Obstructive sleep apnea, or OSA, is a common sleep disorder characterized by repeated breathing pauses during sleep. While most people are aware of the immediate health risks associated with OSA, such as daytime drowsiness, many are unaware of the potential long-term complications, including its link to pulmonary hypertension.

Understanding obstructive sleep apnea and pulmonary hypertension

Obstructive sleep apnea occurs when the upper airway becomes partially or completely blocked during sleep, leading to interruptions in breathing. This causes a decrease in blood oxygen levels and increased carbon dioxide levels.

Pulmonary hypertension is a condition characterized by high blood pressure in the arteries of the lungs. It occurs when the blood vessels in the lungs constrict, making it harder for blood to flow through them. Untreated OSA can contribute to the development or progression of pulmonary hypertension, says advanced heart failure cardiologist Ronald Zolty, MD.

“When you have obstructive sleep apnea, not enough oxygen gets to the lungs, and you have vasoconstriction, or less blood going to the vessels,” he explains. “Over time, when you’ve had long periods of constriction, pulmonary hypertension develops.”

Symptoms of pulmonary hypertension

Recognizing the symptoms of pulmonary hypertension is important for early detection and intervention. Common symptoms include:

1. Shortness of breath. Patients may experience breathlessness even during minimal physical exertion or at rest.
2. Fatigue. Persistent tiredness and lack of energy are common symptoms.
3. Chest pain. Atypical chest pain may occur due to the strain on the heart and inadequate blood supply.
4. Dizziness or fainting spells. Reduced blood flow to the brain can lead to dizziness or even fainting episodes.
5. Swollen ankles and legs. Fluid retention can occur due to the increased pressure in the pulmonary arteries.

Symptoms of obstructive sleep apnea

Anyone who has OSA is at risk of developing pulmonary hypertension, says pulmonary critical care specialist Tammy Oleskevich Wichman, MD, adding, “The more severe the obstructive sleep apnea is, the higher the risk of pulmonary hypertension.”

It’s estimated that 20% to 30% of people have sleep apnea, but most don’t realize they have it. Symptoms include:

• Daytime sleepiness
• Snoring
• Restlessness while sleeping
• Periods of not breathing while sleeping, followed by gasping or choking.
• Headaches upon waking

The importance of diagnosis and treatment

Diagnosing and treating OSA is essential in preventing the development or progression of pulmonary hypertension. An evaluation performed at an accredited sleep center can provide an OSA diagnosis.

“When a patient is referred for pulmonary hypertension, part of the workup is to do a sleep study,” Dr. Zolty says. “It is not rare for patients with pulmonary hypertension to have sleep apnea.”

Early intervention is crucial as it increases the chances of resolving pulmonary hypertension before it becomes irreversible. By treating OSA, the oxygen levels in the blood improve, reducing the strain on the pulmonary arteries and allowing them to function more efficiently.

Treatment options for obstructive sleep apnea

Several effective treatment options are available for obstructive sleep apnea. These include:

1. Continuous positive airway pressure, or CPAP. This therapy involves wearing a mask over the nose or mouth during sleep, which gently delivers a continuous flow of air, keeping the airways open.
2. Oral appliances. Custom-made dental devices can be used to reposition the jaw and tongue, helping to keep the airway open.
3. Lifestyle changes. Weight loss, regular exercise and avoiding alcohol can help alleviate symptoms.
4. Surgery. In some cases, various surgical procedures, including the Inspire implant, may be necessary.

By recognizing and effectively treating obstructive sleep apnea, the risk of developing or worsening pulmonary hypertension can be mitigated, according to Dr. Oleskevich Wichman.

“Most patients whose sleep apnea is well managed do not develop pulmonary hypertension, or it's very mild, and they can live a very long time,” she says.