Sleep apnea affects over 22 million Americans, many of whom go undiagnosed. Read more about what this new research means for those with heart disease.

Karla Walsh
June 22, 2021
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Getty Images / Big_Ryan / Elinalee
| Credit: Getty Images / Big_Ryan / Elinalee

Heart disease is the leading cause of death in America. In fact, every 36 seconds (yep, about once every TV show commercial), one American dies from cardiovascular disease, according to the latest data from the U.S. Centers for Disease Control and Prevention (CDC).

While it clearly can be fatal, a lot of Americans bounce back after a heart attack or continue to live life long after a diagnosis with an arrythmia, partially-blocked arteries or another form of heart disease.

But a new American Heart Association (AHA) study published yesterday in the journal Circulation found that the majority of these individuals with cardiovascular disease also share another common condition-sleep apnea-and both of these conditions can make the other worse.

About 22 million Americans have sleep apnea, and a whopping four in five of moderate and severe cases go completely undiagnosed, reports the American Sleep Apnea Association (ASAA). What makes it such a complicated condition to pin down is the fact that this all happens while we're sleeping.

Sleep apnea occurs when a person involuntarily stops breathing while asleep. The vast majority of the time, the sleeper begins breathing again quickly enough that they don't fully wake up and realize anything is "off." (Translated from Greek, "apnea" literally means "without breath", the ASAA explains.) There are three types: obstructive sleep apnea, central sleep apnea and mixed sleep apnea, and obstructive sleep apnea is the most common. It's also the kind of sleep apnea that somewhere between 40% and 80% of Americans with heart disease have, including about 30% to 50% of people with high blood pressure.

Obstructive sleep apnea (OSA) happens when an upper airway is obstructed, which leads to a disruption in breathing. Beyond these lapses in breathing while asleep, symptoms include snoring, difficulty staying asleep and daytime sleepiness.

Risk factors for OSA somewhat overlap with heart disease risk factors. OSA is much more likely among people who are obese, have a large neck circumference, any craniofacial abnormalities, smoke, have family history for sleep apnea or suffer from nighttime nasal congestion. Those who have OSA-diagnosed or not-are at greater risk for several cardiovascular complications, the AHA researchers say:

  • High blood pressure
  • Heart rhythm disorders
  • Stroke
  • Worsening heart failure or coronary artery disease
  • Heart attack
  • Type 2 diabetes
  • Metabolic syndrome

As a result of these findings, the study authors recommend that cardiologists prescribe a sleep study to screen for OSA among heart disease patients with tough to control hypertension, heart rhythm issues that recur even after treatment and those with heart failure, especially if the individual is feeling especially sleepy during the day or noticing sleep-disordered breathing patterns.

The researchers explain that an OSA diagnosis might directly impact all of those who have these overlapping conditions, but "the high prevalence of OSA among people with cardiovascular disease, along with evidence that OSA treatment improves patient quality of life, are reasons to screen and provide treatment," according to the statement writing group.

With the proper treatment, which often includes a continuous positive airway pressure (CPAP) machine, "patients report better mood, less snoring, less daytime sleepiness, improved quality of life and work productivity," says Chair of the scientific statement writing group Yerem Yeghiazarians, M.D., who is also a professor of medicine and the Leone-Perkins Family Endowed Chair in Cardiology at the University of California, San Francisco.

Plus, you might not even need to visit a sleep lab for that study.

"Screening advances have changed how we diagnose and treat obstructive sleep apnea. For example, many patients do not have to go to an overnight sleep study center anymore. There are now sleep devices approved by the FDA that patients use at home and send back to their doctor for assessment," Dr. Yeghiazarians says.

Whether you already have a diagnosed form of heart disease or not, talk to your doctor if you notice any of the symptoms of sleep apnea noted above. Because a long, healthy, well-rested life (and what happens after we get a good night of sleep!) is something we all deserve to experience.