What diseases does sleep apnea (obstructive sleep apnea) predispose you to?

Diseases Associated with Sleep Apnea

Sleep apnea significantly increases the risk of cardiovascular diseases (particularly hypertension, stroke, and heart failure), type 2 diabetes, and metabolic disorders, making early identification and treatment critical for reducing morbidity and mortality. 1, 2

Cardiovascular Diseases

Sleep apnea is strongly associated with multiple cardiovascular conditions:

• Hypertension: OSA is a major risk factor for resistant hypertension 1, 3
• Heart failure: Both congestive and acute heart failure are significantly linked to sleep apnea 1, 2
• Stroke: Patients with OSA have a substantially higher risk of cerebrovascular events 2
• Coronary artery disease: Moderate to severe sleep apnea significantly increases risk 2
• Cardiac arrhythmias: Particularly atrial fibrillation 3, 2
• Pulmonary hypertension: Associated with increased OSA risk 3

The pathophysiologic mechanisms linking OSA to cardiovascular disease include:

• Recurrent hypoxemia and hypercarbia
• Increased sympathetic nerve activity
• Decreased parasympathetic nerve activity
• Oxidative stress and vascular endothelial dysfunction
• Cardiac remodeling 2

Metabolic Disorders

Sleep apnea has bidirectional relationships with several metabolic conditions:

• Type 2 diabetes: OSA contributes to insulin resistance and glucose intolerance, while diabetes may accelerate progression of sleep apnea 4, 1
• Obesity: Both a cause and consequence of OSA, creating a vicious cycle 5
• Metabolic syndrome: OSA is an independent risk factor for metabolic syndrome components 6
• Dyslipidemia: Hyperlipidemia is commonly associated with OSA 7
• Non-alcoholic fatty liver disease: More common in patients with OSA 1

Other Associated Conditions

• Cognitive and psychological effects:

  • Impaired vigilance and concentration
  • Depression and psychological comorbidities 7
  • Decreased quality of life 1, 2

• Sensory impairments:

  • Hearing impairment (both high-frequency and low-to-mid frequency ranges) 1

• Endocrine disorders:

  • Hypothyroidism (untreated) increases OSA risk 3
  • Polycystic ovarian disease is associated with higher OSA rates 1
  • Low testosterone levels in men 1

• Respiratory conditions:

  • Asthma and COPD are more common in patients with OSA 7

Clinical Implications

The presence of sleep apnea significantly increases healthcare utilization and costs 1. Early identification and treatment of OSA is essential as it can:

• Improve quality of life
• Lower rates of motor vehicle accidents
• Reduce risk of chronic health consequences 1
• Decrease healthcare utilization and costs 1

Risk Factors to Consider

Key risk factors that may help identify patients at risk for OSA include:

• Obesity (BMI ≥ 30 kg/m²), especially central obesity 3
• Increased neck circumference (≥17 inches in men, ≥15.5 inches in women) 3
• Age over 42 years 3
• Male sex 3
• Postmenopausal status in women 3
• Family history of OSA 3

Screening Considerations

Patients with the following conditions should be considered for OSA screening:

• Resistant hypertension
• Type 2 diabetes
• Cardiovascular disease
• Obesity
• Daytime sleepiness or fatigue
• Witnessed apneas or loud snoring 3

Early identification and appropriate treatment of OSA can significantly reduce the risk of these associated conditions and improve patient outcomes.