At a Glance
Pulmonary hypertension is a condition in which blood pressure in the arteries of the lungs becomes abnormally high, making it harder for the heart to pump blood through the lungs. Sleep disorders such as sleep apnea can worsen pulmonary hypertension by causing repeated drops in oxygen levels and added strain on the heart and lungs.
If you find yourself very tired during the day and unusually winded when you exercise, you might be tempted to attribute these feelings to being out of shape or getting older. But if fatigue and difficulty catching your breath are common experiences for you, it might be worth talking to your doctor, especially if you have obstructive sleep apnea (OSA).
Feeling exhausted and having trouble breathing are two early symptoms of a serious medical condition called pulmonary hypertension (PH). This condition affects the heart and lungs, and it's much more common among people with obstructive sleep apnea than in the general population.
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What Is Pulmonary Hypertension?
People with pulmonary hypertension have high blood pressure in the vessels that carry blood from the heart to the lungs. Pulmonary hypertension happens when arteries in the lungs become thick and narrow. This makes the heart work harder to pump blood through the lungs. It also decreases oxygen levels in the blood leaving the lungs.
In its late stages, PH can lead to heart failure, so if you think you might have it, it’s important to seek a diagnosis and to begin treatment as soon as possible.
Causes of Pulmonary Hypertension
Pulmonary hypertension has many possible causes. It often develops as a result of another medical condition that affects the lungs or heart, including:
- Obstructive sleep apnea
- Chronic obstructive pulmonary disease (COPD) or pulmonary fibrosis
- Blood clots in the lungs
- Heart defects
- Heart valve disease or left-sided heart failure
- Human immunodeficiency virus (HIV)
- Certain autoimmune conditions, such as rheumatoid arthritis
Pulmonary hypertension is associated with the use of some medications, including appetite suppressants. Long-term use of certain recreational drugs, such as cocaine and amphetamines, may also lead to PH.
Can Sleep Apnea Cause Pulmonary Hypertension?
Obstructive sleep apnea is a condition in which a person’s airway repeatedly narrows or collapses while they are asleep, resulting in temporary disturbances in breathing. About 20% of people with moderate to severe OSA also develop pulmonary hypertension.
The pauses in breathing that occur with OSA cause the blood’s oxygen levels to dip and its carbon dioxide levels to rise. In an attempt to correct this problem, the body redirects blood to areas of the lungs where it might receive more oxygen. Over the long term, this can cause the lining of blood vessels to stop functioning properly, leading to narrow arteries and high blood pressure in the lungs.
Both OSA and PH tend to occur more frequently in older individuals and people with obesity. Additionally both are known to co-occur with heart failure and lung disease.
People with pulmonary hypertension tend to experience worse heart and lung damage if they also have moderate to severe OSA. Similarly, the prognosis for people with both OSA and PH — in terms of their likelihood of surviving 1, 4, or 8 years past diagnosis — is significantly worse than the prognosis for people who only have OSA.
Symptoms of Sleep Apnea and Pulmonary Hypertension
Sleep apnea and pulmonary hypertension can cause some similar symptoms, especially those related to breathing and fatigue. Because both conditions affect oxygen levels and the heart-lung system, symptoms may overlap or become more noticeable when the two conditions occur together. These symptoms may include:
- Shortness of breath, particularly during activity
- Daytime fatigue or excessive sleepiness
- Loud snoring or gasping during sleep
- Morning headaches
- Chest discomfort or pressure
- Swelling in the legs, ankles, or feet
- Difficulty concentrating or feeling lightheaded
How Do Doctors Diagnose the Connection?
Doctors diagnose the connection between sleep apnea and pulmonary hypertension by evaluating both conditions and looking for signs that they may be affecting each other. This usually involves reviewing symptoms, medical history, and risk factors such as obesity, lung disease, or heart problems.
To diagnose sleep apnea, doctors often recommend a sleep study, which monitors breathing patterns, oxygen levels, and sleep stages overnight. Pulmonary hypertension may be evaluated with tests such as an echocardiogram, which uses ultrasound to assess pressure in the pulmonary arteries and how well the heart is functioning. In some cases, additional tests, such as blood oxygen measurements, pulmonary function tests, or a right heart catheterization, may be used to confirm the diagnosis.
How Do You Treat Pulmonary Hypertension and Sleep Apnea?
While pulmonary hypertension has no cure, there are several treatments available that can help manage symptoms and slow its progression. Depending on the nature and severity of your PH, your doctor may recommend:
- Medications
- Oxygen therapy
- Weight loss, potentially via surgery
- A lung or heart transplant
If you have both pulmonary hypertension and obstructive sleep apnea, you'll also likely be prescribed continuous positive airway pressure (CPAP) therapy — the first line treatment for OSA. This therapy uses a machine to deliver pressurized air into the nostrils and/or mouth through a mask, which helps keep the upper airway from collapsing. In people with PH and OSA, CPAP therapy has been shown to reduce blood pressure in the lungs.
When to See a Doctor
If you have OSA and you're concerned about developing pulmonary hypertension, talk to your doctor. You can reduce your risk of getting pulmonary hypertension, along with other health problems, by properly managing your OSA.
OSA and PH both can cause a person to feel tired during the daytime. However, unlike OSA, pulmonary hypertension can cause:
- Difficulty breathing, especially during exertion
- Chest pain
- Dizziness
- Shortness of breath
- Swollen ankles
- A racing heart
If you have OSA, be on the lookout for these symptoms, and if you experience any of them, make sure to talk to your doctor about testing for pulmonary hypertension.
Frequently Asked Questions
Yes, sleep apnea can contribute to high blood pressure. Repeated pauses in breathing during sleep can lower oxygen levels and trigger the body’s stress response, which may cause blood pressure to rise. Over time, untreated obstructive sleep apnea can increase the risk of developing hypertension and other cardiovascular problems.
No, pulmonary hypertension is different from typical high blood pressure. High blood pressure usually refers to elevated pressure in the arteries throughout the body. Pulmonary hypertension specifically involves increased pressure in the arteries that carry blood from the heart to the lungs.
CPAP therapy may help some people who have both obstructive sleep apnea and pulmonary hypertension. By keeping the airway open during sleep, CPAP can improve oxygen levels and reduce strain on the heart and blood vessels in the lungs. In some cases, this may help lower pulmonary artery pressure or prevent the condition from worsening.
Untreated sleep apnea can lead to a variety of health complications over time. Repeated drops in oxygen levels and disrupted sleep can increase the risk of conditions such as high blood pressure, heart disease, stroke, type 2 diabetes, and pulmonary hypertension. It can also cause excessive daytime sleepiness, poor concentration, and reduced quality of life.
Whether pulmonary hypertension can be reversed depends on the underlying cause. In some cases, treating the condition that contributes to increased pressure in the pulmonary arteries, such as sleep apnea or certain lung diseases, may help improve symptoms and slow or reduce disease progression. However, pulmonary hypertension is often a chronic condition that requires ongoing medical management.
Medical Disclaimer: This content is for informational purposes and does not constitute medical advice. Please consult a health care provider prior to starting a new treatment or making changes to your treatment plan.
Written by
Lucy Bryan, Contributing WriterLucy Bryan is a writer and editor with more than a decade of experience in higher education. She holds a BA in journalism from the University of North Carolina at Chapel Hill and an MFA in creative writing from Penn State University. In addition to writing in the domain of public health, she’s also a fiction and nonfiction writer whose first book, In Between Places: A Memoir in Essays, debuted in June 2022.
Reviewed by
Gerard J. Meskill, MD, FAASM, Medical ReviewerDr. Gerard J. Meskill is a neurologist and sleep medicine physician specializing in the diagnosis and treatment of sleep disorders, including narcolepsy, obstructive sleep apnea, and insomnia. He is board-certified in both neurology and sleep medicine and has extensive experience helping patients manage complex sleep conditions and disorders of excessive daytime sleepiness.
