Often the first person to notice sleep apnea is not the one who has it. It is the partner who hears the snoring stop, the silence, and then the gasp. Sleep apnea is common, often missed, and closely tied to heart health, which is why it is worth taking seriously.

What sleep apnea is

The National Heart, Lung, and Blood Institute describes sleep apnea as breathing that stops and restarts many times during sleep, which can keep the body from getting enough oxygen. The most common type is obstructive sleep apnea, in which the upper airway is repeatedly blocked. Obesity, large tonsils and hormone changes can narrow the airway. A less common type, central sleep apnea, happens when the brain does not send the signals to breathe. Left undiagnosed, the NHLBI notes, poor sleep from apnea can lead to problems concentrating, making decisions and remembering things.

It is far from rare. A 2021 American Heart Association scientific statement estimated that about 34 percent of middle-aged men and 17 percent of middle-aged women meet the criteria for obstructive sleep apnea.

Signs to watch for

The NHLBI lists these symptoms:

  • Loud, frequent snoring, or breathing that stops and starts
  • Gasping for air during sleep
  • Daytime sleepiness and trouble focusing
  • Dry mouth or headache on waking
  • Fatigue or insomnia, which are more common presentations in women
  • Waking often during the night to urinate

As the NHLBI notes, fatigue, headaches and insomnia are more common presentations in women, so sleep apnea is not only a question for loud snorers.

Why it matters for the heart

Each pause in breathing drops oxygen levels, jolts the nervous system and fragments sleep, night after night. The AHA statement found that sleep apnea is present in 40 to 80 percent of people with high blood pressure, heart failure, coronary artery disease, pulmonary hypertension, atrial fibrillation and stroke, yet it is often unrecognized in heart care.

The statement recommends screening for sleep apnea in people with high blood pressure that is hard to control, and in people whose atrial fibrillation returns after cardioversion or ablation. We cover that connection in atrial fibrillation and stroke risk and the blood pressure side in blood pressure and brain health.

Testing

Questionnaires can raise suspicion, but they cannot make the diagnosis. The U.S. Preventive Services Task Force found in 2022 that there is not enough evidence to screen adults who have no symptoms, so testing is aimed at people with symptoms or related conditions.

The diagnosis needs a sleep study. The American Academy of Sleep Medicine’s guideline says that either an overnight study in a sleep lab (polysomnography) or a home sleep apnea test with a technically adequate device can be used for adults with uncomplicated, likely moderate to severe sleep apnea. People with significant heart or lung disease and some other conditions are usually tested in a lab.

Treatment

The AHA statement advises that everyone with obstructive sleep apnea be considered for treatment, including weight loss and behavior changes where they fit:

  • CPAP (continuous positive airway pressure) should be offered for severe sleep apnea. A mask gently holds the airway open with air pressure. Fit and comfort matter, and many people need a few adjustments before it works well.
  • Oral appliances made by a dentist can be considered for mild to moderate sleep apnea or for people who cannot use CPAP.
  • Medicine. In December 2024, the FDA approved tirzepatide (Zepbound) as the first medication for moderate to severe obstructive sleep apnea in adults with obesity, used with diet and exercise. Our article on GLP-1 medications has more on that class.
  • Surgery is an option for some people when other treatments do not work.

A follow-up sleep test is often done to confirm that treatment is working. For more on why good sleep matters as we age, see sleep and healthy aging.

Never drive drowsy. Call your doctor if a partner notices pauses in your breathing or you are sleepy during the day despite a full night in bed. If you are worried about any of this, Dr. Shtern can review your symptoms, blood pressure and heart rhythm and arrange testing. If you would like to meet her first, the first visit is a complimentary meet and greet.

This article is general information, not advice for your situation. Members can call the office with questions about their own care.