OSA, Hypertension and Cardiovascular Disease
The prevalence of diagnosed sleep disorders among Veterans treated at Veterans Affairs (VA) medical facilities increased significantly during fiscal years 2012 through 2018. Specifically, the prevalence of sleep-related breathing disorders increased from 5.5% in 2012 to 22.2% in 2018. Many believe that this increase is directly related to the introduction of testing for OSA, which was absent for years prior. Now that Veterans are being tested for OSA, the prevalence among Veterans is clear. Common co-morbid conditions among Veterans diagnosed with sleep disorders include obesity, diabetes, congestive heart failure, depression, post-traumatic stress disorder (PTSD), and traumatic brain injury (TBI).
It has been widely accepted in the medical community that OSA is a notable risk factor for cardiovascular disease. Patients with untreated OSA have been shown to have a higher incidence of cardiovascular events. The association between OSA and cardiovascular diseases appears to be particularly grounded in the fact that OSA is considered an independent risk factor and strongly linked to hypertension. Studies show that hypertension is highly prevalent in patients with OSA. Studies support that untreated OSA, even in mild cases, can contribute to the development and/or progression of hypertension, which in turn increases the risk for other cardiovascular conditions, including coronary artery disease (CAD), and congestive heart failure (CHF).
Sleep Medicine-related studies have also demonstrated that effective CPAP treatment can reduce the risk of cardiovascular disease in OSA patients; However, many patients often suffer from undiagnosed and hence untreated OSA for years. This is particularly true in the veteran population because the testing for, and treatment of OSA was virtually absent for a very long time. This fact is clear when considering the increase in diagnosed disorders from 2012 through 2018 (Veterans Affairs; from 5.5% to 22.2%). This increase is less likely a function of "new incidents", but more l likely the result of an increase in testing and therefore, diagnosis.
In untreated patients, chronic undiagnosed OSA can cause significant cardiovascular morbidity (including hypertension and CAD) prior to initiating treatment with CPAP. In such cases, although sustained CPAP treatment can prevent further cardiovascular complications, the damage already done by untreated OSA in the cardiovascular system could be substantial. It’s important then, for Veteran Advocates to understand the link between untreated OSA, hypertension, and secondary Cardiovascular disease.
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