Why Cardiologists Are Paying More Attention to Sleep Health
Cardiovascular care has traditionally focused on risk factors such as hypertension, dyslipidemia, diabetes, and lifestyle behaviors. Increasingly, however, sleep health—particularly obstructive sleep apnea (OSA)—is recognized as a clinically relevant contributor to cardiovascular risk and disease progression.
This shift reflects growing evidence that untreated sleep disorders can place ongoing strain on the cardiovascular system, even when daytime risk factors are managed appropriately.
Cardiovascular physiology during sleep
Healthy sleep is associated with protective cardiovascular changes, including reduced heart rate and blood pressure, decreased sympathetic activity, and increased parasympathetic tone. This normal nocturnal “dipping” pattern supports cardiovascular recovery.
Sleep disruption and sleep-disordered breathing interfere with these processes. Recurrent arousals and intermittent hypoxemia can blunt nocturnal blood pressure dipping, promote sympathetic activation, and contribute to endothelial dysfunction and cardiovascular stress over time.¹ ²
Obstructive sleep apnea and cardiovascular risk
OSA is highly prevalent among patients with hypertension, atrial fibrillation, heart failure, and prior stroke, yet it often remains undiagnosed.³ ⁴ Repeated airway obstruction during sleep leads to intermittent hypoxemia, intrathoracic pressure swings, and sleep fragmentation—mechanisms linked to elevated blood pressure, autonomic imbalance, inflammation, and arrhythmia risk.
Importantly, clinically significant OSA may be present even in the absence of excessive daytime sleepiness, particularly in cardiovascular populations.⁵
Why sleep health matters in cardiology practice
Evaluation of sleep health can provide valuable insight in patients with:
Hypertension that remains difficult to control
Recurrent atrial fibrillation
Persistent fatigue disproportionate to cardiac findings
Ongoing cardiovascular risk without a clear explanation
Professional societies increasingly acknowledge sleep apnea as a relevant comorbidity in cardiovascular disease and a consideration in comprehensive risk assessment.³ ⁶ Addressing sleep disorders is not a replacement for guideline-directed therapy, but a complement to it.
Impact of treatment and collaborative care
Effective treatment of OSA—most commonly with CPAP—stabilizes breathing during sleep, reduces intermittent hypoxemia, and decreases sleep fragmentation. Clinical studies have demonstrated associations between CPAP therapy and improvements in blood pressure control, sympathetic activity, and markers of cardiovascular stress, particularly among patients with moderate to severe OSA and adequate adherence.⁷ ⁸
As a result, cardiology, primary care, and sleep medicine increasingly collaborate to identify and manage sleep-related contributors to cardiovascular disease. This integrated approach supports more complete risk assessment and aligns daytime treatment with nighttime physiology.
When to consider sleep evaluation
Sleep evaluation should be considered in patients with cardiovascular disease who report loud snoring, witnessed apneas, unrefreshing sleep, or excessive daytime fatigue, as well as in those with resistant hypertension or recurrent atrial fibrillation.
Sleep health is no longer peripheral to cardiovascular care—it is an increasingly recognized component of evidence-informed practice.
BetterNight partners with cardiologists to make sleep apnea evaluation and treatment more accessible for patients with cardiovascular risk. Through a streamlined, telehealth-enabled pathway, we support screening, home sleep testing, and therapy initiation while keeping referring providers informed—helping integrate sleep health into comprehensive cardiovascular care. Click here to learn more
Somers VK, et al. Sympathetic neural mechanisms in obstructive sleep apnea. J Clin Invest.
Floras JS. Sleep apnea and cardiovascular disease: an enigmatic risk factor. Circulation.
American Heart Association. Sleep apnea and cardiovascular disease: scientific statement. Circulation.
Javaheri S, et al. Sleep apnea and cardiovascular disease. J Am Coll Cardiol.
Kapur VK, et al. Clinical practice guideline for diagnostic testing for adult OSA. J Clin Sleep Med.
American Academy of Sleep Medicine. Sleep is essential to health. J Clin Sleep Med.
Marin JM, et al. Long-term cardiovascular outcomes in men with OSA treated with CPAP. The Lancet.
Pedrosa RP, et al. Effects of OSA treatment on blood pressure. Hypertension.