Sleep Apnea, Diabetes, and Hypertension

Sleep apnea is strongly associated, in a dose-dependent manner, with hypertension, independent of other risk factors.

  • Sleep apnea is first on the list of identifiable causes of hypertension defined by the National Institute of Health’s seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure.
  • 45% of people with sleep apnea who do not have high blood pressure will develop hypertension within 4 years if their sleep apnea remains untreated.1
  • An independent, dose-response association was observed between sleep apnea at baseline and hypertension at year 4 in a community-based sample of 709 patients.2
  • 80% of patients with drug-resistant hypertension have sleep apnea.3

Microvascular and macrovascular complications in patients with type 2 diabetes are associated with hypertension.

  • The Third National Health and Nutrition Evaluation Survey showed that more than 70% of people with diabetes have high blood pressure.
  • Studies demonstrate that lowering blood pressure reduces the incidence of strokes, heart failure and microvascular complications in patients with diabetes by 33-50%.4
  • A reduction of 10 mm Hg in systolic blood pressure has been correlated with a 12% reduction in diabetes-related complications.5

Treatment of sleep apnea has been shown to reduce blood pressure.

  • Effective treatment of sleep apnea with continuous positive airway pressure (CPAP) led to a significant reduction in diurnal and nocturnal blood pressure. Mean reduction was 10 mm Hg.6
  • In patients with refractory hypertension and sleep apnea, a single night of CPAP therapy resulted in reduced systolic blood pressure. After 2 months of CPAP use, significant reductions were observed in systolic and diastolic blood pressure.7 In patients using CPAP therapy, each 10-point drop in baseline AHI correlated with a 0.89 mm Hg drop in blood pressure.8
  • Adherence to CPAP therapy in hypertensive patients was shown to reduce blood pressure by 1.39 mm Hg for each hour of use.9

Taken together, these studies suggest that treatment of sleep apnea may help to reduce the risk of hypertension-related complications.

1 Arzt M, et al. Am J Respir Crit Care Med 2005;172:1447-51
2 Peppard PE et al. New Engl J Med, 2000; 342: 1378-84
3 Logan AG, et al. J Hypertens 2001;19 :2271-7
4 Centers for Disease Control and Prevention
5 Adler AI, et al. BMJ 2000;321:412-9
6 Becker HF et al. Circulation 2003;107:68-73
7 Logan AG et al. Eur Resp J 2003;21:241-47

8 Bazzano LA et al. Hypertension 2007;50:417-23
9 Haentjens P et al. Arch Intern Med 2007;167:757-64