Study Registration And Literature Search
The present systematic review and meta-analysis was conducted following the general recommendations of the Cochrane Handbook for Systematic Reviews of Interventions and adheres to the PRISMA statement , and has been registered at PROSPERO with identifier number CRD42018093961.
A systematic search was conducted including three databases, i.e. MEDLINE , Embase and Web of Science , in order to identify all RCTs that evaluated the possible BP-lowering effect of either CPAP or MAD therapy in patients affected by OSA regardless of accompanying daytime somnolence or symptoms of unrefreshing sleep .
Sleep Apnea And High Blood Pressure A Dangerous Pair
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.
Who Gets Sleep Apnea
Sleep apnea occurs in about 25% of men and nearly 10% of women. Sleep apnea can affect people of all ages, including babies and children and particularly people over the age of 50 and those who are overweight.
Certain physical traits and clinical features are common in patients with obstructive sleep apnea. These include excessive weight, large neck and structural abnormalities reducing the diameter of the upper airway, such as nasal obstruction, a low-hanging soft palate, enlarged tonsils or a small jaw with an overbite.
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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.
Elevated Carbonic Anhydrase Activity
Carbonic anhydrase compensates for respiratory acidosis secondary to apnea-related hypercapnia by upregulating resorption of bicarbonate in the proximal nephron. Arterial bicarbonate concentration is positively correlated with OSA severity independent of HTN . In one 2020 study on patients with OSA, AHI reductions correlated with reductions in venous bicarbonate concentrations . Carbonic anhydrase inhibitors perpetuate respiratory acidosis during apneic events by eliminating the compensatory ability for the kidneys to reabsorb bicarbonate. The lingering acidemia stimulates respiratory drive to breathe off the excess carbon dioxide, thus correcting the apneic episode and hypercarbia. A 2020 study on participants with OSA found that acetazolamide reduces AHI and BP with or without concomitant CPAP therapy . This identifies carbonic anhydrase inhibitors as a potential frontline treatment for OSA and associated HTN.
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Can Sleep Apnea Cause High Blood Pressure During The Day
While sleep apnea does cause a spike in blood pressure which can carry through to the next day, those with hypertension already are at higher risk of sleep apnea.
It is estimated that 30-50% of people with high blood pressure have sleep apnea. Obstructive sleep apnea occurs most commonly in those aged 30-70.
Most sufferers of high blood pressure do not have symptoms unless their blood pressure is significantly high or is elevated for a prolonged period. If left, over time hypertension puts increased pressure on your cardiovascular system which can lead to heart attacks and strokes.
The best way to keep an eye on your blood pressure is to have regular checks at your doctors office. If you are worried or if you have a family history of high blood pressure, it is worth investing in an affordable and reliable home blood pressure machine. You can monitor your blood pressure regularly and check it at certain times of day or night for any patterns.
These are easily found at your local drug store or online and are straightforward to use. It is important to successfully identify the best combination of treatments for those with high blood pressure and sleep apnea to avoid long-term strain and consequences.
How Sleep Apnea And High Blood Pressure Are Connected
Sleep Apnea and high blood pressure are closely related. As blood oxygen declines during the night, as is common for someone who has untreated Sleep Apnea, it has a side effect of raising blood pressure levels. When blood oxygen content is low, the brain sends signals to the blood vessels to tighten as a way of helping improve the flow of blood oxygen1.
Research has shown treating Sleep Apnea, through faithful adherence to using CPAP therapy, can lower blood pressure levels by increasing blood oxygen during sleep. High blood pressure is one of many risks of untreated Sleep Apnea.
This article covers Sleep Apneas link to cardiovascular conditions, as well as Sleep Apnea its link to hypertension. Well provide tips that can help you get better sleep as you continue living with Sleep Apnea.
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Next Steps To See If Sleep Apnea Is Impacting Your Blood Pressure
If you suffer from hypertension but arent sure if sleep apnea or another sleep disorder is a contributing cause, getting an evaluation to rule it out is important. Reach out to your doctor or a sleep expert to set up a sleep study and to explore your treatment options. The solution could simply be a consultation away.
If youre unsure if your sleep-disordered breathing is caused by sleep apnea, check out our sleep quiz. If youre ready to discover how a sleep specialist can help you, contact Sleep Centers of Middle Tennessee today to find out if sleep apnea is affecting your blood pressure.
With obstructive sleep apnea and high blood pressure having such a strong connection, a simple and free 10 minute sleep test evaluation may be the best thing you can do for your heart.
Sleep and high blood pressure have more in common than you may originally think they affect each other to the point where seeking treatment for one condition may also end up treating another. Proper sleep and caring for your heart not only keep you healthy, but they keep each other healthy too!
How Can I Lower My Blood Pressure In 5 Minutes
If your blood pressure is elevated and you want to see an immediate change, lie down and take deep breaths. This is how you lower your blood pressure within minutes, helping to slow your heart rate and decrease your blood pressure. When you feel stress, hormones are released that constrict your blood vessels.
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Sleep Apnea And High Blood Pressure: Cause And Effect
Theres an abundance of studies that suggest sleep apnea and high blood pressure are connected and dangerous together. Around 25 million individuals in the U.S. have sleep apnea, according to the American Academy of Sleep Medicine. Obstructive sleep apnea occurs when your breathing is interrupted briefly and repeatedly while you sleep. Its been found to increase your risk for high blood pressure.
Chronic loud snoring is a telltale sign of OSA, combined with sounds of choking or gasping. Usually, the individual with OSA doesnt even realize theyre snoring and it takes a bed partner or family member to point it out to them. Not all people with OSA snore though.
Daytime sleepiness is another main indicator of OSA.
Consequences And Effects Of Untreated Sleep Apnea
Untreated sleep apnea and cause:
- Pulmonary hypertension: Affects your lung arteries and the right side of your heart.
- Resistant hypertension: Blood pressure that stays above goal regardless of coincident use of several antihypertensive agents, one being a diuretic.
- Edema: Swelling in the legs
- Heart disease: OSA is said to be a risk factor for heart disease development
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A Dysfunctional Relationship: The Osa & Hypertension Connection
Multiple research studies show that patients with OSA are more likely to have hypertension, independent of other risk factors like weight. Sleep apnea seems to be more associated with isolated diastolic or combined systolic/diastolic hypertension than isolated systolic HTN. Those with mild sleep apnea, an apnea-hypopnea index between 5-15 , are twice as likely to get hypertension. People with moderate sleep apnea, defined as an AHI between 15 and 30, are three times as likely to develop high blood pressure. This trend supports what doctors call a “dose-response curve” in the relationship between OSA and high blood pressure: the worse the sleep apnea, the more likely people are to have high blood pressure. This sort of relationship is the best evidence that two separate medical conditions are truly linked.
Metabolic Derangements And The Gut Microbiome
The hypothesis that administration of prebiotics and probiotics alleviates OSA-associated HTN continues to be investigated. In a 2018 study on rats exposed to chronic intermittent nocturnal hypoxia, researchers observed that cecal acetate levels were 48% lower in study rats with OSA that were not treated with prebiotics and probiotics. After administration of Hylon VII and Clostridium butyricum , both acetate levels and SBP normalized to match those of the control rats . Hylon VII is a cornstarch resistant to human brush border enzymatic digestion. It therefore provides an available substrate for bacterial fermentation into acetic acid, a short chain fatty acid that improves barrier function and mucosal integrity of the gastroenteric epithelial lining while also reducing activation of neuronal microglia, which are the inflammatory cells of the CNS. The abundance of SCFA-producing bacteria was significantly lower in rats with HTN compared to normotensive rats, and neuronal microglia activation was threefold higher in rats with HTN .
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Resistant Hypertension And Sleep Apnea
For some with high blood pressure, even after taking your daily medications your numbers can still be dangerously high. This issue, known as Resistant Hypertension, is a medical condition in which blood pressure isnt easily controlled. To resolve resistant hypertension a good place to start is by informing your doctor of the issue.
One of the treatments that can work for Resistant Hypertension is CPAP therapy3. If youre currently undergoing treatment with a CPAP machine and your blood pressure isnt going down, you might want to check your sleep data from the previous night to see if any improvements can be made to ensure your number of nightly apneas are as low as possible.
Here are some tips for improving the quality of your sleep and the effectiveness of CPAP therapy:
- Use an APAP machine. Unlike CPAPs, which use one set pressure, APAP machines offer the advantage of being able to provide different pressures during the night, depending on what your body needs. If your body needs a higher pressure for any reason your APAP machine is able to automatically adjust and keep you getting restful sleep.
- Get a machine with smart data. Many machines, like the AirSense 10 APAP, offer advanced data tracking features, allowing you to optimize your sleep without additional visits to the doctors office. With the AirSense, some of the data you can track and improve on includes the following:
- Apnea Events per Hour
Severe Obstructive Sleep Apnea Has Been Linked To Drug
In 2014, a group of researchers set out to test their hypothesis that untreated severe obstructive sleep apnea is connected to high blood pressure in patients with a high risk for cardiovascular diseaseâdespite medical management of high blood pressure with an intensive hypertensive drug regimen.
The findings of this study were published in a 2014 article appearing in the Journal of Clinical Sleep Medicine. The article reports that, indeed, untreated severe obstructive sleep apnea is associated with high blood pressure, even when patients are undergoing treatment with an intensive hypertensive drug regimen. This suggests that severe obstructive sleep apnea can contribute to medication-resistant hypertension.
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The Importance Of Sleep Apnea Testing & Treatment
A sleep assessment is recommended if you or a loved one are exhibiting sleep apnea symptoms, such as frequent headaches, snoring or trouble breathing while sleeping, or lethargy and daytime sleepiness.
A home sleep study is more affordable and less time-consuming than a standard sleep study. The individual will receive the home sleep test and instructions on administering an overnight unattended sleep study. While sleeping, the device will record the patients blood oxygen levels, heart and breathing rates, and how often their body moves blood oxygen saturation.
Following the self-administered test, the results will be analyzed by one of ApneaMeds board-certified sleep physicians. They will provide a recommended treatment for sleep apnea, which will help the management of diabetes. The standard treatment uses an automatic positive airway pressure machine called APAP. A CPAP machine uses self-adjusting air pressure to keep the individuals airways open while sleeping.
Contact our team to learn more if you have any questions about ApneaMeds at-home sleep apnea test or our sleep apnea treatment equipment.
Bidirectional And Doseresponse Relationship
OSA and HTN exist in a bidirectional relationship such that the presence of one disease increases the risk of the other . Patients may not be diagnosed with both at the time of clinical assessment, but the discovery of one disease merits the investigation of the other. In a 2018 Taiwanese study assessing the prevalence of OSA in a cohort of 215 patients with preexisting HTN, 81.9% were diagnosed with new onset OSA . A different study using PSG to observe the effects of HTN on sleep characteristics in 304 participants who had no prior diagnosis of OSA found that HTN was associated with decreased sleep efficiency, decreased mean and minimum oxygen saturation during apneic episodes, increased AHI, and increased oxygen desaturation index , which is defined as the number/hour of apneic events resulting in reductions in oxygen saturation by4% from baseline . A 2020 study of 4,500 people with OSA identified that merely mild OSA increased the likelihood of having HTN by 78% when compared to control subjects without OSA .
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Treating Sleep Apnea And High Blood Pressure
There are many ways to treat sleep apnea and high blood pressure. To start, your healthcare provider may recommend lifestyle changes like losing weight, being more active or quitting smoking.
They may also suggest wearing a continuous positive airway pressure machine while sleeping and taking blood pressure medications. A CPAP machine pumps air into your lungs through a facemask.¹ If you have an benefit with your Humana plan, you can order a CPAP machine from our OTC store.
Blood pressure medications, when taken as directed, can help lower high blood pressure. If your healthcare provider prescribes you a blood pressure medication, its quick and easy to start a new prescription with CenterWell Pharmacy.
Osa And Resistant Hypertension
Resistant hypertension, which is defined as BP that remains higher than 140/90mmHg despite treatment with three different classes of anti-hypertensive medicines at their optimal doses, is a common secondary effect of OSA., For example, Calhoun et al. observed that 90% of male patients and 77% of female patients with resistant hypertension had OSA. In another clinical study conducted by Ruttanaumpawan et al., they reported that OSA was associated with an increased risk of resistant hypertension, with an adjusted odds ratio of 1.025 . Furthermore, two cross-sectional studies revealed that there was doseeffect relationship between the severity of OSA and the magnitude of BP increase, as well as the number of anti-hypertensive medicines used to manage hypertension., In recent times, a clinical study revealed that clinically significant OSA was independently associated with concentric hypertrophy in patients with resistant hypertension, which suggests that OSA might accelerate the adverse cardiovascular remodeling in subjects with resistant hypertension.
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Osa And Nocturnal Hypertension
According to the circadian patterns of BP, high BP could be broadly classified into two categories: dipping and non-dipping. Briefly, a dipping pattern is when there is more than a 10% decrease in nighttime BP compared with daytime BP. By contrast, nocturnal hypertension is present when there is less than a 10% of reduction in BP at night or when the nighttime BP is higher than during the day. A number of previous studies have revealed that nocturnal hypertension imposed greater adverse effects on the cardiovascular system than daytime hypertension., It has been reported that the prevalence of nocturnal hypertension is substantially higher in subjects with OSA. For example, Loredo et al. reported that ~84% of patients with OSA in their study experienced nocturnal hypertension. Data from the Wisconsin Sleep Cohort Study indicated that there was a doseeffect relationship between the severity of OSA and the risk of nighttime BP elevation. The main mechanism contributing to nighttime BP elevation is the sympathetic overactivation caused by hypoxemia, frequent arousals and sleep deprivation. Treatment of OSA with CPAP therapy reversed the nighttime BP elevation. It is clinically important to screening for OSA in patients with non-dipping or difficult-to-treat hypertension.