Sleep Apnoea and Heart Problems: A Comprehensive Overview

Quick takeaways

• Sleep apnea may put extra strain on your heart over time. Repeated breathing interruptions can lower oxygen levels and raise blood pressure, which may increase long-term heart risk.
• Several serious heart conditions are linked to untreated sleep apnea, including high blood pressure, irregular heartbeat disorders, heart disease, heart attack, and stroke.
• Continuous positive airway pressure (CPAP) and other sleep apnea therapies may help reduce certain cardiovascular risks.

Could an untreated sleep condition be affecting your heart health while you sleep?

Sleep apnea can affect breathing throughout the night, which may trigger stress responses that can harm the heart over time. Research has shown that individuals with obstructive sleep apnea (OSA) face ahigher risk of cardiovascular disease.¹

Because untreated sleep apnea may increase risks of high blood pressure, heart disease and other conditions, being aware of these connections can help you better advocate for your health and talk to providers about effective treatments.²

Understanding sleep apnea and its cardiovascular impact

To understand potential links between sleep apnea and heart health, it’s important to understand the different types of sleep apnea and how they can affect your body and heart.

Types of sleep apnea

Three main types of sleep apnea are:

• Obstructive sleep apnea (OSA). A condition where the muscles around the throat relax to the point of collapse, restricting airflow during sleep. Breathing may become shallow or stop for seconds to minutes³ at a time.
• Central sleep apnea (CSA). This type of sleep apnea occurs when the brain doesn’t send signals to the muscles that control breathing,⁴ causing breathing to pause during sleep.
• Mixed/complex sleep apnea (CompSA). As the name suggests, this type is complex because people experience breathing interruptions due to both OSA and CSA.

OSA, the most common form of sleep apnea, is becoming increasingly widespread in the U.S.. By 2050, around 46% of adults aged 30 to 69 are expected to have OSA. The rise is especially sharp among women — their rates of OSA are expected to jump by 65% by 2025, outpacing the increase seen in men. ⁵

Sleep apnea and heart health: is there a link?

Obstructive sleep apnea (OSA) can lead to interrupted breathing. These breathing disruptions may impact heart function by:

• Lowering oxygen. If you experience interruptions in breathing of 30 seconds or more, your blood oxygen level can reach 80% or lower.⁵ Healthy oxygen levels play an important role in heart health.⁶
• Interrupting sleep cycles. Frequently waking up during the night can put stress on your body, causing your heart rate and blood pressure to rise. Studies show that ongoing sleep troubles (especially those linked to OSA) may increase the risk of certain heart issues.⁷
• Increasing inflammation. Sleep apnea may put your body under physical stress, raising stress hormones and inflammation⁸ levels that can contribute to changes in blood vessels over time.⁹ When blood vessels don’t function as well, it may increase the likelihood of developing high blood pressure or heart disease.
• Raising carbon dioxide levels. Interrupted breathing during sleep may lead to a buildup of carbon dioxide in the blood, which can place added strain heart muscles.

In some cases, sleep apnea symptoms can mimic the symptoms of other conditions, including heart failure. Researchers have reported cases where people felt symptoms like chest pain or heart palpitations related to obstructive sleep apnea.¹¹

At the same time, nighttime chest pain may also be caused by conditions like acid reflux. Overlapping symptoms exist between conditions like sleep apnea, gastroesophageal reflux disease (GERD) and heart disease. ⁵ This makes a comprehensive evaluation, such as a sleep study or a visit to a cardiologist, necessary.

Never ignore chest pain — always talk to a doctor to determine the cause and appropriate treatment.

Heart conditions associated with sleep apnea

Researchers have found that untreated sleep apnea may increase the risk of heart-related conditions, such as:

• High blood pressure. Disordered breathing during sleep may raise nighttime blood pressure and has been linked to hypertension, a condition in which a person consistently has high blood pressure.¹
• Heart rhythm problems. People with sleep apnea are 2 to 4 times more likely to have atrial fibrillation (AFib), which is the most common type of irregular heartbeat.¹⁰
• Heart failure. People with heart failure are often also diagnosed with sleep apnea.
• Stroke and vascular disease. Researchers consider sleep apnea to significantly increase a person’s risk of stroke. This means living with obstructive sleep apnea (OSA) may raise the likelihood of stroke even if you don't have other common risk factors.

Because these conditions can often overlap, it's important to talk to your doctor if you have sleep apnea and notice new symptoms that might be related to heart health.

How sleep apnea is diagnosed in people with heart disease

Doctors typically use a combination of health history, screening tools and sleep studies to check for sleep apnea in people living with heart disease. Here's what that process can look like.

First steps: screenings and risk checks

Screening tools can help doctors determine whether someone is at risk before they order full sleep studies or other testing. If you already have a condition like high blood pressure or heart failure, you could be at higher risk of sleep apnea.¹ That higher risk could lead a doctor to ask about or consider signs of sleep apnea like:

• Excessive daytime sleepiness
• Morning headaches
• Feeling irritable or moody
• Difficulty concentrating or staying alert
• Frequent snoring or gasping during sleep
• High blood pressure that’s hard to control¹²
• Heart palpitations or irregular heartbeat¹²

Sometimes, sleep apnea goes undiagnosed in individuals with heart problems because symptoms can overlap with other heart conditions.¹³ That’s why screening for sleep apnea is especially important.

Sleep tests your doctor may recommend

Sleep tests capture information about how you sleep and can help doctors make a sleep apnea diagnosis. There are two types of sleep tests that your doctor can prescribe:

• Home sleep test. Home sleep tests (HSTs) are devices that you take home and use while sleeping in the comfort of your own bed. They monitor your body while you sleep and share valuable information back to your doctor about your sleeping behavior.
• In-lab sleep study. A polysomnogram (PSG), or in-lab sleep study, is conducted overnight in a lab, where a technician can monitor your sleep. These tests provide detailed information about brain activity, breathing, oxygen levels and heart rhythms during sleep. They can be especially important for people with complex medical histories or heart conditions, as they provide accurate, data-rich results your doctor can analyze.

Your doctor can decide which test is the right option for you based on discussions about your medical history, goals for seeking a sleep test and other factors. ¹⁴

What doctors look for in test results

Doctors analyze data from sleep tests to determine if you have sleep apnea and to understand how the condition might be impacting your sleep, heart health and other body functions.

For example, they will look at something called the apnea-hypopnea index (AHI). AHI reflects how many times an hour you have an apnea (breathing paused for 10 seconds or more) or hypopnea (shallow breathing due to a partial airway blockage). An AHI score above 5 is considered abnormal. ¹²

Doctors also consider how low your oxygen levels drop when you sleep, how deep and light sleeping periods are balanced through the night, and how often you wake up.

Heart health checks alongside sleep tests

For someone with an existing heart condition or a suspected heart health problem, doctors may order heart tests alongside or separate from sleep studies to get a fuller picture of overall health needs. Some tests they may order include: ¹⁵

• Echocardiograms. This is a type of ultrasound that takes images of your heart to help confirm how well all of its parts are functioning.
• Ambulatory blood pressure monitoring. This test tracks blood pressure continuously for 24 hours. It helps your doctor better understand your average blood pressure range, and when and how those numbers might change throughout the day.¹⁶
• Heart rhythm monitoring. This test tracks how your heart beats and lets doctors understand if there are irregular rhythms when you're sleeping.
• Advanced imaging. Cardiac MRI, CT or PET scans can help your doctor better understand how your heart functions and if there are issues like buildup or blockages that might indicate disease.

Treatment options and heart health benefits

Treating sleep apnea may help improve sleep quality and could support overall heart health. Here are some common approaches to treating sleep apnea and what they might mean for heart health.

CPAP and other airway therapies

CPAP, or continuous positive airway pressure, delivers continuous pressurized air into the nose or mouth via a mask you wear while sleeping. This pressure helps keep your airway open, which supports better breathing and sleep quality.

For people with sleep apnea, there is a 55% lower risk of dying from heart-related issues with CPAP therapy.

For people with more complex sleep apnea, other options, such as bilevel PAP or ASV, may be prescribed. Regardless of device type, positive results require consistent use. Your care team can help you find what works best and make sure you’re comfortable using it.

Special considerations for people with heart failure and sleep apnea

Someone who already has a heart-related diagnosis may need to take special precautions when starting any new treatment, including CPAP therapy. Treatment of sleep apnea can be safe and beneficial for those with heart conditions, but you should always talk with your doctor. They may take additional steps such as:

• Starting treatment gradually and checking in on your heart to make sure it’s responding well.
• Coordinating care between cardiologists and sleep specialists to ensure overall safety and effectiveness of any treatment.

Other sleep apnea treatments

Continuous positive airway pressure (CPAP) is highly effective and is the most used and understood method for treating sleep apnea. ¹⁷ CPAP therapy has also been shown to help people with sleep apnea live longer. ¹⁸ Alternative options are available for people who may be looking for a different treatment approach. These can include:

• Oral appliances. These devices reduce sleep apnea symptoms by holding the lower jaw forward to keep the airway from becoming blocked. They may be recommended to treat mild-to-moderate sleep apnea.
• Positional therapy. Some people sleep in certain types of positions that have been shown to reduce OSA symptoms. For example, they may avoid sleeping on their backs, as that position can increase sleep apnea, snoring, and breathing problems.
• Implanted devices. A newer treatment approach, hypoglossal nerve stimulation, involves implanting a device that stimulates the nerve that controls tongue muscles. This may help keep the tongue from moving into a position that blocks the airway.²¹

Research continues in the field of sleep apnea treatment, and new devices may emerge that can support sleep quality.

Lifestyle changes

Around 30% of people with obstructive sleep apnea (OSA) also have obesity.²² Losing weight can reduce the severity of OSA symptoms for some people, and doctors often recommend it as part of a care plan.²³ However, weight is one of many risk factors for sleep apnea.

Regardless of your weight, if you are dealing with sleep apnea — and especially if you have concerns about heart health — consider talking with your doctor about lifestyle changes that can help lower your risks and support better heart health. Some lifestyle changes that may help with sleep apnea and heart health include:

• Regular exercise
• Eating a heart-healthy diet
• Cutting back on alcohol and quitting smoking

Medications, sleep apnea and heart health

Some heart medications can have an impact on sleep apnea results. ¹⁹ Likewise, some sleep medications can impact heart health. Doctors and other medical providers work to balance what they prescribe, especially when treating people who have more than one condition. If you're taking medications for any condition, don't adjust them on your own. Talk to your doctor about concerns and how you believe various treatment options are impacting each other.

Why team-based care matters

If you have multiple health conditions, like sleep apnea and heart disease, you may need to work with more than one doctor. ²⁰ A doctor who specializes in cardiovascular health might not be an expert in treating sleep conditions, and vice versa. That’s why people with multiple health conditions may work with a few different doctors, including:

• A primary care doctor, who helps to coordinate care and may be the person who refers you to a specialist to get tested for sleep apnea.
• A cardiologist, who monitors heart function and blood pressure, prescribes relevant medications for heart health, and recommends other heart-related tests or treatments.
• A sleep specialist, who orders sleep studies, interprets sleep test results, and prescribes and manages treatments like CPAP.

Nutritionists and other specialists may also help support lifestyle changes. Working with a coordinated team can help ensure your treatment plan supports overall heart health and better sleep quality.

Looking ahead

Research on sleep apnea and heart health is ongoing, and new technologies may help make it easier to diagnose and manage these conditions.

• Smart devices like watches and rings may help support early detection of sleep and heart conditions.¹²
• AI and digital tools could help doctors analyze data and spot risks sooner, leading to earlier and more focused care.
• New therapies, such as nerve stimulation or emerging medicines, may help enhance comfort and support treatment effectiveness.

While these new treatments aren't widely available or, in some cases, fully functional, they demonstrate the need to remain engaged with your care team. By talking about your sleep or heart concerns with your doctor, you open the door to deeper discussions about treatments that may be right for you.

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