Sleep Apnea and Cardiovascular Disease

After examining years of emerging research,  the American Heart Association added sleep in 2022 as its 8th habit for a healthy heart.   It recognized that poor sleep and sleep disorders impact our cardiovascular health.  

Atrial fibrillation (AFib)—an irregular and often rapid heartbeat—is increasingly recognized as being closely linked to obstructive sleep apnea (OSA). During apnea episodes, oxygen levels drop and the body releases stress hormones that strain the cardiovascular system, leading to inflammation and electrical instability in the heart, which produce symptoms of feeling your heart is racing, dizziness, lightheadedness, fatigue, and even stroke. Women have worse symptoms of AFIB and worse outcomes (stroke risk, stroke severity, and all-cause mortality).

OSA can worsen the condition or make it harder to treat. Studies show that up to 50% of individuals with AFib also have undiagnosed sleep apnea, and treating OSA with therapies like CPAP can significantly reduce the frequency and severity of AFib episodes. For those managing AFib, screening for sleep apnea is a crucial and often overlooked step in improving heart rhythm stability and long-term outcomes.

OSA contributes to the development of resistant hypertension due to repeated episodes of oxygen desaturation and arousal during sleep, leading to sympathetic nervous system activation. This persistent elevation in blood pressure increases the risk of cardiovascular events. See our page "Sleep Disorders and Hypertension" for more information.

Sleep apnea is strongly linked to heart failure, both as a risk factor and a complicating condition. During apnea episodes, breathing repeatedly stops or becomes shallow, leading to drops in oxygen and spikes in blood pressure. These stress the heart over time, contributing to ventricular remodeling, fluid retention, and impaired heart function.

 Both forms of sleep apnea, OSA and CSA, are common in heart failure patients and are associated with higher rates of hospitalization, arrhythmias, and even mortality.

Treatment with CPAP (for OSA) or adaptive servo-ventilation (ASV) and other specialized therapies (for CSA) can help improve cardiac output, oxygenation, and sleep quality, and may reduce hospitalizations. Recognizing and treating sleep apnea in people with heart failure is a critical part of comprehensive cardiac care.

OSA is linked to a higher incidence of stroke, through atrial fibrillation or other causes of cardiovascular disease. The condition's impact on blood pressure, endothelial function, and inflammatory pathways contributes to this elevated risk.

Women with sleep apnea are often underdiagnosed, yet research shows they may face a higher risk of stroke and cardiovascular complications compared to men with the same condition. Unlike men, women are more likely to report subtle symptoms like fatigue, insomnia, and mood changes rather than loud snoring—leading to missed diagnoses.

When untreated, sleep apnea in women can lead to greater blood pressure variability, inflammation, and oxygen deprivation, all of which increase the risk of stroke and heart disease. Recognizing these sex-specific patterns is essential for early detection and prevention.

1. Discuss the quality and quantity of your sleep with your cardiologist

2. Ask for a referral to a sleep physician with the intention of adding this dimension to an integrative medicine approach

3. Make sure you get a copy of your sleep study

4. Discuss results with both the cardiologist and sleep physician

5. Ensure your chosen treatment addresses both improving the quality of your sleep as well as reducing the number of sleep-disordered breathing events down to as close to 5 per hour (ideally).

6. Don't be discouraged when you need to keep making adjustments

7. Prioritize your sleep hygiene, creating a consistent bedtime routine in a sleep-friendly environment

8. Get support from other sleep apnea patients who have been able to adjust to treatment

1. American Heart Association adds sleep to 8 essential habits for a healthy heart.  American Heart Association https://newsroom.heart.org/news/american-heart-association-adds-sleep-to-cardiovascular-health-checklist

2. Gami, A. S., Pressman, G., Caples, S. M., Kanagala, R., Gard, J. J., Davison, D. E., et al. (2004). “Association of atrial fibrillation and obstructive sleep apnea.” Circulation, 110(4), 364–367. https://doi.org/10.1161/01.CIR.0000136587.68725.8E

3. Somers, V. K., White, D. P., Amin, R., Abraham, W. T., Costa, F., Culebras, A., et al. (2008). “Sleep apnea and cardiovascular disease: An American Heart Association/American College of Cardiology Foundation Scientific Statement.” Circulation, 118(10), 1080–1111.https://doi.org/10.1161/CIRCULATIONAHA.107.189375

4. Sleep apnea and atrial fibrillation.Healthline https://www.healthline.com/health/atrial-fibrillation/sleep-apnea-and-afib

5. Sleep apnea and hypertension.Cleveland Clinic https://consultqd.clevelandclinic.org/exploring-the-connection-between-sleep-apnea-and-cardiovascular-disease

6. Heart failure and sleep apnea. Cleveland Clinic Journal of Medicine https://www.ccjm.org/content/86/9_suppl_1/10

7. Stroke and sleep apnea.American Heart Association https://www.ahajournals.org/doi/pdf/10.1161/CIR.0000000000000988