Link Between Sleep Apnea and Pulmonary Hypertension

Can sleep apnea cause pulmonary hypertension? This is one of the questions people frequently have. Sleep apnea will not only affect their sleeping pattern; it can also cause a number of serious problems with their lungs and heart function.

Yes, it will. Breathing interruption during sleep causes hypoxemia, which leads to contraction of pulmonary blood vessels and results in increased pressure in these vessels. Consequently, the heart has to pump blood against an increased resistance, possibly resulting in pulmonary hypertension.

The Link Between Sleep Apnea and Pulmonary Hypertension: What Happens Inside Your Body

Obstructive sleep apnea (OSA) is a sleeping disorder that arises when muscles that hold the palate and tongue soften too much during sleep and collapse the airway, halting airflow at least 10 seconds at a time. Neck fat tissue in people with obesity squashes the airway and abdominal weight in individuals squashes against the diaphragm, decreasing the lung volume. The consequence is a much easier and much more frequent collapsing of the airway.

Each apnea episode elicits a reflex known as hypoxic pulmonary vasoconstriction. The lungs also feel the low oxygen levels and automatically constrict their blood vessels, diverting the blood to more ventilated parts of the body. This is a defense mechanism in acute cases, but when it discharges hundreds of times in each night over months or years, it permanently restructures the pulmonary arteries. Their muscular walls become thicker, their lumens become narrower and vascular resistance increases. The heart muscle on the right side (right ventricle) which is compelled to work against this resistance gradually dilates and becomes weak.

This is the way sleep apnea and pulmonary hypertension may get into a vicious cycle: OSA leads to PH, and as the right heart gets weaker, the number of liquids retained increases, causing even more weight and pressure on the airways, which increases their vulnerability to collapses. Knowledge of the physical symptoms of being overweight that come with this process, breathlessness that cannot be explained, swollen ankles, extreme fatigue, can aid the patients to pursue the appropriate care before severe damage of the heart takes place.

Can Pulmonary Hypertension Caused by Sleep Apnea Be Reversed?

It is the question that patients most desire to be answered and the evidence provides true cause of hope. The reversibility of pulmonary hypertension is heavily determined by the duration the pulmonary hypertension has existed and the level of vascular remodeling developed.

The alterations in the pulmonary arteries in the initial phases are more functional: the vessels are sphincter, yet the tissue at the same time is intact. When the trigger, OSA, is removed, these vessels are able to relax and the normalization of pulmonary arterial pressure can occur. This is precisely what several studies have reported on patients who underwent bariatric surgery and observed that there is a reduction in the mean pulmonary arterial pressure of 20-40 percent in the 12-24 months following the initiation of weight loss.

In more severe situations, when years of long-term hypoxia have led to actual thickening of the arterial walls, full recovery cannot be expected, but significant improvement can. The most important thing is to take action. Options offered at BodEvolve such as gastric sleeve surgery, gastric bypass, duodenal switch, and SADI-S, all result in rapid and substantial weight loss directly eliminating the mechanical etiology of airway obstruction and decreasing systemic inflammation.

Dr. Frenzel is our lead surgeon who is triple board-certified and dual fellowship-trained and has more than 15 years of experience handling complicated bariatric cases. He, together with Dr. Brian Holt and a full multidisciplinary team, has led thousands of patients through the full weight loss plan which consists of pre-operative cardiac assessment, follow-up and support.

Why Bariatric Surgery Is the Most Powerful Tool Against Sleep Apnea and Pulmonary Hypertension

The standard non-surgical sleep apnea therapy is CPAP therapy which can help decrease the number of nightly hypoxic episodes. Nonetheless, CPAP is not the cure but it controls OSA. When the mask is removed, the anatomical blockage is left. In patients with OSA caused by obesity, weight loss, which is meaningful and sustained, is the only intervention that eliminates the cause of the condition.

Bariatric surgery is not only providing weight loss vastly greater than diet and exercise can provide the vast majority of people with severe obesity, but it does so in a manner that encompasses the inter-related health issues with being overweight simultaneously. Take into account the clinical outcome:

• OSA resolution: Over 80% of patients experience full resolution or substantial improvement in sleep apnea following bariatric surgery.
• Pulmonary pressure: Documented reductions in mean pulmonary arterial pressure in studies tracking patients 12 to 24 months post-surgery.
• Cardiac function: Right ventricular strain decreases as both preload (fluid volume) and afterload (vascular resistance) fall.
• Diabetes improvement: Surgery resolves type 2 diabetes in up to 85% of cases, removing a further driver of vascular damage. Get to know the most appropriate type 2 diabetes surgery.Inflammatory markers: C-reactive protein, IL-6, and other inflammatory mediators that cause damage to the pulmonary vessels decrease drastically after major weight loss.
• Inflammatory markers: C-reactive protein, IL-6, and other inflammatory mediators that damage pulmonary vessels fall sharply after significant weight loss.

Medical weight management is a non-surgical starting point which is structured and should be used by patients who may not be yet fit to meet the surgical standards. Revision weight loss surgery can get the ball rolling again to those who have undergone bariatric surgery previously without success. 

Take Control of Your Breathing and Your Health Today

The question is no longer can sleep apnea cause pulmonary hypertension, it has been answered in the yes. The question now is what will you do about it? The positive news is that airway narrowing, increased lung pressure and hard work of the heart are all stops in the long process of treating obesity at its source; bariatric surgery has the potential to break the chain and even reverse the process. BodEvolve Bariatric has assisted more than 14,000 patients in regaining their health, their vitality, and their future.

You do not have to wait until you have a cardiovascular crisis. Call our team, investigate your opportunities, and make the first step on the way to clear sleep, healthier lungs, and lighter and long life. Book your appointment now at our Arlington, Dallas, Richardson, and Texarkana center.