A claim you hear on longevity podcasts
Strong consensus for. Of 10 studies that test it, 7 agree and 3 partly agree.
The claim checked: Sleep apnea goes along with heart disease, stroke and type 2 diabetes Hear it at 4:44
Seven of ten studies agree that sleep apnea goes along with heart and blood vessel disease. In 709 Wisconsin workers, more breathing trouble at night meant more high blood pressure four years later. In 1022 patients, sleep apnea was tied to stroke or death from any cause, apart from other risk factors. Three studies partly agree. A community study found the link for heart failure in men but could not settle it for coronary heart disease. A genetic study found no link for most heart conditions. Most studies tested only part of this list. A link does not show that apnea is the cause.
Computed from 10 studies that test this point, each judged by two readers, in full. 10 more studies are waiting for a full read and do not count yet.
“And sleep apnea is associated with hypertension or high blood pressure, atrial fibrillation, heart failure, coronary artery disease, stroke, metabolic syndrome, type two diabetes, obesity,”
other primary study · 2006
“Disregarding treatment, OSA was associated with an almost five-fold increase in risk of development of CAD independent of age, sex, hypertension, diabetes and current smoking.”
Increased incidence of coronary artery disease in sleep apnoea: a long-term follow-up. Eur Respir J
Who: 308 middle-aged (30-69 yrs) snorers from a Gothenburg sleep clinic without heart disease at baseline, 245 males and 63 females, mean age 49.0
PMID 16641120
other primary study · 2024
“The current study found that, overall, pOSA was associated with an increased unadjusted prevalence of all CVDs and risk factors, including hypertension, diabetes, hyperlipidemia, MetS, CHF, CHD, angina, heart attack, stroke, and development of any CVD in general.”
Obstructive Sleep Apnea and Its Cardiac Implications in the United States: An Age-Stratified Analysis Between Young and Older Adults. J Am Heart Assoc
Who: US adults aged 20 or older in NHANES 2013-2018 (mean age 47.6 years, mean BMI 29.6, about 52% women); probable OSA defined by self-reported symptoms
PMID 38842290
pooled analysis · 2025
“These findings establish OSA as a modifiable and clinically relevant risk factor for coronary heart disease, heart failure, stroke, and cardiovascular mortality, reinforcing the need for systematic screening and integration of OSA management into cardiovascular prevention frameworks.”
Association Between Obstructive Sleep Apnea and Cardiovascular Risk: A Systematic Review and Meta-Analysis of Prospective Cohort Studies. Medicina (Kaunas)
Who: Adults free from cardiovascular disease at baseline with objectively assessed OSA, in prospective cohorts from North America, Europe and Asia
PMID 41303825
other primary study · 2000 · landmark
“We found a dose–response association between sleep-disordered breathing at base line and the presence of hypertension four years later that was independent of known confounding factors.”
Prospective study of the association between sleep-disordered breathing and hypertension. N Engl J Med
Who: 709 participants of the Wisconsin Sleep Cohort Study, a population-based sample of Wisconsin state agency employees, without physician-diagnosed stroke or cardiovascular disease
PMID 10805822
other primary study · 2005 · landmark
“In conclusion, the obstructive sleep apnea syndrome is significantly associated with the risk of stroke or death from any cause, and this association is independent of other risk factors, including hypertension.”
Obstructive sleep apnea as a risk factor for stroke and death. N Engl J Med
Who: 1022 patients aged 50 or older referred to the Yale Center for Sleep Medicine for suspected sleep-disordered breathing, no prior stroke or myocardial infarction; 697 with OSA syndrome (AHI 5 or higher)
PMID 16282178
other primary study · 2015 · landmark
“We recorded a much higher than previously estimated prevalence of sleep-disordered breathing and an independent association between the disorder and diabetes, hypertension, metabolic syndrome, and depression, albeit mainly in the highest severity quartile of the apnoea-hypopnoea index (>20·6 events per h).”
Prevalence of sleep-disordered breathing in the general population: the HypnoLaus study. Lancet Respir Med
Who: Population-based HypnoLaus cohort in Lausanne, Switzerland, aged 40-85 years (median 57), 1024 men, mean BMI 25.6, with home polysomnography
PMID 25682233
other primary study · 2012 · landmark
“Compared with participants without OSA, the presence of OSA was associated with increased adjusted risk of incident hypertension; however, treatment with CPAP therapy was associated with a lower risk of hypertension.”
Association between treated and untreated obstructive sleep apnea and risk of hypertension. JAMA
Who: 1889 adults without hypertension referred to a sleep center in Zaragoza, Spain, for polysomnography: 1579 with OSA (AHI of 5 or more) and 310 controls without OSA
PMID 22618924
other primary study · 2023
“However, there were no significant associations were found between genetically predicted OSA and risk of other CVDs, such as coronary artery disease, myocardial infarction, any stroke, and venous thromboembolism.”
Causal associations of obstructive sleep apnea with cardiovascular disease: a Mendelian randomization study. Sleep
Who: Summary-level genetic data, mainly European ancestry: FinnGen OSA GWAS and 12 cardiovascular outcomes from the UK Biobank and genetic consortia
PMID 36480010
other primary study · 2010 · landmark
“OSA is associated with increased risk of incident heart failure in community-dwelling middle-aged and older men; its association with incident coronary heart disease in this sample is equivocal.”
Prospective study of obstructive sleep apnea and incident coronary heart disease and heart failure: the sleep heart health study. Circulation
Who: 1927 men and 2495 women aged 40 or older in the community-based Sleep Heart Health Study, free of coronary heart disease and heart failure at baseline
PMID 20625114
other primary study · 2009 · landmark
“Sleep-disordered breathing is associated with all-cause mortality and specifically that due to coronary artery disease, particularly in men aged 40–70 y with severe sleep-disordered breathing.”
Sleep-disordered breathing and mortality: a prospective cohort study. PLoS Med
Who: Community adults aged 40 or older in the Sleep Heart Health Study, untreated for sleep-disordered breathing; 53.3% women
PMID 19688045
Nine of ten studies agree that sleep apnea goes along with metabolic syndrome, a cluster of high blood sugar, high blood pressure and belly fat, or with type 2 diabetes. In 2121 adults in Lausanne, people with the most breathing pauses had higher odds of both. One clinic study partly agrees: it found no difference in how many people had diabetes. Most of these studies measure people at one point in time, so they show a link, not which came first.
Computed from 10 studies that test this point, each judged by two readers, in full. 2 more studies are waiting for a full read and do not count yet.
other primary study · 2015 · landmark
“In the fully adjusted models (model 4), the upper quartile of the apnoea-hypopnoea index (Q4, >20·6 events per h) was associated independently with the presence of hypertension (odds ratio 1·60, 95% CI 1·14–2·26; p=0·0292 for trend across severity quartiles), diabetes (2·00, 1·05–3·99; p=0·0467), metabolic syndrome (2·80, 1·86–4·29; p<0·0001), and depression (1·92, 1·01–3·64; p=0·0292).”
Prevalence of sleep-disordered breathing in the general population: the HypnoLaus study. Lancet Respir Med
Who: 2121 general-population adults aged 40-85 in Lausanne, Switzerland (1024 men, median age 57, mean BMI 25.6), with home polysomnography
PMID 25682233
trial or observed group · 2013 · landmark
“An independent association between OSA, insulin resistance, and type 2 diabetes has been consistently demonstrated by a number of cross-sectional studies, observational studies, and large population-based studies (22–25).”
Obstructive sleep apnea: a cardiometabolic risk in obesity and the metabolic syndrome. J Am Coll Cardiol
Who: Narrative review of adults with OSA, obesity and the metabolic syndrome, with supporting animal data
PMID 23770180
other primary study · 2003
“The authors conclude that in a clinic-based sample of patients, obstructive sleep apnoea syndrome is associated with a high frequency of type‐2 diabetes and impaired glucose tolerance.”
Impaired glucose-insulin metabolism in males with obstructive sleep apnoea syndrome. Eur Respir J
Who: 595 consecutive men aged 21-78 referred to a sleep laboratory for snoring and suspected OSAS, BMI under 40; 494 with OSAS and 101 nonapnoeic snorers
PMID 12882466
other primary study · 2001
“The main result of this study is that, in hypertensive men, despite the fact that obesity is strongly associated with diabetes mellitus, severe OSA seems to add significantly to this association.”
Sleep-disordered breathing and glucose metabolism in hypertensive men: a population-based study. J Intern Med
Who: Age-stratified sample of hypertensive men aged 40-79 from a population-based cohort in Uppsala, Sweden, with a whole-night home sleep study
PMID 11240844
other primary study · 2006
“Based on this analysis, we found that the presence of OSA was independently associated with a nearly six-fold increased risk of having the metabolic syndrome, (OR = 5.88, 95% CI 1.96–17.63, p = 0.002).”
Obstructive sleep apnoea is independently associated with the metabolic syndrome but not insulin resistance state. Cardiovasc Diabetol
Who: Consecutive subjects referred to a UK hospital sleep laboratory for suspected sleep apnoea, 38 with newly diagnosed OSA and 41 without OSA; those on glucose or lipid lowering treatment excluded
PMID 17078884
other primary study · 2006
“The metabolic syndrome and several of its components were independently associated with OSA.”
Obstructive sleep apnea and the metabolic syndrome in community-based Chinese adults in Hong Kong. Respir Med
Who: Community-based Chinese adults aged 30-60 in Hong Kong (150 men, 105 women) who had overnight polysomnography
PMID 16337115
other primary study · 2012
“In a large “real-life” sample of OSA patients at diagnosis, the metabolic syndrome according to NCEP-ATP III criteria occurred in about half of the subjects, and severe OSA was significantly associated with a diagnosis of metabolic syndrome, i.e. occurrence of three or more components of the syndrome.”
Metabolic syndrome, insulin resistance and sleepiness in real-life obstructive sleep apnoea. Eur Respir J
Who: Consecutive adults with newly diagnosed OSA (AHI >= 10) at a sleep lab in Palma de Mallorca, 2005-2007; 424 men, 105 women; mean age 51.3 years, mean BMI 30.8; 17.0% with diabetes
PMID 22075482
other primary study · 2007
“Our study demonstrates that the presence of OSA was associated independently, by degree of severity, to the number of components of metabolic syndrome present, and correlated with insulin resistance and inflammatory parameters (Hs-CRP).”
The association of OSA with insulin resistance, inflammation and metabolic syndrome. Respir Med
Who: 98 consecutive men referred to a sleep laboratory for suspected OSA, mean age 54.9 years; diabetes mellitus was an exclusion
PMID 17466499
other primary study · 2013
“Subjects with moderate to severe OSA were 1.67 times more likely to have impaired fasting glucose or type 2 diabetes than those without OSA.”
Consequences of obstructive sleep apnea on metabolic profile: a Population-Based Survey. Obesity (Silver Spring)
Who: Probabilistic population sample of adults aged 20-80 living in Sao Paulo, Brazil, with full-night polysomnography; 38% had OSA
PMID 23712988
other primary study · 2007
“No significant differences were noted between the 2 groups in the proportion of patients with diabetes and dyslipidemia.”
Relationship of metabolic syndrome and obstructive sleep apnea. J Clin Sleep Med
Who: Consecutive patients referred to a Mayo Clinic sleep center in Phoenix for OSA evaluation; mean age 63.2 years, mean BMI 32.2, 41% women
PMID 17803009
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