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April 14, 2024

18 Secondary Conditions Linked to Sleep Apnea (The Insider’s Guide)

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This is your Insider’s Guide to the 18 most common secondary conditions to sleep apnea for VA disability benefits.

Service connected sleep apnea can cause or aggravate a variety of other conditions including, cardiovascular diseases, chronic fatigue syndrome (CFS), gastroesophageal reflux disease (GERD), mental health conditions, neurological disorders, and type 2 diabetes.

Note: This article is for a list of secondary conditions that can be caused or aggravated by your sleep apnea. If you’re trying to connect your sleep apnea secondary to another service connected disability, click here.

Secondary Conditions to Sleep Apnea for VA Disability Benefits

Cardiovascular Diseases Secondary to Sleep Apnea

Cardiovascular diseases secondary to sleep apnea are a significant health concern, as sleep apnea can profoundly impact heart health.

Here’s an overview of the connection and the specific cardiovascular conditions that can arise:

Hypertension (High Blood Pressure): Obstructive sleep apnea (OSA) is strongly linked to hypertension. The repetitive pauses in breathing during sleep, characteristic of sleep apnea, lead to low oxygen levels and increased sympathetic nervous system activity, both of which can raise blood pressure.

Coronary Artery Disease and Heart Attack: The stress and oxygen deprivation from repeated waking during the night can contribute to the development of coronary artery disease. Over time, this may increase the risk of a heart attack.

Heart Failure: Sleep apnea can exacerbate heart failure by increasing the workload on the heart. As the heart struggles to pump adequately against the variable pressures in the chest caused by the efforts to breathe against a closed airway, heart function can deteriorate.

Atrial Fibrillation: There is a well-documented association between sleep apnea and atrial fibrillation. The fluctuations in autonomic nervous system activity, along with changes in intrathoracic pressure and hypoxia, can trigger and maintain this irregular heart rhythm.

Stroke: Sleep apnea is a risk factor for stroke, likely due to its association with hypertension, atrial fibrillation, and other cardiovascular disturbances.

Pulmonary Hypertension: In more severe cases, particularly when sleep apnea is chronic and untreated, it can lead to increased pressure in the pulmonary arteries, which can stress the right side of the heart and lead to heart disease specific to the pulmonary circulation.

Chronic Fatigue Syndrome Secondary to Sleep Apnea

Chronic Fatigue Syndrome (CFS), also known as Myalgic Encephalomyelitis (ME), can indeed be influenced or exacerbated by sleep apnea, though the two conditions have distinct etiologies and presentations.

Here’s how sleep apnea might contribute to or complicate chronic fatigue syndrome:

Sleep Disruption: Sleep apnea primarily disrupts sleep by causing frequent awakenings throughout the night due to breathing pauses, known as apneas. These disruptions prevent the deep, restorative sleep that is necessary for the body to repair and rejuvenate. The result is persistent daytime fatigue, a key symptom that overlaps with CFS.

Oxygen Deprivation: Each episode of apnea in sleep apnea results in a drop in blood oxygen levels. Chronic low oxygen levels at night can lead to various symptoms during the day, such as fatigue, cognitive impairment, and a reduced capacity to perform physical activities, all of which are also characteristics of CFS.

Inflammatory Response: Sleep apnea can induce a systemic inflammatory response due to the stress of intermittent hypoxia (low oxygen levels) and sleep fragmentation. Chronic inflammation has been proposed as a potential contributing factor to CFS, as it can affect various bodily systems and exacerbate fatigue.

Impact on Immune System: There is evidence that sleep apnea can affect immune function, which may also play a role in CFS. The immune dysregulation observed in many sleep apnea patients could contribute to or worsen the immune dysfunction often seen in CFS patients.

Exacerbation of Existing Symptoms: For those already suffering from CFS, any additional health issue like sleep apnea that disrupts sleep can exacerbate their existing symptoms, making it harder to manage and recover from fatigue.

GERD Secondary to Sleep Apnea

GERD is another condition that can be exacerbated by or associated with sleep apnea.

The interplay between these two conditions involves a few key physiological mechanisms:

Increased Intra-abdominal Pressure: During obstructive sleep apnea events, the effort to breathe against a closed airway significantly increases the negative pressure inside the chest cavity. This can, in turn, cause a vacuum effect that pulls stomach acids upward into the esophagus. Moreover, these efforts can also increase intra-abdominal pressure, pushing stomach contents toward the lower esophageal sphincter (LES), which if weakened, fails to prevent the backflow of acid.

Transdiaphragmatic Pressure Changes: With each apneic event, the diaphragm works harder to draw air into the lungs, which alters the pressure gradient across the diaphragm and may further contribute to acid reflux if the LES is not functioning properly.

Relaxation of the Lower Esophageal Sphincter (LES): It’s also theorized that the autonomic fluctuations associated with sleep apnea episodes might influence the tone of the LES, causing it to relax at inappropriate times and allow gastric contents to rise into the esophagus.

Disruption of Esophageal Clearance: Sleep apnea can disrupt the normal mechanisms that clear the esophagus of acid. Normally, swallowing and saliva help to clear and neutralize acid in the esophagus, but sleep fragmentation and repeated awakenings might impair these mechanisms.

Arousal from Sleep: The frequent arousals from sleep that characterize sleep apnea can also disturb the esophageal motility and the body’s ability to clear refluxed material during sleep, prolonging the contact time of acid with the esophageal lining, which can exacerbate GERD symptoms.

Mental Health Conditions Secondary to Sleep Apnea

Sleep apnea can significantly affect mental health due to its impact on sleep quality and overall brain function.

Various mental health conditions can either be exacerbated by or arise secondary to sleep apnea.

Here are some of the key relationships between sleep apnea and mental health:

Depression: There is a strong link between sleep apnea and depression. The chronic sleep disruption caused by sleep apnea can lead to significant mood swings, irritability, and feelings of sadness. The physiological stress of frequent nighttime awakenings and reduced oxygen levels can contribute to a depressed mood. Furthermore, the chronic fatigue and daytime sleepiness can affect a person’s ability to engage in daily activities, further contributing to depressive symptoms.

Anxiety: Anxiety disorders can also be exacerbated by the presence of sleep apnea. The stress of not sleeping well, coupled with the direct effects of oxygen deprivation on the body, can heighten anxiety levels. Many patients with sleep apnea may experience increased worry about their health, which can further perpetuate anxiety.

Cognitive Impairment: Sleep apnea can lead to cognitive difficulties such as problems with memory, attention, and executive function. These cognitive impairments can affect job performance, personal relationships, and daily functioning, which can further impact mental health.

Mood Disorders: Beyond depression, other mood disorders can be influenced by sleep apnea. The lack of restorative sleep can make emotional regulation more challenging, leading to mood instability and increased irritability.

Post-Traumatic Stress Disorder (PTSD): For those suffering from PTSD, sleep disturbances are a common symptom. The presence of sleep apnea can exacerbate these disturbances, leading to more pronounced PTSD symptoms, especially if sleep apnea induces frequent nightmares or disrupts sleep.

Neurological Disorders Secondary to Sleep Apnea

Sleep apnea, particularly obstructive sleep apnea (OSA), can have profound effects on neurological health.

The repeated interruptions in breathing during sleep not only disrupt sleep architecture but also lead to reduced oxygen levels and changes in cerebral blood flow.

These factors can contribute to or exacerbate various neurological disorders:

Cognitive Impairment and Dementia: Chronic sleep apnea can lead to cognitive decline over time. The intermittent hypoxia (low oxygen levels) and sleep fragmentation associated with sleep apnea are thought to contribute to the development of neurodegenerative conditions like Alzheimer’s disease and other forms of dementia. Studies have shown that treating sleep apnea can help stabilize or slow cognitive decline in some patients.

Stroke: Sleep apnea is a recognized risk factor for stroke. The sudden drops in blood oxygen levels during sleep can increase blood pressure and strain vascular walls, contributing to the formation of clots or the weakening of arteries, which can eventually lead to a stroke. Additionally, the repetitive episodes of hypoxia can lead to inflammation and changes in the arteries’ structure and function.

Parkinson’s Disease: Research has suggested that there may be a link between sleep apnea and Parkinson’s disease, although the relationship is not fully understood. Sleep disturbances common in sleep apnea could exacerbate Parkinson’s symptoms, and there is some evidence that the physiological stress and inflammation caused by sleep apnea could contribute to neurodegeneration.

Epilepsy: For individuals with epilepsy, sleep apnea can increase the frequency and severity of seizures. The disruption in sleep architecture and decreased oxygen levels can lower the seizure threshold in susceptible individuals. Managing sleep apnea with CPAP therapy has been shown to reduce seizure frequency in some cases.

Peripheral Neuropathy: While less directly connected than other conditions, there is some evidence to suggest that the systemic effects of sleep apnea, such as oxidative stress and inflammation, might exacerbate peripheral neuropathy, particularly in people with diabetes.

Headaches: Morning headaches are common in individuals with sleep apnea. These may be caused by the decreased oxygen and increased carbon dioxide levels in the blood due to disrupted breathing during sleep.

Diabetes Secondary to Sleep Apnea

Sleep apnea, particularly obstructive sleep apnea (OSA), has been linked to an increased risk of developing type 2 diabetes.

The connection between these two conditions involves several physiological mechanisms that can exacerbate insulin resistance and affect glucose metabolism:

Intermittent Hypoxia: During episodes of sleep apnea, the body experiences periods of low oxygen levels (hypoxia). This intermittent hypoxia can increase stress hormones such as cortisol, which can in turn increase blood glucose levels and worsen insulin resistance.

Sympathetic Activation: Sleep apnea leads to increased activation of the sympathetic nervous system, the part of the autonomic nervous system responsible for the “fight or flight” response. This heightened sympathetic activity can also increase blood glucose levels and contribute to insulin resistance.

Sleep Fragmentation: The frequent arousals from sleep that characterize sleep apnea disrupt the normal sleep architecture. Poor sleep quality and shortened sleep duration can affect the hormones that regulate appetite and metabolism, such as ghrelin and leptin, leading to increased appetite and potentially weight gain, further exacerbating diabetes risk.

Inflammation: Sleep apnea is associated with systemic inflammation, marked by elevated levels of inflammatory cytokines like TNF-alpha and IL-6. Chronic inflammation is a known factor in the development of insulin resistance and type 2 diabetes.

Oxidative Stress: The oxidative stress from repeated episodes of low oxygen levels during sleep can lead to cellular damage and dysfunction, which is another pathway through which insulin resistance may be exacerbated.

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About the Author

Brian Reese
Brian Reese

Brian Reese

Brian Reese is one of the top VA disability benefits experts in the world and bestselling author of You Deserve It: The Definitive Guide to Getting the Veteran Benefits You’ve Earned (Second Edition).

Brian’s frustration with the VA claim process led him to create VA Claims Insider, which provides disabled veterans with tips, strategies, and lessons learned to win their VA disability compensation claim, faster, even if they’ve already filed, been denied, gave up, or don’t know where to start. 

As the founder of VA Claims Insider and CEO of Military Disability Made Easy, he has helped serve more than 10 million military members and veterans since 2013 through free online educational resources.

He is a former active duty Air Force officer with extensive experience leading hundreds of individuals and multi-functional teams in challenging international environments, including a combat tour to Afghanistan in 2011 supporting Operation ENDURING FREEDOM.

Brian is a Distinguished Graduate of Management from the United States Air Force Academy, Colorado Springs, CO, and he holds an MBA from Oklahoma State University’s Spears School of Business, Stillwater, OK, where he was a National Honor Scholar (Top 1% of Graduate School class).

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