About sleep apnea

Sleep apnea comorbidities: An overview

A few weeks ago, we began talking about sleep apnea comorbidities in our post on sleep apnea side effects. A comorbidity is a health condition that often exists at the same time in the same patient as a different health condition. 

That doesn’t necessarily mean that one health condition causes the other. What it does mean is that the two conditions are so frequently found together – such as diabetes and sleep apnea – that doctors acknowledge that there’s some kind of connection between them, without necessarily knowing the nature of that connection. Because of this connection, each condition is considered a “comorbidity” of the other.

Among the most serious sleep apnea comorbidities are stroke, diabetes, heart disease and even potentially cancer.4 These health conditions can all be fatal, and are all connected with obstructive sleep apnea (and especially severe sleep apnea).

Major sleep apnea comorbidities explained

Diabetes. The connection between diabetes and sleep apnea  is long established and well accepted in the medical community. According to a 2008 study published in the journal Chest, “the majority of patients with type 2 diabetes also have obstructive sleep apnea (OSA).”1 That isn’t just a coincidence; the study goes on to warn that this connection offers “compelling evidence that OSA is a significant risk factor for cardiovascular disease and mortality."

Heart failure. As the study above points out, cardiovascular (i.e., heart) disease is so closely associated with common sleep apnea comorbidities that it’s among the most frequently cited when discussing the health risks of sleep-disordered breathing. “Sleep apnea is frequently observed in patients with heart failure (HF),” state the authors of a 2012 study published in the American Journal of Cardiology. The same authors go on to point out that sleep apnea patients have blood pressure that’s “frequently elevated.” Sleep apnea also has a tendency to reduce cardiac output “and may promote the progression of HF,” the authors add.2

Stroke. Obstructive sleep apnea (OSA) “is highly prevalent in patients with transient ischemic attacks and stroke,” according to a 2012 study published in Expert Review of Cardiovascular Therapy, which also goes on to identify sleep apnea as “an independent risk factor for stroke and all-cause mortality.”3

Cancer. Though the evidence of a connection isn’t as strong as with the other comorbidities, a study published last year in the American Journal of Respiratory and Critical Care Medicine has linked snoring and sleep-disordered breathing with an increased risk of cancer.4 “The study, which tracked 1,500 people for 22 years, found that mild or moderate snoring also increases your risk of cancer death,” summarized Cindy Kuzma in Men’s Health magazine.

Obesity. All of these conditions are even more risky if you add in obesity – "morbidly obese men with a history of OSAS (obstructive sleep apnea syndrome) have a high risk of sudden cardiovascular death" a study from the Journal of Internal Medicine warns.5

Unfortunately, the list of sleep apnea comorbidities doesn’t end here. Clinical experts also talk about post-traumatic stress disorder (PTSD),6 hypertension, depression7 and a number of other sleep apnea comorbidities.



  1. Tasali E, Mokhlesi B, Van Cauter E. "Obstructive sleep apnea and type 2 diabetes: interacting epidemics." Chest. 2008 Feb;133(2):496-506. doi: 10.1378/chest.07-0828. http://www.ncbi.nlm.nih.gov/pubmed/18252916 (accessed October 21, 2013).
  2. Kasai T. "Sleep apnea and heart failure." J Cardiol. 2012 Aug;60(2):78-85. doi: 10.1016/j.jjcc.2012.05.013. Epub 2012 Jul 21. http://www.ncbi.nlm.nih.gov/pubmed/22824295 (accessed October 21, 2013).
  3. Das AM, Khan M. "Obstructive sleep apnea and stroke." Expert Rev Cardiovasc Ther. 2012 Apr;10(4):525-35. doi: 10.1586/erc.12.25. http://www.ncbi.nlm.nih.gov/pubmed/22458584 (accessed October 21, 2013).
  4. F. Javier Nieto, Paul E. Peppard, Terry Young, Laurel Finn, Khin Mae Hla, Ramon Farré. "Sleep-disordered Breathing and Cancer Mortality." Am J Respir Crit Care Med. 2012 July 15; 186(2): 190–194. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3406081 (accessed October 21, 2013).
  5. Rössner S, Lagerstrand L, Persson HE, Sachs C. "The sleep apnoea syndrome in obesity: risk of sudden death." J Intern Med. 1991 Aug;230(2):135-41. http://www.ncbi.nlm.nih.gov/pubmed/1865165 (accessed October 21, 2013).
  6. Jacob F. Collen, M.D., Christopher J. Lettieri, M.D., F.A.A.S.M., and Monica Hoffman, M.D."The Impact of Posttraumatic Stress Disorder on CPAP Adherence in Patients with Obstructive Sleep Apnea." J Clin Sleep Med. 2012 December 15; 8(6): 667–672. (Accessed January 16, 2014).
  7. Institute of Medicine. Sleep Disorders and Sleep Deprivation: An Unmet Public Health Problem. Washington, DC: The National Academies Press; 2006.


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