What to know about sleep apnea and heart failure

Sleep apnea is a type of sleep disorder in which a person repeatedly stops and starts breathing during their sleep.

Apnea causes breathing to stop for 10 seconds or more. The brain responds to apnea by waking up just enough to breathe. Usually, the person is not aware of these waking episodes that may last only a few seconds.

Types

The two main types of sleep apnea are obstructive sleep apnea (OSA) and central sleep apnea (CSA).

OSA is the most common type. OSA occurs when the throat muscles relax during sleep and collapse on themselves, blocking a person’s upper airway. The most common causes are obesity or unusual upper airway anatomy.

CSA occurs when a person’s brain does not send out signals to maintain normal breathing, or the body does not correctly receive those signals. CSA is common among people with heart failure.

Repeated stops in breathing temporarily reduce the supply of oxygen to a person’s heart and lungs. This repetitive lack of oxygen triggers the release of stress hormones, leading to stress on the heart. In addition, blood pressure might increase, putting further strain on the heart.

The American Heart Association (AHA) associates sleep restriction with inflammation, which they say can elevate the risk of damage to the heart. People with sleeping disorders such as sleep apnea are far more likely to have heart disease and heart disorders.

Sleep apnea may also increase a person’s risk for other health conditions, such as:

• high blood pressure
• stroke
• glaucoma and dry eyes
• type 2 diabetes
• metabolic syndrome
• kidney disease
• dementia
• depression
  

Treatment of sleep apnea is dependent on its cause. If other medical problems are present, sleep apnea symptoms may improve with the treatment of these conditions. For example, if obesity is causing OSA, weight loss may resolve sleep apnea.

Heart disease

Around 40–80% of people in the United States with cardiovascular disease also have OSA, yet it is underrecognized and undertreated.

According to the Centers for Disease Control and Prevention (CDC), heart disease is the leading cause of death in the U.S.

Heart disease refers to several types of heart conditions, including:

• heart failure
• coronary artery disease
• myocardial infarction or heart attack
• arrhythmia or irregular heartbeat
• cardiomyopathy
• heart valve disease

A 2018 review focusing on the relationship between OSA and heart failure states that OSA contributes substantially to the development and progression of heart failure.

The symptoms of sleep apnea include:

• waking up with a morning headache
• snoring, sometimes loudly, though snoring is less common with CSA
• witnessed episodes of apnea
• waking up several times a night to urinate, also known as nocturia
• frequent awakenings during the sleep cycle
• a dry mouth
• excessive daytime sleepiness
• problems with memory and concentration
• irritability
• decrease in sex drive or erectile dysfunction
• falling asleep while reading, watching TV, during class, or while driving

Learn more about specific sleep apnea symptoms.

Managing sleep apnea depends on how severe a person’s sleep apnea is. Sleep testing can determine the type of apnea and its severity. If people receive a diagnosis of sleep apnea, they may be able to make some helpful changes to their diet and lifestyle or require specific treatment.

Lifestyle changes

For mild OSA, a doctor may suggest a person adopts certain lifestyle changes, such as:

• maintaining a moderate weight
• staying physically active and getting regular exercise
• limiting alcohol and caffeine consumption, where applicable
• reviewing and changing medications that may cause sleep apnea
• sleeping on one side
• quitting smoking if the person smokes

Read on for tips on how to quit smoking.

Treatments

Besides lifestyle changes, doctors typically recommend continuous positive airway pressure (CPAP) machines to treat moderate to severe OSA. CSA is often more difficult to treat and may require more complex pressure delivery systems. It is best for people to receive this therapy through a sleep clinic.

The CPAP machine comprises a face or nose mask with a long flexible hose attached to the CPAP machine. It delivers pressurized air through the mask to keep a person’s airway open during their sleep.

Learn more about different CPAP masks.

Other sleep apnea management options include oral devices, upper airway stimulation, and surgery.

According to a 2020 report from the AHA, the prevalence of heart failure continues to rise over time. The report estimates that 6.2 million adults in America over the age of 20 had heart failure between 2013 and 2016, compared with about 5.7 million between 2009 and 2012.

Sleep apnea can occur alongside heart failure. Certain conditions and genetic and lifestyle factors can increase the risks.

Medical conditions that may increase a person’s chance of developing heart failure include:

• diabetes
• high blood pressure
• obesity
• conditions related to heart disease such as angina, atrial fibrillation, Marfan syndrome, and congenital heart defects

Behaviors that can increase a person’s risk for heart failure include:

• smoking tobacco
• eating foods high in fat and salt
• not doing an adequate amount of physical activity
• excessive alcohol intake

Heart failure is a serious medical condition. Doctors and other clinicians can help a person manage their heart failure.

Research suggests that CPAP use reduces the risk of death and hospitalization in people with both heart failure and OSA.

People who use CPAP regularly show improvements in physical functioning, mood, sleepiness, and pain and miss fewer workdays.

Sleep apnea treatment combined with heart failure treatment may reverse a person’s existing heart damage by improving cardiac function.

Sleep apnea is a sleep-related breathing disorder that doctors link to heart failure.

Heart failure is a serious condition that develops when a person’s heart does not pump enough blood to meet their body’s needs.

Treating sleep apnea can relieve some symptoms of heart failure and may stop the condition from worsening. In turn, if a person can manage symptoms of heart disease, this can reduce their risk of developing sleep apnea.