The Connection Between Sleep Apnea and Your Blood Pressure

If you have both sleep apnea and high blood pressure (hypertension), you might chalk it up to coincidence. But there may be more to it because each can affect the other.

“The relationship between OSA and hypertension is a two-way street,” says sleep medicine specialist Aparna Bhat, MD.

The relationship between OSA and BP

Obstructive sleep apnea (OSA) can raise your risk of high blood pressure (BP). And the opposite is true, too: Hypertension can make sleep apnea worse.

Of course, they don't always come as a package deal. You can have one without the other. Of the two types of sleep apnea (obstructive and central), obstructive sleep apnea is more commonly associated with unmanaged high blood pressure. It’s also the most common kind.

Dr. Bhat explains why obstructive sleep apnea and high blood pressure can be connected.

How OSA causes high blood pressure

When you have obstructive sleep apnea, the muscles in your mouth and throat relax too much while you sleep. That causes your airways to collapse and your breathing to pause as you snooze. OSA can affect the quality of your sleep (and that of anyone sharing a room with you, if you snore).

Normally, your body uses sleep as a time to recover. Your heart rate slows, your stress hormone levels fall and your blood pressure dips. That gives your heart and blood vessels a chance to rest.

But when sleep apnea repeatedly interrupts your sleep, you don’t reap those benefits.

“When our sleep is restful, our blood pressure is supposed to decrease,” Dr. Bhat says. “OSA has the opposite effect.”

If you have OSA, your body stays on high alert throughout the night.

“When you have sleep apnea, your oxygen levels drop and activate your body’s fight-or-flight response,” she continues. “That causes a surge of stress hormones (cortisol) that signal your blood vessels to tighten and raise blood pressure.”

Over time, those repeated stress responses can strain your heart and blood vessels.

How hypertension can lead to sleep apnea

Now, for the other side: If you have high blood pressure, you can be at higher risk for developing obstructive sleep apnea. That’s especially true if your blood pressure isn’t well managed with medication or other treatments.

“Unmanaged blood pressure can result in fluid buildup or swelling in the body,” Dr. Bhat explains. “When you lie down at night, that fluid can move to your neck, leading to throat swelling.” That swelling narrows your airway and contributes to OSA.

What’s more, if you have blood pressure that doesn’t respond well to medication (resistant hypertension), it can cause even more fluid to build up. That’s because resistant hypertension can contribute to abnormally high levels of a hormone called aldosterone. A buildup of aldosterone can cause you to absorb more sodium, retain more fluid and swell more.

Will using a CPAP lower blood pressure?

Because obstructive sleep apnea and high blood pressure are so closely connected, treating both is important.

CPAP (continuous positive airway pressure) is considered the gold standard treatment for OSA. A CPAP machine isn’t an oxygen machine. Instead, it delivers pressurized air through a mask to help keep your airway open while you sleep.

“When consistently worn through the night, CPAP can reduce systolic blood pressure,” Dr. Bhat reports. (That’s the top number on your BP reading.)

How? A CPAP machine helps keep your airways open throughout the night. That can mean more restful sleep that allows your blood pressure to dip as it should.

CPAP is often the first treatment that providers recommend. But depending on your needs, other therapies may also help improve sleep apnea and support healthier blood pressure levels. Your provider may also recommend:

• Weight loss: Achieving a healthy weight can improve blood pressure and lessen the severity of sleep apnea in people with obesity. Healthy eating and exercise may help. So might a medication called tirzepatide (Zepbound®), which is used for treating OSA in adults with obesity.
• Oral appliance therapy (OAT): Sleeping with a customized dental device can help move your jaw forward during the night. That can help keep your airways open while you sleep. Consistently wearing these oral appliances at night may lower your systolic blood pressure.
• Hypoglossal nerve stimulation (Inspire®): This surgical treatment uses an implanted device that stimulates your tongue muscles to keep your airways open while you sleep. Though not directly tied to improved blood pressure, it can help treat OSA.

Final thoughts

Over time, untreated sleep apnea and high blood pressure can have serious effects.

“OSA and hypertension are both risk factors for heart health, stroke, disability and worse,” Dr. Bhat states. “Managing OSA has an impact on your heart health, mental health and, ultimately, your quality of life.”

Talk with a healthcare provider about how high blood pressure and sleep apnea are affecting your life. They can help you find the right treatments to protect your heart, your sleep and your overall well-being.