OSA screenings for hypertensive patients

Untreated obstructive sleep apnea (OSA) contributes to poor blood pressure control and cardiovascular risk. Family physicians have a unique opportunity to elevate hypertension care with routine screenings for OSA. This is in line with the American Heart Association’s inclusion of sleep in the “Life’s Essential 8”¹ and their associated recommended screening for OSA in patients with resistant/poorly controlled hypertension, pulmonary hypertension and recurrent atrial fibrillation after cardioversion or ablation.²

Cardiovascular disease (CVD)² and hypertension³ are among the most common comorbidities in patients with OSA. More than the frequent co-occurrence, the important reality is that cardiovascular disease and hypertension can be made worse by OSA.

Cardiovascular disease and OSA

OSA affects 40–60% of patients with cardiovascular disease³ and up to 80% of those with chronic heart failure.⁴ Among stroke patients, 60-70% have OSA,⁵ and 48% of people with OSA experience cardiac arrhythmias.⁶ In severe cases, OSA further heightens the risk of cardiovascular morbidity⁷ and mortality.¹

Key points to share with patients:

• In people with coronary artery disease (CAD), use of positive airway pressure (PAP) therapy ≥4 hours per night is linked with a lowered risk of future cardiovascular events by ~30%.⁸

• Treatment of OSA with PAP therapy is associated with reduced atrial fibrillation (AFib) recurrence after ablation.⁹

• Untreated OSA increases stroke risk,¹⁰ and post-stroke OSA is linked to slower recovery and higher mortality.¹¹ 

• Untreated OSA can impair recovery following a heart attack or stroke.^12,13 

Hypertension and OSA

OSA affects up to 80% of those with resistant hypertension.² The repeated oxygen drops and sympathetic surges that occur in people with OSA make blood pressure harder to control, even with the use of blood pressure medications.¹⁴

Key points to share with patients:

• Untreated OSA is an independent risk factor for hypertension.¹⁴

• Treating OSA with PAP therapy can significantly lower both systolic and diastolic blood pressure, particularly in people with resistant hypertension and good adherence.¹⁴

• The American Heart Association recommends OSA screening for patients with resistant hypertension or pulmonary hypertension.²

The bottom line?

OSA screening should be a routine part of cardiovascular care.

Let our patient conversation guide help you make sleep a regular topic with your patients with hypertension.

References

1. Lloyd-Jones DM, et al. Circulation. 2022;146(5): e18-e43. 

2. Yeghiazarians Y, et al. Circulation. 2021;144(3):e56-e67.

3. Wang B, et al. J Thromb Thrombolysis. 2023;56(1):65-74. 

4. Polecka A, et al. J Clin Med. 2023;12(19):6139.  

5. Seiler A, et al. Neurology. 2019;92(7):e648-e654.

6. Yacoub M, et al. J Sleep Disord Ther. 2018;7(1):283. 

7. Lavie P, et al. Eur Respir J. 2005;25(3):514-520. 

8. Yang D, et al. J Clin Sleep Med. 2023;19(12):2015-2025. 

9. Naruse Y, et al. Heart Rhythm. 2013;10(3):331-337.

10. White J, et al. Intl Journal of Research and Review. 2025;12(2):380-392. 

11. Bassetti CLA, et al. Eur Respir J. 2020;55(4):1901104.

12. Shah NA, et al. Sleep Breath. 2010;14(2):131-136.  

13. Levicka P, et al. Sleep Med X. 2025;10:100142. 

14. Shiina K, et al. Hypertens Res. 2024;47(11):3085-3098.