Sleep apnoea and heart problems: A comprehensive overview

Quick takeaways

• Sleep apnoea 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 apnoea, including high blood pressure, irregular heartbeat disorders, heart disease, heart attack and stroke.
• Continuous positive airway pressure (CPAP) and other sleep apnoea therapies may help reduce certain cardiovascular risks.

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

Sleep apnoea 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 apnoea (OSA) face a higher risk of cardiovascular disease.¹

Because untreated sleep apnoea 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 your treatment options.²

Understanding sleep apnoea and its cardiovascular impact

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

Types of sleep apnoea

Three main types of sleep apnoea are:

• Obstructive sleep apnoea (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 apnoea (CSA). This type of sleep apnoea occurs when the brain doesn’t send signals to the muscles that control breathing,⁴ causing breathing to pause during sleep.
• Mixed/complex sleep apnoea (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 apnoea, is becoming increasingly widespread in the UK. The number of people living with obstructive sleep apnoea in the UK is projected to increase by 66% between 2020 and 2050.²⁴

Sleep apnoea and heart health: is there a link?

Obstructive sleep apnoea (OSA) can lead to interrupted breathing. These breathing disruptions may impact heart functions 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 apnoea 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 build-up of carbon dioxide in the blood, which can place added strain heart muscles.

In some cases, sleep apnoea 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 apnoea.¹¹

At the same time, nighttime chest pain may also be caused by conditions like acid reflux. Overlapping symptoms exist between conditions like sleep apnoea, 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 apnoea

Researchers have found that untreated sleep apnoea 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 apnoea 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 diagnosed with sleep apnoea.¹¹
• Stroke and vascular disease: Researchers consider sleep apnoea to significantly increase a person’s risk of stroke. This means living with obstructive sleep apnoea (OSA) may raise the likelihood of stroke even if you don’t have other common risk factors.²

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

How sleep apnoea is diagnosed in people with heart disease

Doctors typically use a combination of health history, screening tools and sleep studies to check for sleep apnoea 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 apnoea.¹ That higher risk could lead a doctor to ask about or consider signs of sleep apnoea like:¹²

• 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 control
• Heart palpitations or irregular heartbeat

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

Sleep tests your doctor may recommend

Sleep tests capture information about how you sleep and can help doctors make a sleep apnoea 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 behaviour.
• 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 analyse.

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 analyse data from sleep tests to determine if you have sleep apnoea 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 apnoea-hypopnoea index (AHI). AHI reflects how many times an hour you have an apnoea (breathing paused for 10 seconds or more) or hypopnoea (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 build-up or blockages that might indicate disease.

Treatment options and heart health benefits

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

CPAP and other airway therapies

CPAP, or continuous positive airway pressure, delivers continuous pressurised 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 apnoea, there is a 55% lower risk of dying from heart-related issues with CPAP therapy.¹⁸

Special considerations for people with heart failure and sleep apnoea

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 apnoea 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 apnoea treatments

Continuous positive airway pressure (CPAP) is highly effective and is the most used and understood method for treating sleep apnoea.¹⁷ CPAP therapy has also been shown to help people with sleep apnoea 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 apnoea symptoms by holding the lower jaw forward to keep the airway from becoming blocked. They may be recommended to treat mild-to-moderate sleep apnoea.
• 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 apnoea, 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

Lifestyle changes

Around 30% of people with obstructive sleep apnoea (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 apnoea.

Regardless of your weight, if you are dealing with sleep apnoea – 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 apnoea and heart health include:

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

Medications, sleep apnoea and heart health

Some heart medications can have an impact on sleep apnoea 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 any concerns or questions you have about how to best manage your medications.

Why team-based care matters

If you have multiple health conditions, like sleep apnoea and heart disease, you may need to work with more than one doctor.²⁰ A doctor who specialises 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 apnoea.
• 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 apnoea 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 analyse data and spot risks sooner, leading to earlier and more focused care.¹²
• New therapies, such as nerve stimulation or emerging medicines, may help enhance comfort and support treatment effectiveness.¹²

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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This blog post contains general information about medical conditions and treatments. It is not intended to be a substitute for professional medical advice, diagnosis or treatment. The information is not advice, and should not be treated as such. You must not rely on the information on this website as an alternative to medical advice from your doctor or other professional healthcare provider.

If you have any specific questions about any medical matter, you should consult your doctor or other professional healthcare provider. If you think you may be suffering from any medical condition, you should seek immediate medical attention. You should never delay seeking medical advice, disregard medical advice, or discontinue medical treatment because of information on this website. The views expressed on this blog and website have no relation to those of any academic, hospital, practice, or other institution with which the authors are affiliated and do not directly reflect the views of Resmed or any of its subsidiaries or affiliates.

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