Are you suffering from obstructive sleep apnea syndrome and hypertension? Recently, it has been widely accepted by the medical community that obstructive sleep apnea (OSA) is a risk factor for the development of hypertension, also known as high blood pressure. You may be among the more than 18 million Americans that have been diagnosed with sleep apnea, but may be unaware that you have developed hypertension as a complication of obstructive sleep apnea.
According to the Centers for Disease Control and Prevention, there is a high prevalence of obstructive sleep apnea among veterans. This may be because veterans are disproportionately affected by risk factors that lead to obstructive sleep apnea, like psychological distress, mental illness, and respiratory conditions. Many veterans, particularly Gulf war veterans, develop respiratory conditions like COPD, asthma and chronic bronchitis, due to exposure to chemicals and other toxic substances. This makes veterans more susceptible to developing obstructive sleep apnea.
In order to better understand what this could mean for your VA claim, we must first discuss the relationship between obstructive sleep apnea and hypertension.
What Is High Blood Pressure?
Blood pressure is the force that the blood exerts on the walls of the blood vessels. According to the American Heart Association, high blood pressure, or hypertension, occurs when this force is consistently too high. This is measures by the relationship between systolic blood pressure, the force that occurs each time the heart pumps our blood, and diastolic blood pressure, the force that occurs between heartbeats.
High blood pressure occurs when the systolic pressure is 130 or higher and the diastolic pressure is 80 or higher (130/80 mm Hg). This is classified as stage 1 hypertension. The American College of Cardiology recently lowered the for stage 1 hypertension systolic limit from 140 to 130.
High blood pressure is a risk factor for heart disease and heart failure, so cardiology specialists will monitor hypertensive patients for signs of cardiovascular disease. Individuals with hypertension might take medication for their condition and track their levels through techniques like ambulatory blood pressure monitoring. Cardiology specialists will also recommend lifestyle changes like weight loss and a healthy diet for blood pressure reduction. The Journal of the American Medical Association (JAMA) frequently publishes recommendations for blood pressure reduction and control.
Some individuals may have a severe type of high blood pressure called resistant hypertension. This condition is hypertension that stays high despite the use of several antihypertensive medications.
What Is Obstructive Sleep Apnea (OSA)?
Obstructive sleep apnea (OSA) is a sleep disorder in which breathing stops temporarily throughout the sleep cycle. Experts estimate that of the general population of the United States, about 22 million individuals are living with OSA. Out of these individuals, about 80% of the mild to moderate cases are undiagnosed. Breathing can stop for a few seconds or several minutes. These episodes of sleep apnea can occur a few times or dozens of times.
It is important to note that we are only discussing obstructive sleep apnea at the moment. This is because hypertension is only linked to obstructive sleep apnea and not the other kind of sleep apnea – central sleep apnea.
Obstructive sleep apnea occurs when the muscles in the back of the throat and tongue relax. Consequently, blocking your airway and preventing breathing from happening. Episodes of obstructive sleep apnea typically end with the person waking up briefly in order to reopen his or her airway.
Some common symptoms of obstructive sleep apnea include:
- Loud snoring
- Coughing, gasping or choking
- Excessive daytime sleepiness
- Observable episodes of stopped breathing
- Sore throat or dry mouth
- Nighttime sweating
- Mood changes and difficulty concentrating
- Morning headaches
Diagnosis of obstructive sleep apnea generally requires a sleep study, which often uses a technique called polysomnography to measure breathing. If detected, there are several options for the treatment of OSA. Specific treatments will depend on OSA severity. Specialists measure OSA severity on a scale called the hypopnea index. The index measures the number of apneas that occur per hour.
Many people with obstructive sleep apnea need to use a continuous positive airway pressure (CPAP) machine during the night. They might use a nasal continuous positive airway pressure device or one that covers the mouth as well. CPAP therapy machines deliver air pressure into the nose and mouth to keep the air passages open during sleep.
While sustained CPAP treatment can be effective for many OSA patients, severe OSA may require treatments like surgery. Severe OSA is when the patient has 30 or more apneas per hour of sleep. This is particularly true when they don’t respond to airway pressure treatment.
What Is The Link Between Obstructive Sleep Apnea and Hypertension?
According to the American Heart Association, obstructive sleep apnea is implicated as a factor in the development of hypertension. Recent studies show that 50% of patients with hypertension also have associated obstructive sleep apnea. The Wisconsin Sleep Cohort study, which was a long-term sleep heart health study, also found that individuals with untreated severe sleep-disordered breathing were 2.6 times more likely to experience coronary heart disease or heart failure than adults without this disorder.
So, there is evidence that sleep apnea affects blood pressure. In individuals without these conditions, blood pressure naturally dips at night. Studies show that some people with OSA don’t experience this dip in blood pressure. These individuals are referred to as “nondipping.” The prevalence of nondipping OAS patients may indicate a link between high blood pressure and obstructive sleep apnea.
Obstructive sleep apnea impairs sleep quality by shortening sleep intervals. This causes elevated blood pressure. Why is this? Obstructive sleep apnea causes disrupted or limited breathing while you are asleep. When breathing is limited, oxygen levels in the body can drop. This drop in blood oxygen levels causes an increase in blood flow. Increased blood flow puts pressure on the blood vessels’ walls which causes elevated blood pressure levels. This suggests a connection between sleep apnea and blood pressure spikes.
Blood pressure levels are not just elevated at night. In many people that have obstructive sleep apnea, blood pressure remains elevated during the daytime when breathing is normal. Also, consider how proper diet and regular exercise help to control normal blood pressure. Obstructive sleep apnea is often accompanied by respiratory conditions, like asthma, shortness of breath, and other respiratory problems that may make it difficult to exercise regularly. As a result, blood pressure levels may be adversely affected.
What Does This Mean For My Disability Claim?
If you are seeking VA benefits for high blood pressure and sleep apnea, you need to file a claim for secondary service connection to receive compensation for both of these conditions. Secondary service connection is when a service-connected condition or injury causes a new condition or aggravates a non-service connected disability. In this case, if a veteran is already service-connected for obstructive sleep apnea and later develops hypertension because of their obstructive sleep apnea, they can file a claim for hypertension secondary to obstructive sleep apnea. To receive compensation for this secondary condition, you need a current diagnosis of hypertension.
For VA purposes, elevated blood pressure, or hypertension, is considered a systolic blood pressure reading of 160 or more and a diastolic pressure reading of 100 or more, i.e. 160/100 mm Hg. Hypertension must be confirmed by blood pressure readings taken two or more times on at least three different days. If secondary service connection is granted for your hypertension disability, blood pressure readings help determine both the severity of your hypertension and the rating percentage that the VA could potentially assign to your claim.
When making an association between sleep apnea and hypertension for a VA claim, evidence is needed to support your claim. There are several kinds of evidence that can be used to support this secondary claim. Service treatment records and medical records from the VA or private medical facilities detailing your condition may be helpful. Medical articles and literature that discuss the relationship between obstructive sleep apnea and high blood pressure are also beneficial. A favorable medical opinion from a doctor, such as a cardiology specialist, that states that your hypertension is caused by, or a complication of, obstructive sleep apnea may also be very beneficial for your claim. You can file a claim for hypertension as secondary, or as a complication of, obstructive sleep apnea by visiting with the Veteran’s Administration by visiting their website.
The attorneys at Hill & Ponton are also available to help you with your claim. Our attorneys are dedicated to working with former service members, so veterans can obtain the disability compensation they deserve. If your VA claim has been denied, contact us today for a free case evaluation.association between sleep apnea and hypertension