Sleep Apnea, Diabetes, and Cardiovascular Disease

Patients with cardiovascular disease are very likely to have sleep apnea.

Prevalence of sleep apnea in Cardiovascular Diseases

  • The risk of developing cardiovascular disease (CVD) is increased in patients with sleep apnea, independent of hypertension, age, BMI, and smoking.1
  • In a 10-year study, severe sleep apnea was associated with increased risk of fatal and nonfatal cardiovascular events.2
  • Recurrence of atrial fibrillation after cardioversion is higher than 80% in patients with untreated sleep apnea compared to 50% in controls, independent of confounding factors.3
  • The magnitude of nocturnal oxygen desaturation, an important physiological consequence of sleep apnea, is an independent risk factor for the incidence of atrial fibrillation in people under 65 years of age.4
  • In a population-based sample, the adjusted hazard ratio for mortality associated with cardiovascular disease in subjects with untreated moderate-to-severe sleep apnea was 5.2.5

Heart disease and stroke account for 65% of deaths in patients with diabetes.6

  • Cardiovascular events occur more often and at an earlier age in patients with diabetes.7
  • Cardiovascular events are more likely to lead to death in patients with diabetes.8
  • The risk of myocardial infarction (MI) in patients with diabetes is equivalent to that of patients without diabetes who have had a previous MI.8

Treatment of sleep apnea can mitigate risk of cardiovascular disease.

  • The incidence of fatal cardiovascular events is significantly higher in patients with untreated sleep apnea compared to patients using continuous positive airway pressure (CPAP) therapy to treat their sleep apnea.9
  • Even in patients with mild sleep apnea, CPAP therapy was associated with a 64% reduction in risk of cardiovascular disease.10
  • In a 7-year cohort follow-up study, researchers demonstrated that effective CPAP treatment reduces the risk of CVD. Study subjects were free of hypertension, indicating that the CPAP-mediated reduction in CVD was independent of blood pressure control.11
  • Patients on CPAP therapy experienced a lower recurrence of atrial fibrillation after cardioversion than did patients with untreated sleep apnea.12
  • Effective CPAP treatment has been shown to decrease the incidence of new cardiovascular events in patients with coronary artery disease.13

Some of the impact of sleep apnea and diabetes on the cardiovascular system can be attributed to the effects of these conditions on blood pressure. Read more about sleep apnea, diabetes, and hypertension.

Both sleep apnea and diabetes are associated with increased risk of stroke. Read more here.

1 Peker Y et al. Am J Respir Crit Care Med 2002;166:159-65
2 Marin JM et al. The Lancet 2005;365:1046-53
3 Kanagala R et al. Circulation 2003;107:2589-94
4 Gami AS et al. J Am Coll Cardio 2007;l 49:565-71
5 Young T et al. SLEEP 2008; 31:1071-8

6 Centers for Disease Control
7 National Institute of Diabetes and Digestive and Kidney Disorders
8 Adler AI, et al. BMJ 2000;321:412-9

9 Marin J et al. Lancet 2005 ;365:1046-53
10 Buchner NJ et al. Am J Respir Crit Care Med 2007;176:1274-80
11 Peker Y et al. Sleep 1997;20:645-53
12 Kanagala R et al. Circulation 2003 ;07:2589-94
13 Milleron O et al. Eur Heart J 2004;25:728-34