add strain to their cardiovascular system. In those without sleep apnea, blood pressure levels drop by 10 to 20 percent during sleep. However, individuals with sleep apnea experience irregular heart rate, causing adrenaline to be released into the bloodstream and raising blood pressure.

Sleep Apnea and Low Blood Pressure

While many individuals are aware of the correlation between high blood pressure and sleep apnea, some may not understand how low blood pressure and sleep apnea are related. Several years ago, a doctor from Stanford University found that low blood pressure does in fact correspond with sleep apnea.

This is because when someone has low blood pressure, they have negative pressure that builds up in the chest cavity and the diaphragm or the motor of the body that transfers air into the lungs, does not get the air into the body because of an obstruction.

Treating Sleep Apnea

  • Sleep apnea exercises

What Is The Connection Between Sleep Apnea And Hypertension

Does Sleep Apnea Cause Blood Clots?

In addition to the other health conditions hypertension contributes to, high blood pressure can also make sleep apnea symptoms worse, and vice versa. These two conditions have a cyclical effect upon each other, which is concerning if you happen to have both.

Obstructive sleep apnea restricts your breathing by blocking your airways. The blocked airway restricts how much oxygen enters the body, which puts added stress on your cardiovascular system.

In whats known as blood pressure dipping, blood pressure can lower between 10 and 20 percent each night in healthy individuals. Those with obstructive sleep apnea experience dips of less than 10 percent, which puts them at higher cardiovascular risk.

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How Hypertension Affects Your Body

High blood pressure contributes to hundreds of thousands of fatalities each year, with nearly half a million deaths in the United States alone. According to the Center for Disease Control, Tennessee has a high prevalence of hypertension in adults ages 20 and older, with an age-adjusted prevalence between 32 and 38.6 percent.

Left untreated, hypertension can damage your heart and contribute to severe health issues that can lead to a disability or even premature death. Some of these include:

  • Cardiovascular Disease
  • Kidney Disease or Failure

Obesity And Insulin Resistance

OSA, hypertension, obesity, and insulin resistance share a complex relationship in which all four factors influence and exacerbate one another.Obesity predisposes people to OSA. Obesity also increases a persons risk of developing high blood pressure. Research suggests that when a person has both OSA and excess weight, the two conditions may affect one another in ways that impair cardiovascular health. For example, OSA and obesity both cause elevated levels of leptin in the blood. Leptin is a hormone that promotes hunger, which can further contribute to weight gain. Leptin also stresses the cardiovascular system and may promote the development of hypertension.

People with insulin resistance require higher and higher levels of the hormone insulin to be able to use a type of sugar in the blood called glucose for energy. Over time, insulin resistance can result in uncontrolled glucose levels in the blood and the development of diabetes. Obesity is a known cause of insulin resistance. Recent studies have shown that OSA is also a cause of insulin resistance, regardless of ones weight. High blood pressure is yet another risk factor for insulin resistance. Because insulin resistance is an activator of the sympathetic nervous system, it may cause or worsen high blood pressure as well.

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Risk Factors For Hypertension

Age is a common risk factor for hypertension, as well as gender and family history. And while its a common health condition among American adults, hypertension does not have any visible symptoms or signs of illness. This is why its sometimes called the silent killer.

Hypertension is strongly connected to conditions like heart disease, heart failure, stroke, and even erectile dysfunction. These conditions are also linked to sleep-disordered breathing, also referred to as sleep apnea. Research indicates up to 50% of people suffering from hypertension also have sleep apnea, which is why anyone struggling with high blood pressure can benefit from a sleep test.

The good news is that hypertension is highly treatable with a healthy diet, productive sleep habits, and exercise. If your hypertension doesnt respond well to these lifestyle changes or medication, getting a sleep test to see if you have undiagnosed sleep apnea is important.

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How Is Sleep Apnea And High Blood Pressure Related

Can Your Sleeping Pattern Increase Your Blood Pressure

Patients with untreated sleep apnea are 2.6 times more likely to suffer from heart disease and heart failure than adults who do not suffer from sleep apnea. Through observations, patients with sleep apnea do not experience a drop in blood pressure at night probably because the brain is working harder to keep your body breathing at night. People without sleep apnea do experience a drop in blood pressure at night. This dip is normal because the heart will slow down at night to allow it to recover.

Blood oxygen levels in a healthy body are also supposed to increase at night. When someone is struggling to breathe during the night, their blood oxygen levels do not have the opportunity to decrease at night, thus increasing blood pressure. All of this leads to high blood pressure and, eventually, if left untreated, heart disease.Its important to note there has been a link discovered between hypertension and Obstructive Sleep Apnea. It is less clear if there is a connection between Central Sleep Apnea and hypertension.

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