Sleep & Pulmonary Hypertension

The connection between sleep health and pulmonary hypertension

Sleep health has a defining influence on the development and progression of pulmonary hypertension (PH). To understand how sleep health influences PH, first you need to understand just what PH is.

What is Pulmonary Hypertension (PH)?

Pulmonary hypertension (PH) is defined as a rare and severe lung disease which affects the pulmonary arteries. These are the arteries which deliver blood that is low in oxygen from the right ventricle of the heart to the lungs. This blood is replenished with oxygen and sent back into the body to serve the cells, organs and systems.

When PH sets in, these important arteries become narrow and thickened. This forces the hearts of people with this condition to work much harder than normal to pump blood. When the pulmonary arteries are stressed, they develop their own kind of hypertension.

Over time, PH can cause an enlargement of the heart itself, as well as weakened heart tissue and other complications that might lead to a form of heart condition known as right heart failure.

Causes of PH

Some of the most common causes of PH include:

  • The use of “fen-phen” (dexfenfluramine and phentermine): this appetite suppressant drug is currently banned in the US
  • Liver problems: chronic liver disease, liver cirrhosis and other liver diseases
  • Rheumatoid diseases: scleroderma or systemic lupus erythematosus (SLE)
  • Lung-related concerns: tumors, emphysema, chronic obstructive pulmonary disease (COPD), pulmonary fibrosis, or other lung conditions
  • Heart problems: aortic valve disease, left heart failure, mitral valve disease, congenital heart disease, and thromboembolic disease
  • Low oxygen conditions: resulting from genetics, high altitude living, obesity, or sleep apnea

How does sleep affect PH?

Good sleep health

When you get a full 8 hours of uninterrupted sleep, your body has the opportunity to heal damage all the way to the cellular level.

Deep sleep can only be achieved during long periods of consolidated sleep, and during this time, human growth hormone (HGH) is released into the body to repair and recharge organs and tissues.

Someone who has PH may be able to better manage its symptoms and help prevent it from worsening, if they get enough sleep.

Poor sleep health

Without the benefit of a solid night of sleep, the body loses its opportunity to repair and recharge.

Both PH and OSA also share two common risk factors—one which can be controlled (obesity) and another which cannot be controlled (aging).

In addition, untreated sleep apnea or other variations of sleep-disordered breathing can contribute to the development and/or progression of PH.

How is sleep apnea related to PH?

According to research from the American College of Chest Physicians, between 17 and 53 percent of people with sleep apnea also develop pulmonary hypertension.

Sleep apnea can lead to increases in pulmonary artery pressure. These increases occur due to the repeating loss of oxygen in the bloodstream due to apneas.

An apnea is defined as a 10-second (or longer) cessation in breathing which results in a drop in blood oxygen. Frequent and lengthy apneas, in particular, can lead to significant loss of blood oxygen. This can increase levels of carbon dioxide (a waste product) in the blood as well. This troubling and unhealthy imbalance in blood chemistry can overtax the cardiopulmonary system.

Also problematic are apnea's long cessations in breathing, which cause unhealthy changes to the internal pressure of the lungs. This also has an effect on artery and heart health in the long term if apneas are left untreated.

3 things you can do

If you or a loved one has PH, there are some things you can do to offset symptoms and find relief.

  1. Get a sleep study to see if your PH is related to undiagnosed or untreated obstructive sleep apnea (OSA).
  2. Continuous positive airway pressure (CPAP) is an effective treatment for OSA which can lead to major improvements in overall cardiac health. CPAP has been shown to reduce pulmonary artery pressure.
  3. Consider a weight loss program if you are obese, as obesity is a risk factor for both OSA and PH.