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.
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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Obstructive Sleep Apnea Is Common
Obstructive sleep apnea is characterized by recurrent episodes of partial or complete collapse of the upper airway during sleep, with partial collapse leading to hypopnea and complete collapse leading to apnea. These episodes result in intermittent hypoxemia, microarousals, sleep fragmentation, daytime sleepiness, and impairment in quality of life.
In tandem with the increasing obesity epidemic, the prevalence of moderate to severe obstructive sleep apnea is 17% in men and 9% in women 50 to 70 years old.
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Sleep Apnea Creates Norepinephrine Spikes In The Body
When your airway is blocked or constricted at night when youre asleep, your body must find a way to open up the airway so you can breathe. It does this by releasing norepinephrine, also sometimes referred to as adrenaline. Norepinephrinenorepi is the main awake neurotransmitter in the brain, and it arouses the brain to signal the throat to open up and let air in.
Although most people dont actually wake up, the arousal is enough to increase the muscle tone in the throat and return it to how it normally is during the day. Unfortunately, the norepinephrine release also creates a fight or flight response in your body that increases your heart rate, as well as your blood pressure.
Its release is so effective at raising blood pressure in the body, norepinephrine is used in the ICU to treat people in shock and at risk of death for low blood pressure. This is because its the most powerful agent we know of to increase blood pressure.
The more frequently you have these respiratory events at night, the more norepinephrine youre going to release, and the more your blood pressure will rise. This can make keeping blood pressure under control exceedingly difficult if you have undiagnosed sleep apnea or arent properly treated.
What Health Conditions Are Linked To A Lack Of Sleep
Adults who sleep less than 7 hours each night are more likely to say they have had health problems, including heart attack, asthma, and depression.3 Some of these health problems raise the risk for heart disease, heart attack, and stroke. These health problems include:
- High blood pressure. During normal sleep, your blood pressure goes down. Having sleep problems means your blood pressure stays higher for a longer period of time.4 High blood pressure is one of the leading risks for heart disease and stroke. About 75 million Americans1 in 3 adultshave high blood pressure.5
- Type 2 diabetes. Diabetes is a disease that causes sugar to build up in your blood, a condition that can damage your blood vessels. Some studies show that getting enough good sleep may help people improve blood sugar control.6
- Obesity. Lack of sleep can lead to unhealthy weight gain. This is especially true for children and adolescents, who need more sleep than adults. Not getting enough sleep may affect a part of the brain that controls hunger.6
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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
Research On Sleep Apnea And High Blood Pressure
Its hard to study a question like that because you cant easily induce apnea or high blood pressure directly in subjects.
But one way to find an answer is to look at how treatment for one of the symptoms affects the others.
The most common treatment to reduce apneas during sleep is using continuous positive airway pressure .
One study looked at the effects of using CPAP treatment for 12 weeks on patients with both obstructive sleep apnea and hypertension . They found:
CPAP treatment for 12 weeks compared with control resulted in a decrease in 24-hour mean and diastolic blood pressure and an improvement in the nocturnal blood pressure pattern.
While it wasnt a huge amount, there was a statistically significant decrease in blood pressure as a result of the treatment.
Another study had a similar approach and had the same conclusion :
Sleep apnea elicits increases in blood pressure and endothelin-1, with reductions in both after treatment
In other words, it does appear that apneas are the cause of high blood pressure.
SummaryResearch has shown that reducing the frequency of apnea events through CPAP treatment also reduces blood pressure. While there may be other factors leading to high blood pressure, it does appear that sleep apnea does cause an increase in blood pressure by itself.
Hypertension And Poor Sleep
There is a clear link between a persons sleep patterns and their risk for high blood pressure. A study by the Journal of Sleep Medicine found that people who get less than six hours of sleep each night were 20 percent more likely to have hypertension.
A study by the journal Hypertension showed that people who get less than six hours of sleep each night were shown to have higher blood pressure the next day, as compared to those who got the recommended amount the night before. This pattern, continued over time, only works to compound the issues and increase the risk for hypertension.
As mentioned earlier, about half of people experiencing hypertension have obstructive sleep apnea as well. Hypertension doesnt cause sleep apnea, but there is a connection between the two.
How Is Sleep Apnea Diagnosed
If your doctor determines that you have symptoms suggestive of sleep apnea, you may be asked to have a sleep evaluation with a sleep specialist or may order an overnight sleep study to objectively evaluate for sleep apnea.
- Testing includes an overnight sleep study called a polysomnogram . A PSG is performed in a sleep laboratory under the direct supervision of a trained technologist. During the test, a variety of body functions, such as the electrical activity of the brain, eye movements, muscle activity, heart rate, breathing patterns, air flow, and blood oxygen levels are recorded at night during sleep. After the study is completed, the number of times breathing is impaired during sleep is tallied and the severity of the sleep apnea is graded.
- For adults, a Home Sleep Test can sometimes be performed instead. This is a modified type of sleep study that can be done in the comfort of home. It records fewer body functions than PSG, including airflow, breathing effort, blood oxygen levels and snoring to confirm a diagnosis of moderate to severe obstructive sleep apnea.
An HST is not appropriate to be used as a screening tool for patients without symptoms. Its not used for patients with significant medical problems . Its also not used for patients who have other sleep disorders in addition to the suspected obstructive sleep apnea.
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Obstructive Sleep Apnoea And Hypertension: The Esada Study
Population-based epidemiological studies strongly implicate obstructive sleep apnoea as an independent risk factor for cardiovascular morbidity and mortality . Final proof of a causal relationship between OSA and premature cardiovascular disease, and the true strength of that relationship, will depend on the results of large, well-designed randomised controlled trials of OSA treatment, several of which are ongoing . In the meantime there is considerable interest in the various mechanistic pathways whereby OSA might lead to increased cardiovascular disease/events. A clearer understanding of these pathways will probably have practical therapeutic implications for reducing cardiovascular risk in OSA populations in the future. Devices such as continuous positive airway pressure and mandibular repositioning devices are effective treatments for OSA, but the reality is that they are found to be unacceptable or are used infrequently by many patients with OSA, particularly those who are minimally symptomatic. Other treatments directed specifically at mitigating cardiovascular risk in such patients may be needed and this will require a clear understanding of the dominant mechanisms for increased cardiovascular disease and/or cardiovascular events in OSA.
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Current Research Indicates A Connection Between Obstructive Sleep Apnea And Hypertension
A 2018 article published by the Journal of Hypertension notes that the connection between obstructive sleep apnea and both acute and chronic increases in blood pressure is well-established by scientific literature.
While central sleep apnea is common in patients with advanced heart failure, these patients typically have low blood pressure. The relationship between central sleep apnea and hypertension, if there is any, is therefore currently unclear.
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If you have high blood pressure and are experiencing pain and sleeplessness TYLENOL® PM may be an appropriate pain reliever/nighttime sleep aid option for you. SIMPLY SLEEP® may also be an appropriate nighttime sleep aid for those with high blood pressure who experience occasional sleeplessness without pain.
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