Sleep Apnea Raises Risk For Hard-To-Treat Hypertension

People with severe sleep apnea are at a higher risk for high blood pressure that does not respond to medication, according to preliminary new research.

Obstructive sleep apnea (OSA) can leave you feeling groggy and tired throughout the day, but it may also be responsible for up to nearly 60 percent of hard-to-treat hypertension, according to new preliminary research presented today at the American Academy of Sleep Medicine meeting in Baltimore.

Researchers looked at 284 people with sleep apnea and found that even among those who were prescribed three or more anti-hypertensive medications, the participants with severe sleep apnea were more than three-times as likely as those with less severe sleep apnea to have high blood pressure that did not respond to medication.

“Our findings suggest that severe OSA contributes to poor blood pressure control despite aggressive medication use,” Harneet Walia, MD, study author and assistant professor of family medicine at the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, said in a statement. “This is important as poor blood pressure control in patients taking multiple anti-hypertensive medications makes them particularly vulnerable to increased cardiovascular risk.”

Nearly 60 percent of patients with severe sleep apnea had resistant blood pressure, according to the research, compared to 28 percent of participants with moderate sleep apnea. The findings indicate that in addition to the multitude of health effects that sleep apnea can cause, it can also make some more difficult to treat.

“Even under the close care of a cardiologist following national guidelines for treatment of cardiovascular risk and comprehensive medication regimens, severe levels of OSA versus a moderate level of OSA appear to be contributing to suboptimal blood pressure control,” Dr. Walia said in a statement.

Stress is the reason why high blood pressure and sleep apnea are closely linked, said Brent Brandow, director of operations at Parkway SleepHealth Centers in North Carolina.

“When you’re sleeping, your body is healing itself,” he said. “But when you have sleep apnea, you don’t get a good night’s sleep, which raises your blood pressure.”

The Link Between Heart Disease And Sleep Apnea

High blood pressure and sleep apnea have been linked in the past, but it is unclear which condition drives the other. However, hypertension isn’t the only form of heart disease linked to the disorder — sleep apnea can also worsen other forms of heart disease, such as atrial fibrillation.

“The back of the throat literally closes up and forms an obstruction during sleeping. This can disrupt sleep because there is an increased effort to breathe against what is basically a closed air passage,” said David Wilber, MD, George M. Eisenberg professor of medicine and director of the Cardiovascular Institute and the division of cardiology at Loyola University Medical Center. “This generates changes in blood pressure and the nervous system that can promote ischemic events, or those associated with less optimal blood flow to the heart, and also with arrhythmias.”

But despite the chicken-and-egg situation, research has shown that treating the sleep apnea can help reduce blood pressure and help alleviate heart disease, and Brandow said using a continuous positive air pressure (CPAP) machine is a must for anyone with sleep apnea.

“Patients we see may be on several high blood pressure medications and when we get down to it, we very often find undiagnosed sleep apnea,” he said. “Once we put them on a CPAP machine, their blood pressure drops drastically, and they can often come off of medication.”

By Amir Khan